Economic Distress, Employment, Social Stressors and Depression Severity among Low-Income Ethnic Minority Patients with Cancer and Diabetes
Kathleen Ell, DSW, University of Southern California, Leopoldo J. Cabassa, PhD, University of Southern California, Anjanette Alise Wells, LCSW, MSW, University of Southern California, Pey-Jiuan Lee, MS, University of Southern California, and Bin Xie, PhD, University of Southern California.
Purpose: The aim of this study is to examine whether and in what ways the severity of depression among low-income ethnic minority patients with cancer or diabetes is related to economic, employment, and social stressors. Methods: Alleviating Depression Among Patients with Cancer (ADAPt-C) and Multifacted Diabetes and Depression Program (MDDP) are two ongoing randomized clinical trials that are testing the efficacy of a socio-culturally tailored collaborative approach to depression care. Baseline data are reported for 462 patients with cancer (n=345; 75%) or diabetes (n=117; 25%) who met diagnostic criteria for clinical depression. Patients were predominantly female (84%), Latino (89%), Spanish-speaking (78%), foreign born (87%), and average age of 50. Patients with diabetes had significantly higher depression scores than those with cancer. Information on economic distress, employment and other social stressors (e.g., family/cultural conflicts, caregiving concerns, legal problems, and worry about community violence) were obtained from a self-reported questionnaire at enrollment. A multivariate logistic regression model was used to explore effects of economic distress, employment and social stressors on the risk of depression severity (moderate-severe depression vs mild depression) controlling for socio-demographic factors (i.e., age, sex, marital status, and nativity), disease comorbidity and general health status. Findings: Among all patients, 34.2% were diagnosed with either moderate or severe depression (PHQ-9 score 15 or above). The most commonly reported social stressor was financial problems (n=343, 74%). The majority of patients reported being worried about their current financial situation, such as having difficulty in paying bills and having no money left over at the end of the month. With respect to employment, 72% were employed prior to diagnosis; however, the majority no longer had a job after their disease was diagnosed (73%). Of 97 employed at baseline, 60% reported worry about wages being lost due to their illness. Results of multivariate logistic regression models revealed that social stressors including work and unemployment problems, cultural conflicts, legal problems, community violence and current economic problems were significantly associated with the risk of having either moderate or severe depression with odds ratios ranging from 1.71 to 2.73 (p<0.05) after controlling for socio-demographic factors (i.e., age, sex, marital status, nativity), disease comorbidity and general health status. Implications: The data suggest that economic, employment related and social stressors negatively affect the severity of depression, thereby highlighting the need for augmenting depression treatment with case management/patient navigation interventions to address these economic and social stress related concerns among low-income ethnic minority patients with depression and serious medical problems. A description of the augmented intervention model will be described.