Racial and Ethnic Variations in Self-Rated Health Among People With Comorbid Depression and Diabetes

Purpose: Researchers agree that there continues to be a lack of research regarding diagnosis and treatment of depression for underserved populations with diabetes (Alegria, Mulveney-Day, & Torres et al., 2007). Both conditions record high prevalence rates independently among African Americans, and when diagnosed together, may hold significant health and societal consequences. Evidence about the adverse interaction between the two conditions is growing among general populations, but little information exists for the comorbidity’s impact among racial and ethnic populations.  Comorbid depression and diabetes has regained focused attention in the United States and globally due to the increasing prevalence rates of obesity and concerns about inabilities to improve health outcomes (Egede & Ellis, 2010).  Self-rated health has been examined at length for individual chronic conditions (Benson, 2010; Maty, James & Kaplan, 2010) and has been found to be a strong predictor of health care utilization (Thomas, Sansing, Davis, et al., 2010). However, few studies have evaluated the association between comorbid depression and diabetes and self-rated health in the health disparities literature as it pertains to African Americans and Caribbean Blacks. Understanding comorbid depression and diabetes for improved disease detection, treatment, and management, as well as improving healthcare utilization stands as an important goal. This study investigated whether the relationship between comorbid depression and diabetes and self-rated health exists among African Americans and Caribbean Blacks.  The study also sought to examine which social determinants impact self-rated health reports; a proxy indication of health care utilization.

Methods:  The analysis sample included 4,741 respondents from the National Survey of American Life (NSAL) data, a cross-sectional study (N=6,082). Missing cases were attributed to unsubstantiated comorbid identities.  Self-rated health, the dependent variable, was classified into three categories (excellent/very good, good, or fair/poor).  Independent determinates included, comorbid depression and diabetes which were defined as the presence of both conditions, sociodemographic factors (race, gender, marital status,  education and nativity).  Three weighted logistic regression models were performed on the main effects, significant demographics covariates and interaction terms. 

Results:The results suggest a significant relationship between comorbid depression and diabetes and self-rated health. Respondents that specified good health were 10.07 times (95% CI 2.92- 34.75, P<0.000) more likely to have the comorbid condition compared those who reported excellent or very good health.  Those who indicated fair or poor health were 34.17 times (95% CI 11.01-106.00, P<0.000) more likely to have comorbid diabetes and depression than respondents who indicated excellent or very good health.  Fair or poor health reports were least likely to indicate health care utilization.  Foreign born individuals and those never married rated their health less favorably than their comparisons.  Significant interaction effects were observed between the comorbidity, self-rated health and race/ethnicity; to the extent that sub-categories of European Americans rated their health better than their African American counterpart.

Implications:  Findings revealed a strong association between comorbid diabetes and depression and self-rated health with variation in some categories of race/ethnicity.  By extension, utilization of health care show access differences that may continue to escalate without future social work investigations on this comorbidity.