Self-Reported Depression and Emotional Distress for Older African American Men Across Intersecting Contexts

Background and Purpose: The under-diagnosis of depression and other mental health conditions in older African American men (AAM) is largely undisputed; as reportedly, AAM have lower rates of depression than Whites and African American women. Previous studies suggest that AAM have such low rates because many of them cannot identify with the clinical terminology used to describe depression, despite exhibiting the symptom criteria. We need to better understand culturally acceptable nomenclature around mental and emotional health to reduce missed opportunities for diagnosis, treatment, and community support for AAM. This study sought to characterize factors that may be more aligned with the mental health status of AAM, such as feeling downhearted and blue.

Methods: Between 2006 and 2010, a large Midwest hospital system examined preventive health screening completion among older African American adults enrolled in Medicare. Participants were recruited from 175 senior residences and centers, church groups and health clinics (N=5800).  Our sample included the self-reported, de-identified baseline data for 1,666 AAM in the parent study. The outcome measure asked, “During the past four weeks, how much of the time have you felt downhearted and blue?” Responses were dichotomized as “all of the time” and “most of the time” (combined and coded as 1) versus all other responses (combined and coded as 0). We examined potential demographic correlates (age, income, education, marital status, and living alone); physical health correlates (pain, general health, and role limitations due to physical health); mental and emotional health (role limitations due to emotional problems, energy fatigue, emotional well-being, and social functioning); and problems interacting with health providers. All items were adapted from the Medical Outcomes Study 36-item Short Form Health Survey, version 1.0. Logistic regression was performed with five variables identified through bivariate analyses and automatic stepwise selection (i.e. married, accomplished less due to emotional problems, depression or anxiety, and interruption to social activities due to physical or emotional problems and doctor never listens to concerns).

Results: The mean age of participants was 73.6 years; 38.2% had some college education while 33.6% reported incomes below $20,000 per year and 45.4% were married. Interestingly, 74.8% reported being “downhearted and blue” most or all of the time but only 18.5% reported feeling moderate to severe anxiety or depression on the day they completed the questionnaire. A test of the full model was statistically significant, χ² = 334.62, p<.001; the strength of association between the five variables and the outcome was moderately weak with Cox and Snell’s R² =.18 and Nagelkerke’s R² =.27. Each independent variable made a statistically significant contribution to the final model. Accomplishing less due to emotional problems was the strongest predictor of feeling downhearted and blue; self-reported anxiety or depression was negatively associated with the outcome.

Conclusions and Implications: Findings suggest a disconnect between the way older AAM express (and link) their mental health to their emotional health. Findings also underscore the importance of language in community and clinical representations for depression for AAM. Future research should examine factors that complicate depression care for AAM.