African Americans, Caribbean Blacks, and Depression: Which Biopsychosocial Factors Should Social Workers Focus on? Results from the National Survey of American Life (NSAL)

Background and Purpose: Current research suggests that African Americans may be more likely to experience depression, especially severe depression, than other racial or ethnic groups in the United States. Previous research comparing depression between African Americans and Caribbean blacks has been mixed, and overall there is scant research comparing the relationship between ethnicity and depression among the U.S. Black population. In an effort to better understand the factors that influence depression in African Americans, the authors have adapted the biopsychosocial model, a model rooted in systems theory, which has been explored as a framework for studying mental and physical disorders. The purpose of this study is to identify the most significant biopsychosocial factors social workers can address in the prevention and treatment of depression in U.S. black clients.

 

Methods: Data was from the 2001-2003 National Survey of American Life (NSAL), which is a nationally representative sample of the U.S. adult population (n=1006). The NSAL is the largest national dataset to date on mental health and African Americans/Caribbean Blacks, and the strength of this dataset is the sufficient power to investigate cultural and ethnic influences on mental disorders. NSAL participants reported depression through a dichotomous, single question that asked whether respondents had a diagnosis of Major Depressive Disorder (MDD) within the past 12 months. The model independent variables were chronic disease, family history of depression, self-esteem, hopelessness, a sense of mastery, spirituality, social support, and discrimination. These independent variables are conceptualized as biopsychosocial factors that could predict MDD.

Results: Bivariate associations showed that those who have a family history of depression (M=5.10) reported significantly higher rates of MDD than those who do not have a family history of depression (M=2.35), X² (1, N=332) = 7.22, p < .01. Respondents who reported higher self-esteem, lower hopelessness, higher sense of mastery, and lower discrimination showed lower likelihood of having MDD.  The logistic regression model suggested that respondents who have ever had a chronic disease were more likely to report depression than those who have not ever had a chronic disease (OR=2.65, p<.05). Respondents with higher self-esteem were less likely to report MDD (OR=.88, p<.01). Caribbean blacks were more likely to report depression compared to African Americans (OR=0.28, p<.01). Additionally, respondents who reported higher discrimination scores were more likely to report depression (OR=1.05, p<.05).

 

Conclusion and Implications: This study suggests that when other variables are controlled for, the biopsychosocial variables that remain significant predictors of MDD are chronic disease, self-esteem, ethnic group identity, and experiences of discrimination. Thus, one logical implication for social workers is that in order to have maximum impact, social work efforts may want to focus on addressing these four most significant areas of concern. Additionally, this study supports the biopsychosocial model, and is supported by the biopsychosocial model. This study suggests that social workers should embrace the interconnectedness and holistic approach of the biopsychosocial model in their case conceptualizations, prevention strategies, and treatment modalities.