Social Participation and Depressive Symptoms in Older African American Cancer Survivors: A Longitudinal Analysis

Background and Purpose:

African Americans are differentially affected by most cancers compared to other racial groups. many older African American cancer survivors experience persisting negative mood and depressive symptoms caused by cancer-related fears, post-traumatic stress, and financial stress (Barnes, Mayo-Gamble, Harris, & Townsend, 2018). Social participation has demonstrated beneficial effects on mental health in older adults with a history of cancer. The objectives of the present study are to: 1) estimate the elevated depression rates in older African Americans with and without a history of cancer; and 2) examine the effects of social participation on depressive symptoms among older African Americans with or without a history of cancer.

Methods: The study sample included 2,000 older African Americans selected from the National Health and Aging Trends Study. Waves from 2011 to 2018 were used. We selected older African Americans with complete data for all used variables in a given round and applied listwise deletion for missing data, resulting in an analytical sample of 2,000 African Americans, who contributed to 7,784 observations in longitudinal survey waves. Of the analytical sample, 372 older African Americans were cancer survivors. Depressive symptoms were measured using the Center for Epidemiologic Studies Depression Scale (CESD-10). Mixed-effects logistic regressions were applied to examine the effects of four social participation activities on depressive symptoms among older African Americans with or without a history of cancer.

Results: Among the overall sample, less than one in five reported elevated depression in older African Americans with or without a history of cancer. Among older African American who had a history of cancer, visiting family and friends (OR=0.47, p=0.00) and attending religious services (OR=0.55, p=0.00) were related to lower odds of depressive symptoms. However, among older African Americans without a history of cancer, joining organized activities (OR=0.70, p=0.00) and going out for enjoyment (OR=0.79, p=0.00) predicted lower odds of depressive symptoms.

Conclusions: Though having a history of cancer is a significant predictor of depression, our findings suggested that the rates of having depressive symptoms are similar between older African Americans with or without a history of cancer in a long term. Social participations have positive effects on reducing depressive symptoms in older African Americans in general, but depressive symptoms are associated with different types of social participation based on older African American’s histories of cancer(s). Older African American with a history of cancer may benefit from mental health interventions focusing on mobilizing support from social support from family, friends, and religious congregants. However, interventions involving community-organized activities and recreative actives may produce positive effects on decreasing depressive symptoms among older African American without a history of cancer. It is of timely importance to more in-depth investigations of social participation activities and depressive symptoms among older African Americans with a history of cancer during the COVID-19 pandemic. Future studies may examine the impact of social participation in virtual environments on older African Americans’ mental health and psychological wellbeing.