Depressive Symptomatology and Physical/Neurodegenerative Multimorbidity Among Older Black Americans

Background and Purpose: The exploration of depressive symptomatology among older Black Americans remains a developing field of inquiry. Older Black Americans also have a disproportionately higher burden of multimorbidity (presence of two or more chronic health conditions). There are gaps in the existing research exploring depressive symptoms and multimorbidity, especially among older Black Americans. Further, no known studies have examined the relationship of both physical and neurodegenerative multimorbidity with depressive symptoms in this population. With the guidance of cumulative advantage/disadvantage theory, this study aims to identify the relationship between physical/neurodegenerative multimorbidity and depressive symptoms among older Black Americans.

Methods: This study was based on a secondary analysis of merged data from the 2018 Health and Retirement Study (HRS) and RAND HRS data (N = 812; age 65+). The outcome of this study was depressive symptomatology. It was measured with the eight-item CES-D scale. Physical multimorbidity was measured with ever being diagnosed with seven diseases (high blood pressure, diabetes, cancer, lung disease, heart disease, stroke, and arthritis). Neurodegenerative multimorbidity was measured with ever being diagnosed with either Alzheimer’s disease or other memory impairments, including dementia. Due to the temporary nature of the measure of depressive symptoms in the HRS (i.e., past week), the current study used a cross-sectional research design, especially with the HRS data (biennial panel data). In other words, predictors measured two years ago may not be strongly related to depressive symptoms in the past week. A negative binomial regression was conducted to test the relationships between the study variables in that depressive symptomatology in the HRS data was a count variable, numerical but not continuous.

Results: The regression model resulted in (a) having more physical multimorbidity was associated with higher counts of depressive symptoms (Incidence rate ratios [IRR] = 1.144, p < .001); (b) a higher number of neurodegenerative problems were also related to higher depressive symptoms among older Black Americans (IRR = 1.908, p = .002). For each additional physical health problem, the rate of depressive symptoms would be expected to increase by a factor of 1.144, controlling for the other predictors. For each additional neurodegenerative problem, the rate of depressive symptoms would be expected to increase by a factor of 1.908, controlling for the other predictors.

Conclusions and Implications: These findings highlight the significance of recognizing and addressing depressive symptoms among older Black Americans with greater physical and neurodegenerative multimorbidity. The key results found that higher numbers of physical and neurodegenerative health conditions were related to higher counts of depressive symptomatology. This result was consistent with prior research that found a relationship between chronic conditions and depressive symptoms among older Black Americans. Health professionals will need to be trained and prepared to work with older Black Americans with more chronic conditions, who may present with higher depressive symptomatology. This may translate into higher acuity care and more complex treatment planning for this group. Collaborations between providers of neurodegenerative and general physical health will be increasingly important as this group of older adults continues to age.