Depressive Symptoms Predict Major Depressive Disorder after 15 Years among Whites but Not Blacks

Abstract

BackgroundBlack–White differences are shown in psychosocial and medical correlates of depressive symptoms and major depressive disorder (MDD). The current longitudinal study compared Blacks and Whites for the association between baseline depressive symptoms and subsequent risk of MDD after 15 years.MethodsData were obtained from the Americans’ Changing Lives (ACL) Study that included 3,361 individuals (2,205 Whites and 1,156 Blacks) from 1986 to 2001. Baseline depressive symptoms measured using an 11-item Center for Epidemiological Studies-Depression (CES-D) in 1986 were predictors. The outcome of 12-month MDD was measured using the Composite International Diagnostic Interview (CIDI) in 2001. Covariates such as baseline socio-demographics (SES), financial difficulty, chronic medical conditions (CMC), and self-rated health (SRH) were measured in 1986. Logistic regression models were used to evaluate the association between baseline CES-D score and CIDI-based MDD after 15 years net of demographics, SES, CMC, and SRH. The models were applied in the pooled sample, as well as in Blacks and Whites. Data on reliability and factor structure of CES-D based on ethnicity were also reported.ResultsIn the pooled sample, we found an interaction between race and baseline depressive symptoms, suggesting a stronger effect of baseline depressive symptoms on the subsequent risk of MDD for Whites compared with that of Blacks. Such an interaction was significant net of socioeconomic and health status. Based on our ethnic-specific models, among Whites but not Blacks, baseline CES-D score was predictive of the subsequent risk of MDD after 15 years, net of SES and health at baseline. Black–White differences in the predictive role of CES-D scores on MDD could not be attributed to the ethnic differences in the reliability of the CES-D, which was even higher for Blacks compared with those of Whites. Loadings of the CES-D positive affect items were reverse among Blacks compared to Whites.ConclusionBlack–White differences exist in the association between baseline depressive symptoms and subsequent risk of MDD >15 years. Ethnic differences in the longitudinal link between baseline CES-D and subsequent risk of MDD may explain some of the Black–White differences in social, psychological, and medical correlates of depressive symptoms and depression. Future research is still needed to compare Blacks and Whites for factor structure of the CES-D.

Confirmatory Factor Analysis of the 12-Item Center for Epidemiologic Studies Depression Scale among Blacks and Whites

“…Comparing sociodemographically matched Black and White pregnant women, Canady et al found that the positive item “ happy ” was the only item among the 20 items with different loadings between Blacks and Whites (29). This finding was similar to what Moazen-Zadeh and Assari found recently investigating the 11-item version of the CES-D scale (24). …”

“…In this study, the CES-D scale item “ people disliked me ” loaded better into the positive affect factor in Blacks but better into the interpersonal problems factor in Whites (24). In another cross-sectional study on NSAL data using the 12-item CES-D scale, CES-D scale negative affect and interpersonal problem domains were more strongly associated with CIDI-based major depressive disorder (MDD) in Blacks compared to Whites (25).…”

“…Through the literature on factor analysis of the CES-D scale among racial and ethnic groups, often invariance of factor structure has been demonstrated while the invariance of loadings has been difficult to establish (24, 37). In other words, factor structure and overall fit of the models are major determinants of measurement equality among racial/ethnic groups and have been subject to invariance in several studies up to now, while the item loadings are subject to more variance due to measurement bias or characteristics of the study sample.…”

“…The Black–White gap in endorsement of positive and negative affect items in self-report measures has been attributed to cultural differences (24, 29). In more collectivist and inter-connected cultures, specifically Blacks and Koreans, individuals have a lower tendency for endorsement of positive affect items compared to Whites (34, 35).…”

“…Concerning the factor structure of the CES-D scale, a recent study on the concordance between the CES-D scale and the CIDI-based diagnosis of depression found the 3-factor model as the best solution for the 11-item CES-D scale (24). Previous studies have indicated that the 4-factor model (i.e., positive affect, negative affect, somatic complaints, interpersonal problems) may be the best solution for the 20-item CES-D scale with very high overall fit in Blacks and Whites (27–29, 36).…”