Racial and ethnic variation in home healthcare nurse depression assessment of older minority patients

Abstract

Objective To determine the racial/ethnic effect of depression symptom recognition by home healthcare nurses. Methods This is a secondary analysis of administrative data from a large, urban home healthcare agency. Patients were 65 years and older with a valid depression screen; identified as Caucasian, African American, or Hispanic; and admitted to homecare in 2010 (N=3711). All demographic and clinical information were obtained from the electronic medical record. Results Subjects were 29.34% Caucasian, 37.81% African American, and 32.85% Hispanic. 6.52% had a formal chart diagnosis of depression and 13.39 % received antidepressant therapy. The rates of positive depression screens by nurses were higher in Caucasians than African Americans or Hispanics (13.41% vs. 9.27% vs. 10.99%; [chi] 2=10.70, DF= 2; p<0.01). Depression screening rates were then stratified by the number of clinical indicators from the chart (depression diagnosis or antidepressant on medication list). The proportion of positive screen increased for minorities with an increase in the number of indicators. African Americans had significantly greater positive screens with 2 indicators compared to Caucasians and Hispanics (50.00% vs. 23.81% vs. 35.59%; [chi] 2=6.65, df=2; p=0.04). Conclusions These findings show a wide range of variation in screening for depression among ethnic groups. The rates increase for minorities with the presence of increased clinical indicators, suggesting that nurses may screen higher in minorities when there is higher clinical suspicion. Future research in home healthcare should be aimed at training nurses to conduct culturally tailored depression screening in order improved management of depression in older minorities.

Racial and Ethnic Differences in the Prevalence of Depressive Symptoms Among U.S. Nursing Home Residents

“…The relatively lower rates of clinically significant depressive symptoms among racial and ethnic minority nursing home residents found in this study (Table 2) are consistent with the findings of many (Akincigil et al, 2012; Callahan & Wolinsky, 1994; Crystal et al, 2003; Gallo et al, 1998; Pickett et al, 2014; Shao et al, 2016), but not all (Blazer et al, 1998; Compton et al, 2006; Skarupski et al, 2005), of the previous studies on community-living elders. These studies used different constructs of depression, such as the Patient Health Questionnaire-2 (PHQ-2) for depression screening, the Center for Epidemiologic Studies–Depression scale for symptoms, and the Diagnostic and Statistical Manual of Mental Disorders, 3 rd Edition for identifying major depressive disorder.…”

“…The rate of clinically-significant depressive symptoms as reported by older persons of different racial and ethnic groups may be affected by multiple factors including their psychosocial function, physical health, cognition, socio-demographic characteristics, as well as culture-related differences in symptom reporting (Akincigil et al, 2012; Pickett et al, 2014; Shao et al, 2016). In particular, racial and ethnic differences exist in cultural beliefs and knowledge about depression, as well as in perceived stigma associated with mental health diagnosis.…”

“…It is also likely that provider-side factors, such as the knowledge, attitude, and training received by nursing staff for residents’ behavioral and mental health issues, play an important role in explaining differences in reported depressive symptoms among nursing home residents. Studies showed that caregivers’ attitudes toward patients and diagnostic and treatment practices might be influenced by patient race or ethnicity (IOM, 2003), and in the case of depression, healthcare providers tended to perceive minority patients’ symptoms as less significant than white patients’ (Pickett et al, 2014; Shao et al, 2016). Our analyses thus further accounted for common nursing home characteristics that may be associated with staff care practices and performance such as ownership, census of Medicaid-financed residents or racial/ethnic minority residents, and nurse staffing levels (see Table 1 for a full list of nursing home variables).…”

“…The prevalence of clinical depression and elevated depressive symptoms is likely to vary over racial and ethnic groups, as suggested by the body of studies on community-living elders. Most of these studies reported lower depressive symptom levels and reduced rates of diagnosed depression among racial and ethnic minority elders compared to non-Hispanic whites (Akincigil et al, 2012; Callahan & Wolinsky, 1994; Crystal et al, 2003; Gallo et al, 1998; Pickett, Bazelais, Greenberg, & Bruce, 2014; Shao, Richie, & Bailey, 2016), although several other studies reported no group differences or even higher depressive symptoms for older minority patients (Blazer, Landerman, Hays, Simonsick, & Saunders, 1998; Compton, Conway, Stinson, & Grant, 2006; Skarupski et al, 2005) when their estimates were derived from samples from alternative geographic areas or different periods of time. These reported variations in depressive symptoms may be explained by racial and ethnic differences in socioeconomic status and culture-related differences in symptom reporting and help-seeking behaviors.…”

How well do older adults recognise mental illness? A literature review

“…These findings are congruent with evidence documenting higher undetected depression and dementia rates among older immigrants and ethnic minorities compared to members of dominant social groups. 51 However, most of the knowledge in this area appears to rely on qualitative investigations, and crosscultural comparisons are limited in scope. Most notable factors associated with poor self-recognition among older minority group members include mental health misconceptions, a lack of mental health labels from native languages and limited awareness.…”