Plant, E.A., Sachs-Ericsson, N. (2004). Racial and Ethnic Differences in Depression: The Roles of Social Support and Meeting Basic Needs, Journal of Consulting and Clinical Psychology, 72(1), 41-52.
The current work examined depressive symptoms and prevalence of major depression for minority group members and Whites from a large random sample. In general, minority group members' responses indicated more depressive symptoms and a marginally higher prevalence of major depression than White participants' responses did. These effects were mediated by the degree to which participants had problems meeting their basic needs. Specifically, minority group members tended to have more problems meeting their basic needs, and these problems were associated with an increased risk for depression and higher levels of depressive symptoms. Household income was also a significant mediator of the relationship between ethnicity and depressive symptoms. In addition, minority group members tended to report a higher quality of interpersonal functioning than White participants did, which appeared to suppress the relationship between ethnicity and depression. These findings suggest that interpersonal functioning may act as a protective factor for minority group members against depressive symptoms and major depression. The implications of the findings for treatment and for improving understanding of the relationship between ethnicity and depression are discussed.
Petty, C., Sachs-Ericsson, N. & Joiner, T. Interpersonal dysfunction: Cause or Result of Depressive Disorders. Journal of Affective Disorders. In Press.
Background: Interpersonal skill deficits are associated with depression; however, the nature of the relationship is not clear. This study examined whether interpersonal skill deficits are a temporary symptom of depression or a stable characteristic of depression-prone individuals, in a large adult general population sample (N = 4,749).
Methods: Interpersonal functioning (IF) was compared among never depressed individuals and three groups of individuals with a history of depression: current depressives, recently remitted, and remitted depressives. Results: State effects of depression were clearly observed and a strong association between IF difficulties and current depression was found. Individuals with an early onset of depression showed some indication of an "interpersonal scar"; but, in general, we did not find evidence that repeated depression "scarred" the individual. Limitations: The cross-sectional methodology limited our ability to examine whether interpersonal deficits were more the result of a depressive episode or were present beforehand. In addition, it would have been more informative to follow participants over the course of several months in order to examine the relation between depression and interpersonal functioning deficits as it unfolded longitudinally. Conclusions: Our findings suggest that interpersonal functioning deficits are in some regards a stable feature among people with a history of depression; however, they possess temporary features as well. Depression may scar interpersonal functioning, but only if it occurs early in life.
Verona, E., Sachs-Ericsson, N., & Joiner, T. (2004). Analysis of suicide attempts in connection to externalizing psychopathology in an epidemiological sample. American Journal of Psychiatry, 161, 444-451.
OBJECTIVE: Borrowing from recent dimensional models of psychopathology, the authors conducted analyses that optimized the common variance shared by internalizing (depression, anxiety) and externalizing (antisocial personality, substance dependence) disorders in statistically predicting suicidal behaviors. These relationships were analyzed in a large epidemiological sample, thus allowing for the examination of gender differences in risk for suicide attempts associated with psychopathology. METHOD: The data were obtained from the Colorado Social Health Survey. Participants (N=4,745) were a community sample recruited by household address. Structured clinical interviews were used to obtain lifetime diagnostic and symptom count information. Symptom counts were included in a factor analysis that yielded two main dimensions of psychopathology: internalizing and externalizing. These factors were used in hierarchical logistic regression analyses to predict history of suicide attempts associated with the presence of internalizing symptoms, externalizing symptoms, and comorbid internalizing and externalizing symptoms. RESULTS: After the investigators controlled for the presence of internalizing symptoms and the comorbidity of internalizing and externalizing symptoms, externalizing symptoms were related to suicidal behavior in both men and women, although comorbidity was most predictive of suicide attempts among women, compared to men. CONCLUSIONS: Suicidal behavior among individuals with externalizing symptoms is not necessarily a result of comorbid depressive or other internalizing disorder. Thus, persons exhibiting antisocial behaviors should receive rigorous assessment for suicidal ideation and behavior.
Sachs-Ericsson, N, Blazer, D. Plant, E.A., Arnow, B. Childhood Sexual and Physical Abuse and the One-Year Prevalence of Medical Problems in the National Comorbidity Study. Health Psychology. In Press.
In a population sample (N = 5,877; ages 15 to 54) we found childhood sexual and physical abuse to be associated with the one-year prevalence of serious health problems for both men and women, even after controlling for family-of-origin problems. We also found that the participant's psychiatric disorders partially mediated the effect of physical and sexual abuse on health. However, childhood physical and sexual abuse continued to independently influence health status after controlling for psychiatric disorders. Contrary to expectations, individuals who experienced a combination of sexual and physical abuse did not have a higher frequency of health problems than those who experienced either type of abuse alone. Implications for these findings are discussed including possible mechanisms that may account for the association between childhood abuse and adult health problems.
Blazer, D., Sachs-Ericsson, N., & Hybels, C.F. Perceived inadequate basic needs predicts mortality in a biracial elderly community sample. American Journal of Public Health. In press.
Objectives: To determine if the perception of basic needs not being met among community dwelling elders increased mortality risk and to determine whether this risk varied by race. Design: Survival analysis of an epidemiological longitudinal study (EPESE) exploring factors predicting mortality over 16 years.
Setting: One urban and four rural counties in the Piedmont of North Carolina
Participants: Four thousand one hundred and sixty two community dwelling subjects aged 65+, approximately equally distributed between Whites and African Americans in 1986 selected in a stratified random sample of households in Piedmont of North Carolina.
Methods: Subjects were administered an in-depth questionnaire in 1986 that assessed demographic characteristics, income, cognitive functioning (SPMSQ) and functional status (Rosow-Breslau). Subjects were also asked about the adequacy of their basic needs being met, including the adequacy of their income, quality of their housing including heat during the winter, and safety of their neighborhoods.
Results: Over fourteen years of follow-up, 81.9% if the sample died, the average number of days survived among those dying being 3, 494. In uncontrolled bivariate analyses, older age, male sex, being unmarried, lower education, lower income, cognitive dysfunction, physical functioning impairment, and perception that basic needs were not being met were associated with increased mortality. In a Cox proportional hazards model that included each of the above variables, perception that basic needs were not being met was a significant predictor of mortality overall (p<.005) and for Whites (p<.01) but not African Americans. Neither sex nor actual income modified the risk of perceived basic needs on mortality.
Conclusion: A perception that basic needs are not being met, even controlling for other known risks for increased mortality, is a strong predictor of mortality over an extended period of follow-up among White community dwelling elders.
Aging and Depression:
Sachs-Ericsson, N., Plant E.A., Blazer, D. Racial differences in the frequency of depressive symptoms among community dwelling elders: The role of socioeconomic factors. Aging and Mental Health. In Press.
In a biracial sample of community dwelling elders (n = 4,162, the Duke EPESE), African Americans endorsed more items than Whites on a standardized depression scale, the CES-D, in unadjusted analyses. However, several indices of socioeconomic status were found to mediate the relationship between race and depression, including education, problems meeting basic needs, and cognitive functioning. When these mediating variables were included in cross-sectional and longitudinal analyses, the association between depressive symptoms and race reversed such that Whites were significantly more likely to endorse depressive symptoms than African Americans. We conclude that these socioeconomic variables influence racial differences in the endorsement of depressive symptoms in community dwelling elders.
Sachs-Ericsson, N. & Blazer, D. Depression in Aging. In (Ed.) M. S. Pathy. Principles & Practice of Geriatric Medicine 4 Edition. John Wiley & Sons, Ltd. West Sussex, England. In Press.
Aging and Dementia:
Sachs-Ericsson, N., Joiner, T., Plant E.A., Blazer, D., The association of depression to cognitive decline in a community sample of elderly adults. American Journal of Geriatric Psychiatry. In Press.
An association between depression and cognitive decline (CD) has been observed in cross-sectional and case controlled studies of elderly populations. Whereas a handful of longitudinal community studies have found depressive symptoms to predate the onset of CD, others have found no association between depression and subsequent cognitive dysfunction. In the current study of a longitudinal sample of community dwelling elders (n = 4,162, the Duke EPESE), we examined the temporal relationship of depressive symptoms and cognitive errors measured three years apart. Depressive symptoms were associated with subsequent CD even after controlling for baseline cognitive status as well as demographic variables (e.g. race, gender age, and socioeconomic status) and physical functioning variables. This was true for the sample as a whole as well as for a sub-sample of participants who evidenced no baseline cognitive difficulties. Theories regarding the role of depression in the subsequent onset of cognitive difficulties are discussed.
Sachs-Ericsson, N. & Blazer, D. Anxiety and Depression in Dementia. In (ed.) Gabe Maletta. Geriatric Psychiatry: Evaluation and Management. Lippincott Williams & Wilkins, PA. In press.
Gender and Psychopathology:
Sachs-Ericsson, N. & Ciarlo, J. (2000). Gender, Social Roles and Mental health: An epidemiological perspective. Sex Roles A Journal of Research, 43(9/10), 339-362.
Sachs-Ericsson, N. (2000). Gender, Social Roles and Suicidal Ideation and Attempts in a General Population Sample. In (Eds.) T. Joiner & M. Rudd. Suicide Science, Kluwer Academic Publishers, Norwell, Mass. 201-220.