Ami N. Bryant

A meta-analysis of the factor structure of the Geriatric Depression Scale (GDS): the effects of language.

BACKGROUND Given the lack of consensus on the factor structure of the Geriatric Depression Scale (GDS), as well as the fact that the GDS factor structure appears to vary across diverse cultural and/or language groups, the present meta-analysis examined whether the factor structure of the GDS varies by language. METHODS A total of 26 published studies using exploratory factor analysis (14,669 participants; 10 languages) were included in the meta-analysis. The factor structure of the GDS was assessed in the overall sample as well as in each language that had been examined in at least two different studies. RESULTS The analysis of the full sample resulted in a four-factor structure, whereas analyses of the individual languages produced structures with 4 to 6 factors. The mean variable cosines between languages ranged from 0.612 to 0.839, suggesting that the different languages produced distinct factor structures. The three factors of dysphoria, social withdrawal-apathy-cognitive impairment, and positive mood were commonly observed across different languages. Of these, the positive mood factor was the most similar across the languages. CONCLUSIONS These results provide strong evidence of language differences in the factor structure of the GDS. The findings suggest a need for researchers and clinicians to be careful when administering the GDS in different languages, as well as a need to take structural differences into account when interpreting results of the GDS.

Racial/ethnic differences in serious psychological distress among older adults in California

This study examined racial/ethnic differences in the prevalence and correlates of past year serious psychological distress ([SPD] defined as having a score of 13 or higher on the K6 scale), as well as impairments caused by SPD among older adults in California.

Racial/ethnic differences in prevalence and correlates of binge drinking among older adults

Objectives: This study examines how the prevalence and correlates of binge drinking among older adults vary by race/ethnicity. Methods: Drawn from the 2007 California Health Interview Survey, adults aged 60 and older (n = 18,772) were selected. Binge drinking was measured dichotomously based on whether individuals reported consuming five or more drinks in a single day (four or more for females) in the previous year. Prevalence rates for binge drinking in the past year were calculated by race/ethnicity. A hierarchical logistic regression analysis was conducted using binge drinking in the past year as the dependent variable. Results: Significant racial/ethnic differences were found in prevalence rates: the presence of binge drinking was most common among non-Hispanic Whites (11.9%), followed by Latinos (10.8%), American Indian/Alaska Natives (9.8%), Blacks (8.0%), and Asians (4.2%). Being a current smoker was found to be the strongest predictor of binge drinking and significant main effects were also found for being Black, being Asian, younger age, being male, being unemployed, having a higher poverty threshold, having better self-rated health, and having more psychological distress. Significant interactions between race/ethnicity and age, sex, employment status, educational attainment, smoking status, and self-rated health were found. These findings indicate that certain correlates of binge drinking vary significantly by race/ethnicity among older adults. Conclusions: Apparent racial/ethnic differences existed in the prevalence and correlates of binge drinking among older adults. Identification of more racial/ethnic specific predictors may be important for the development of racial/ethnic appropriate intervention programs.

Disparities in Health Status and Health Care Access and Use Among Older American Indians and Alaska Natives and Non-Hispanic Whites in California

Objectives: The present study compared the characteristics of health status and health care access and use among older American Indians and Alaska Natives (AIANs) to those of non-Hispanic Whites (NHWs). Methods: Data were drawn from the 2009 California Health Interview Survey, with a total of 17,156 adults aged 60 and older (198 AIANs and 16,958 NHWs) analyzed. Results: Older AIANs reported poorer physical and mental health than did NHWs. AIANs were less likely than NHWs to see a medical doctor and have a usual source of medical care and were more likely than NHWs to delay getting needed medical care and report difficulty understanding the doctor at their last visit. Discussion: These findings highlight the vulnerability and unmet health care needs of older AIANs. More research on the older AIAN population is clearly needed to document their health care needs in order to better inform efforts to reduce health disparities.

The relation between acculturation and alcohol consumption patterns among older Asian and Hispanic immigrants

This study examines the relation between acculturation and alcohol consumption patterns among older Asian and Hispanic immigrants in the state of California. Data were obtained from the 2009 California Health Interview Survey and included Asian (n = 1264) and Hispanic (n = 571) adults aged 60 and older who were born outside of the US. Outcome variables included presence of past year alcohol consumption, past year binge drinking, and number of binge drinking days. Acculturation was measured with items pertaining to English use and proficiency. Hierarchical multiple or logistic regression analyses were conducted separately for each racial/ethnic group and each dependent variable. Alcohol consumption was found in less than half of the sample for both Asians (43.2%) and Hispanics (39.2%). Binge drinking was found in 3.1% of Asians and 8.4% of Hispanics. Acculturation was significantly related to past year alcohol consumption for Hispanics, past year binge drinking for Asians, and binge drinking days for Asians, such that higher level of acculturation predicted a greater likelihood of alcohol consumption but decreased likelihood of binge drinking and fewer binge drinking days. The results indicate that acculturation may be related to alcohol consumption patterns for older immigrants. This suggests future needs to develop an in-depth understanding of the health behaviors of these immigrant elderly groups.

Regional Variation of Racial Disparities in Mental Health Service Use Among Older Adults

PURPOSE Given the paucity of research on the role of geography in mental health care, this study examined whether racial differences in mental health service use varied across geographic regions among older adults. DESIGN AND METHODS Drawn from the Collaborative Psychiatric Epidemiology Surveys (CPES), blacks (n = 1,008) and whites (n = 1,870) aged 60 and older were selected for analysis. Logistic regression analyses were conducted. RESULTS Results showed significant racial disparities in mental health service use in the overall sample, as well as significant variation by region. Although no racial differences were observed in the Northeast, West, or Midwest regions, black elders in the South were significantly less likely than whites to use mental health services (odds ratios [OR], 2.08; 95% confidence interval [CI], 1.34-3.23). IMPLICATIONS The findings suggest that improving the access to mental health care in certain regions, the South in particular, may be essential to reduce racial disparities at the national level. Policy implications are discussed.

Geographic and Racial-Ethnic Differences in Satisfaction With and Perceived Benefits of Mental Health Services

OBJECTIVE This study examined whether racial-ethnic differences in satisfaction with and perceived benefits from mental health services vary by geographic region among U.S. adults. METHODS Drawn from the Collaborative Psychiatric Epidemiology Surveys (CPES), selected samples consisted of 2,160 adults age 18 and older from diverse racial-ethnic groups (Asian, black, Hispanic/Latino, and white) who had used mental health services in the past 12 months. Generalized linear model analysis was conducted for the United States as a whole and separately by geographic region (Northeast, South, Midwest, and West) after adjustment for covariates. RESULTS In the national sample, no significant main effects of race-ethnicity and geographic region were found in either satisfaction with or perceived benefits from mental health services. In the stratified analyses for geographic regions, however, significant racial-ethnic differences were observed in the West; blacks in the West were significantly more likely to report higher satisfaction and perceived benefits, whereas Hispanics/Latinos in the West were significantly less likely to do so. CONCLUSIONS The findings suggest that there are regional variations of racial-ethnic differences in satisfaction with and perceived benefits from mental health services among U.S. adults and that addressing needs of Hispanics/Latinos in the West may help reduce racial-ethnic disparities in mental health care. Clinical and policy implications are discussed.

Racial/ethnic variations in the relation between body mass index and cognitive function among older adults.

OBJECTIVES The present study examines racial/ethnic variations in the relation between body mass index (BMI) and cognitive function among older adults. DESIGN Cross-sectional study of secondary data. SETTING Data were obtained from the 2010 Health and Retirement Study. PARTICIPANTS Racial/ethnic groups analyzed were black (n = 546), Hispanic (n = 110), and non-Hispanic white (n = 4,104). MEASUREMENTS BMI was calculated based on self-reported height and weight. Cognitive function was measured based on Telephone Interview for Cognitive Status-Health and Retirement Study version scores. RESULTS Significant main effects were found for both BMI and race/ethnicity, indicating that cognitive function varies significantly by both. The BMI × race/ethnicity interaction was also found to be significant. The interaction revealed that among the white sample cognitive function scores tended to increase as BMI increased whereas the opposite relation was observed in the Hispanic sample. The black sample displayed a similar pattern as the white sample, although a decrease was observed in cognitive function scores once BMI reached obesity. CONCLUSION The results suggest that the relation between BMI and cognitive function does vary by race ethnicity. Therefore, it can be concluded that high or low BMI may vary as a risk or protective factor for cognitive dysfunction among older adults by race/ethnicity. Implications for research and clinical work are discussed.

Measurement Equivalence of the K6 Scale: The Effects of Race/Ethnicity and Language.

This study examined the measurement equivalence of the K6 across diverse racial/ethnic and linguistic groups in the U.S. differential item functioning analyses using item response theory were conducted among 44,846 U.S. adults drawn from the California Health Interview Survey. Results show that four items (“nervous,” “restless,” “depressed,” and “everything an effort”) varied significantly across races/ethnicities and four items (“nervous,” “hopeless,” “restless,” and “depressed”) varied significantly across languages. In additional effect size analyses designed to separate effects of race/ethnicity from language, the structure of the White English group was substantially different from both the Hispanic/Latino English group and Hispanic/Latino Spanish group, whereas the Hispanic/Latino Spanish group was not different from the Hispanic/Latino English group. The findings suggest that there was evident measurement nonequivalence in the K6 among racially/ethnically and linguistically diverse adults and that the observed nonequivalence in the K6 appears to be driven by language rather than race/ethnicity.

The Relation Between Frequency of Binge Drinking and Psychological Distress Among Older Adult Drinkers

Objectives: The present study examined the relation between past year frequency of binge drinking and psychological distress among older adult drinkers. Method: Data were obtained from the 2009 California Health Interview Survey (CHIS). Adults aged 60 and older who had consumed alcohol in the past year (n = 13,265) were analyzed. Psychological distress was assessed using the Kessler 6 (K6) scale. Multiple regression analyses were conducted. Results: A significant main effect of frequency of binge drinking was found in regression analyses, indicating that an increased frequency of binge drinking was significantly associated with increased psychological distress (B = .10, p < .001). Results from additional analyses showed that binge drinking was related to increased psychological distress when individuals were binge drinking more than once in the past year. Discussion: The results suggest that binge drinking frequently may be related to increased experiences of psychological distress among older drinkers. Research and clinical implications are discussed.