Baqar A. Husaini

Depression in rural communities: Validating the CES-D scale.

This study of 200 adults receiving outpatient services in rural Middle Tennessee was conducted to provide data on the validity of the CES-D as a measure of depressive symptomatology. Specifically, the study sought to determine the CES-Ds ability to discriminate between outpatients and a sample of community residents, between patient groups reflecting different diagnostic classifications and levels of problem severity, and based upon such comparisons, to select cutting points on the CES-D which would indicate levels of depressive symptomatology which denote a need for services. The data indicated that the CES-D distinguished (1) between patients and nonpatients, (2) among various patient groups, and (3) among depressed patients with varying levels of problem severity. Further, the study cites the utility of new cutting points of 17 and 23 to provide an estimate of “possible” and “probable” caseness within the community. The study provides support for the utility of the CES-D in determining levels of depressive symptomatology in the population.

Black-White Inequalities in Mortality and Life Expectancy, 1933–1999: Implications for Healthy People 2010

Objectives. Optimistic predictions for the Healthy People 2010 goals of eliminating racial/ethnic disparities in health have been made based on absolute improvements in life expectancy and mortality. This study sought to determine whether there is evidence of relative improvement (a more valid measure of inequality) in life expectancy and mortality, and whether such improvement, if demonstrated, predicts future success in eliminating disparities. Methods. Historical data from the National Center for Health Statistics and the Census Bureau were used to predict future trends in relative mortality and life expectancy, employing an Autoregressive Integrated Moving Average (ARIMA) model. Excess mortality and time lags in mortality and life expectancy for blacks relative to whites were also estimated. Results. Based on data for 1945 to 1999, forecasts for relative black:white age-adjusted, all-cause mortality and white:black life expectancy at birth showed trends toward increasing disparities. From 1979, when the Healthy People initiative began, to 1998, the black:white ratio of age-adjusted, gender-specific mortality increased for all but one of nine causes of death that accounted for 83.4% of all US mortality in 1998. From 1980 to 1998, average numbers of excess deaths per day among American blacks relative to whites increased by 20%. American blacks experienced 4.3 to 4.5 million premature deaths relative to whites in 1940–1999. Conclusions. The rationale that underlies the optimistic Healthy People 2010 forecasts, that future success can be built on a foundation of past success, is not supported when relative measures of inequality are used. There has been no sustained decrease in black-white inequalities in age-adjusted mortality or life expectancy at birth at the national level since 1945. Without fundamental changes, most probably related to the ways medical and public health practitioners are trained, evaluated, and compensated for prevention-related activities, as well as further research on translating the findings of prevention studies into clinical practice, it is likely that simply reducing disparities in access to care and/or medical treatment will be insufficient. Millions of premature deaths will continue to occur among African Americans.

The stress-buffering role of social support and personal competence among the rural married

This study examines the possible stress-buffering properties of personal competence and social support with regard to depressive symptoms. The hypothesis examined was that individuals lacking both internal and external resources would manifest higher levels of symptoms as a result of increasing number of life events than would individuals possessing such resources. Further, variation by gender was considered. Data on depressive symptoms (CES-D Scale), personal competence, social support, and life events were obtained in a 70-minute interview with randomly selected samples of white married adults (n = 965) from rural counties of Tennessee, Oklahoma, and Ohio. Analyses indicated both the main and buffering effects of personal competence and social support for the total sample. However, these effects varied by sex. While personal competence and life events had consistent main effects for both married males and females–individuals with more stress or lower levels of competence had higher levels of symptoms–effects of social support were more pervasive among the females. Finally, personal competence appeared to have a greater buffering effect than the presence of social support alone. There was also an unanticipated tendency for greater vulnerability to stressors among individuals (particularly males) under conditions of low competence and high support.

Psychiatric Symptoms and Help-Seeking Behavior Among the Elderly

This study of randomly selected black (N = 600) and white (N = 600) elderly individuals residing in Nashville, TN, ex- amines the relationship between psychiatric symptoms and utiliza- tion of both formal and informal resources of help among the black and white elderly. Relevant data were collected through face-to-face interviews with the elderly living either in their own homes or in the high-rise apartments for the elderly. Analyses of data show that significantly greater proporlions of the elderly with psychiatric symptoms in both samples use mental health professionals. Mental health services, however, were less frequently used as compared to the family physician or seeing the clergyman. Furthermore, in both samples, help from clergy, fnends/relatives or praying frequently was higher among the females than males. The elderly males tended to use drinking more than usual and going out for long walks as coping mechanisms. A discussion of these fmdings is provided.

Black–White Mortality From HIV in the United States Before and After Introduction of Highly Active Antiretroviral Therapy in 1996

OBJECTIVES We sought to describe Black-White differences in HIV disease mortality before and after the introduction of highly active antiretroviral treatment (HAART). METHODS Black-White mortality from HIV is described for the nation as a whole. We performed regression analyses to predict county-level mortality for Black men aged 25-84 years and the corresponding Black:White male mortality ratios (disparities) in 140 counties with reliable Black mortality for 1999-2002. RESULTS National Black-White disparities widened significantly after the introduction of HAART, especially among women and the elderly. In county regression analyses, contextual socioeconomic status (SES) was not a significant predictor of Black:White mortality rate ratio after we controlled for percentage of the population who were Black and percentage of the population who were Hispanic, and neither contextual SES nor race/ethnicity were significant predictors after we controlled for pre-HAART mortality. Contextual SES, race, and pre-HAART mortality were all significant and independent predictors of mortality among Black men. CONCLUSIONS Although nearly all segments of the Black population experienced widened post-HAART disparities, disparities were not inevitable and tended to reflect pre-HAART levels. Public health policymakers should consider the hypothesis of unequal diffusion of the HAART innovation, with place effects rendering some communities more vulnerable than others to this potential problem.

Predictors of breast cancer screening in a panel study of African American women.

ABSTRACT Purpose: This study examines the predictors of breast cancer screening participation in a panel study of African American women over age 40. We examine the effect of depression, age, beliefs and concerns about breast cancer and its risk, communication with social networks regarding screening, marital status, participation in religious organizations, breast cancer family history, and participation in a breast cancer education program. Methods: Participants were recruited from 30 African American churches, two low-income housing projects, and from a health fair at a historically African American University (N = 364). Participants were interviewed upon recruitment, and three months later. Multinomial logistic regression models are estimated to assess the relative impact of covariates on the odds of getting a mammogram while controlling for other factors. We also assess predicted probabilities of screening at specific levels of covariates. Results: We find that age, marriage, an educational intervention, talking with friends, and believing that early detection can lead to cure had a positive impact on getting a mammogram between T1 and T2. In contrast, depression significantly reduces the odds of getting a mammogram. Family histories of breast cancer and church participation have no effect on rates of mammography net of other factors.

Social class and depressive symptomatology. The role of life change events and locus of control.

This paper considers the hypothesis that the relationship between social class and impairment may be accounted for by the greater prevalence of life events among lower-class individuals. This hypothesis was evaluated on data from 713 rural Tennessee adults. The data indicated that, although social class indices were inversely related to psychiatric impairment as expected, there was no significant tendency for lower-class individuals to report a greater number of life events. For total number of events, as well as total number of undesirable, unexpected, or unpreventable events, middle- and upper-class individuals tended to report more events. Controls for the event indices did not affect the relationship between social class and symptomatology as the stress hypothesis would predict. However, locus of control was positively related to social class and was found to influence the event-impairment relationship. These data raise questions regarding the etiological role of life events in the relationship between social class and psychiatric impairment. The data suggest that observed social class differences in impairment may arise from the coping styles of certain social classes (as measured by locus of control) rather than from the differential prevalence of life events.

Characteristics of life events and psychiatric impairment in rural communities.

This household survey of a random sample of 713 rural adults (ages 18 to 60) examined the influence of event characteristics upon the relationship between life change events and impairment. Data were obtained on the occurrence of events, event characteristics, demographic characteristics, and psychiatric impairment (using the General Weil-Being Schedule and the Center for Epidemiologic Studies Depression Scale). Analyses indicated that individuals experiencing higher proportions of undesirable, unanticipated, unpreventable, and disruptive events or events having minimal social support manifested higher levels of psychiatric symptomatology. Although total number of events was consistently the best predictor of impairment, it did not diminish the effects of the event characteristics on impairment. The independent effects of these event characteristics are discussed.

Does public and private religiosity have a moderating effect on depression? A bi-racial study of elders in the American South

Religious activities are shown to correlate with rates of psychological depression symptoms in a sample of 995 African American and white elderly residents of Nashville. The data, collected in face-to-face interviews, included indicators of both public and private religiosity. Levels of religiosity and perceived social support were higher among the African-American respondents than among others, and among female respondents. Separate regression analyses of the racial groupings, which appeared to have distinctive religious subcultures, generally show that perceptions of social support mediate the relationship between levels of religiosity and symptoms of depression.

Breast Cancer Screening Among African American Women: Adherence to Current Recommendations

Breast cancer remains one of the leading causes of cancer death among African American women, and rates of mammography screening for African American women remain lower than rates for their Caucasian counterparts. The purpose of the current study was to explore the reasons for nonadherence to American Cancer Society breast screening guidelines among African American women who had not received a mammogram within the past year. Participants included 91 African American women between 40 and 84 years of age recruited from churches, housing projects, and a health fair at a historically African American university who had not received a mammogram within the past 12 months. Findings revealed that 36% of participants had never received a mammogram, 43% did not have their breasts examined by their doctor once a year, 55% did not perform monthly self-examination, and 23% did not know how to examine their breasts for breast cancer. The most frequently reported reason for not getting a mammogram was because the participants doctor had not suggested it.