摘要：Objectives. We estimated racial/ethnic differences in rates of major depression and investigated possible mediators. Methods. Depression prevalence rates among African American, Hispanic, and White adults were estimated from a population-based national sample and adjusted for potential confounders. Results. African Americans (odds ratio [OR] = 1.16, 95% confidence interval [CI] = 0.93, 1.44) and Hispanics (OR = 1.44, 95% CI = 1.02, 2.04) exhibited elevated rates of major depression relative to Whites. After control for confounders, Hispanics and Whites exhibited similar rates, and African Americans exhibited significantly lower rates than Whites. Conclusions. Major depression and factors associated with depression were more frequent among members of minority groups than among Whites. Elevated depression rates among minority individuals are largely associated with greater health burdens and lack of health insurance, factors amenable to public policy intervention. Depression and other mental illnesses are leading causes of disability and premature mortality in the United States, costing more than $150 billion in 1997. 1 Later life depression is particularly costly because of associated mortality, excess disability, and interactions with other physical health problems. 2– 5 While it is generally believed that mental disorders are at least as prevalent among ethnic minority groups as among the White population of the United States, 6, 7 there is a paucity of information on the prevalence of mental disorders among minority groups. 8 Earlier epidemiological studies based on community or clinical samples have limited generalizability. 9– 11 Community-based samples, such as the Epidemiological Catchment Area Study, 12 reflect demographic and cultural characteristics of specific geographic locations and cannot be extrapolated to the national experience. 13 Studies that assess depressive disorders through the use of national probability samples are needed to make inferences to the nation as a whole. The National Comorbidity Survey, which involved a sample of US residents aged 15 to 54 years, gathered epidemiological data on selected psychiatric disorders defined by the Diagnostic and Statistical Manual of Mental Disorders, Revised Third Edition ( DSM-III-R ) and provided evidence of ethnic/racial differences in these disorders. 13, 14 The goal of the current study was to estimate prevalence rates of DSM -based major depression in an older cohort (aged 54 to 65 years) of individuals who took part in the Health and Retirement Survey (HRS). The prevalence of depression in this largely preretirement national cohort is of particular interest because it has been reported that incidence rates of major depression increase in the sixth decade of life 15 ; moreover, it is important to determine the effect on this cohort of the deleterious health sequelae of depression, 2, 10 since these individuals’ medical costs will imminently be covered through Medicare. We sought to estimate the prevalence of major depression within 12 months of the HRS interview among older minority and White Americans and investigate factors associated with differences in prevalence rates that might be altered by clinical, public health, or public policy interventions. In addition, since racial/ethnic differences in sociodemographic (other than race/ethnicity), 2, 16, 17 health, 2, 17– 20 and economic 16, 17, 21 characteristics may be entangled in observed depression frequencies, 22, 23 we evaluated the influence of such factors on racial/ethnic differences in rates of depression.
