Geographic Region May Play Role in Late-Life Depression Severity

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The severity of late-life depression varies by geographic region, a study in the American Journal of Geriatric Psychiatry has found. The results also suggest that geographic region may play a role in racial and ethnic disparities and outcomes in late-life depression.

Olivia I. Okereke, M.D., M.S., an associate professor of psychiatry at Harvard Medical School and director of geriatric psychiatry at Massachusetts General Hospital, and colleagues analyzed data from 25,502 adults who participated in the VITamin D and OmegA-3 TriaL (VITAL) Depression Endpoint Prevention study. Men in the study were at least 50 years old and women in the study were at least 55 years old. Participants identified as Asian, Black, Hispanic, non-Hispanic White, and Other race/ethnicity (such as Native American, Alaska Native, more than one race, and others), and they lived in four geographic regions, the Northeast, Midwest, Southeast, and West.

“Geographic region itself is an understudied depression risk factor,” lead author Chirag Vyas, M.B.B.S., M.P.H., a postdoctoral fellow in the Department of Psychiatry at Massachusetts General Hospital in Boston, told Psychiatric News.

All participants were given the Patient Health Questionnaire-8, and the intensity of their symptoms was measured by frequency, such as whether they had symptoms “more than half the days” or “nearly every day.” Participants were also asked whether they had been diagnosed with depression, took antidepressants, or received counseling for their depression.

Overall, participants in the Midwest, but not other regions, had less severe depression compared with participants in the Northeast. Yet within the Midwest, Black and Hispanic participants had symptom levels that were 23% and 99% higher, respectively, compared with non-Hispanic Whites. In the Northeast, Black participants and those who identified as Other race/ethnicity had up to 30% higher depression severity compared with non-Hispanic Whites. There were no racial/ethnic differences in depression severity among people living in the Southeast or West.

Compared with participants who had been diagnosed with depression and lived in the Northeast, those with diagnosed depression in all other regions were less likely to receive depression care, although the disparity was only statistically significant in the Midwest. Vyas noted that psychiatrist shortages may explain why participants outside of the Northeast with depression were less likely to receive care.

Across all regions, Black participants had a 50% or higher likelihood of not receiving any depression care compared with non-Hispanic Whites, even when accounting for similar depressive symptom severity.

“Although we adjusted for several known social and health determinants in our statistical models, it is possible that the unmeasured confounders such as neighborhood factors, patient-physician factors, or access to care might have influenced these findings,” Vyas explained. For example, health professionals may be less sensitive to depressive symptoms among Black patients compared with non-Hispanic White patients, leading to undertreatment, he said.

“This study not only addressed regional differences in late-life depression but also highlighted the potential role of geographic region of racial/ethnic disparities in depression,” Vyas added. “Overall, nationwide, system-wide efforts may not be adequate to mitigate racial/ethnic disparities in late-life depression, and region-specific, targeted, and tailored strategies may prove beneficial.”

This study was supported by the National Institute of Mental Health. ■