African American Identity by Jas M. Sullivan

Author:Jas M. Sullivan
Language: eng
Format: epub
ISBN: 9780739171752
Publisher: Lexington Books

Chapter Nine

Vascular Depression and African Americans: A Population at Risk

Amanda D. Persaud, Deepika Singh, Susan Krauss Whitbourne, and Joel R. Sneed

Introduction

The vascular depression hypothesis states that a link exists between late-life depression and vascular disease, such that the accumulation of vascular disease leads to lesions in areas of the brain that regulate mood and executive dysfunction. Cardiovascular risk factors, such as obesity, smoking, hypertension, and diabetes, are exceedingly prevalent in the African American community. Not surprisingly, cardiovascular disease, stroke, and vascular dementia are highly prevalent in the African American community. Diagnosis and treatment of vascular depression in the African American community may be complicated by stigma and shame, religiosity, distrust, economic bias, and provider bias. However, vascular depression lies on the boundary between the medical and psychological, and therefore, represents a unique illness that can be alternatively understood as a consequence of vascular disease. As a result, it may be more amenable to treatment than other mental illnesses that are traditionally conceptualized as psychological. Reconceptualizing some late-life depression in this way may reduce stigma and increase help seeking behavior. We will provide an overview of the Heart and Soul Study at Harlem Hospital Center in New York City and detail the ways in which this academic-community partnership has attempted to spread awareness about vascular depression and increase African American participation in mental health research.

Literature Review

The prevalence of major depression in the geriatric community ranges from 1-4 percent (Blazer, 2003; Hybels and Blazer, 2002; Kramer et al., 2004), and commonly co-occurs with medical illness. Katon and Schulberg (1992) found that the prevalence of major depression increases in a linear manner as study samples move from consisting of community-dwelling adults to primary care patients to inpatient medical settings. One estimate of major depression in hospitalized older adults sixty and over ranged from 10 to 21 percent depending on the method of diagnosis (Koenig, George, Peterson, and Pieper, 1997). Depression is also associated with longer hospital stays and a greater number of primary care appointments (Luber et al., 2001; Luber et al., 2000) and, therefore, leads to greater health care costs (Simon, et al., 1995). Depression increased the risk of mortality by as much as 24 percent in the Cardiovascular Health Study (Schulz et al., 2000) and was found to increase the level of functional disability and the effectiveness of rehabilitation programs for older adults with stroke, Parkinson’s disease, heart disease, and fractures (Katz, 1996). Finally, suicide rates are higher among the elderly than any other age group (McIntosh, 1992), and the association between depression and suicide has been clearly indicated (Conwell and Brent, 1995).

It is projected that by 2010, the world’s elderly population will grow by 847,000 people each month, and that by the year 2050, 35 percent of the United States will be age sixty-five or older (Kinsella and Velkoff, 2001). Older adults are also getting older. In 1994, the older adult population between the ages of sixty-five to seventy-four was eight times larger than it was in 1990, the seventy-five

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