Elsevier

Annals of Epidemiology

Volume 24, Issue 11, November 2014, Pages 822-830
Annals of Epidemiology

Original article
Depression, anxiety, antidepressant use, and cardiovascular disease among Hispanic men and women of different national backgrounds: results from the Hispanic Community Health Study/Study of Latinos

https://doi.org/10.1016/j.annepidem.2014.09.003Get rights and content

Highlights

  • We present mental health data from the largest study of diverse Hispanic groups.

  • Depression and anxiety vary by Hispanic group, being highest among Puerto Ricans.

  • Longer exposure to US culture is associated with higher depression and anxiety.

  • CVD risk factors and morbidity are associated with higher depression and anxiety.

  • There may be undertreatment of depression, especially among uninsured.

Abstract

Purpose

To describe prevalence and relationships to cardiovascular morbidity of depression, anxiety, and medication use among Hispanic/Latinos of different ethnic backgrounds.

Methods

Cross-sectional analysis of 15,864 men and women aged 18 to 74 years in the population-based Hispanic Community Health Study/Study of Latinos. Depressive and anxiety symptoms were assessed with shortened Center for Epidemiological Studies Depression Scale and Spielberger Trait Anxiety Scale.

Results

Prevalence of high depressive symptoms ranged from low of 22.3% (95% confidence interval [CI], 20.4–24.3) to high of 38.0% (95% CI, 35.2–41.0) among those of Mexican or Puerto Rican background, respectively. Adjusted odds ratios for depression rose monotonically with number of cardiovascular disease (CVD) risk factor from 1.46 (95% CI, 1.18–1.75) for those with one risk factors to 4.36 (95% CI, 2.47–7.70) for those with five risk factors. Antidepressant medication was used by 5% with striking differences between those with and without history of CVD (15.4% and 4.6%, respectively) and between insured (8.2%) and uninsured (1.8%).

Conclusions

Among US Hispanics/Latinos, high depression and anxiety symptoms varied nearly twofold by Hispanic background and sex, history of CVD, and increasing number of CVD risk factors. Antidepressant medication use was lower than in the general population, suggesting under treatment especially among those who had no health insurance.

Introduction

Depressive symptoms, depressed mood or subclinical depression, as well as anxiety, assessed with screening instruments have been associated with higher risks of heart disease, stroke, and all-cause mortality [1], [2], [3], [4]. There is a bidirectional relationship between depression and cardiovascular disease (CVD), with depression being common after myocardial infarction (MI) [5] and stroke [6].

Although the study by Alegria et al. [7] from the National Latino and Asian American Study, examined a probability sample of 2554 persons from four background groups: Mexicans, Puerto Ricans, Cubans and “other,” it did not distinguish those of Dominican, South American, or Central American backgrounds. Another important study from the National Institute of Mental Health Collaborative Psychiatric Epidemiology Surveys (CEPS) looked only at Mexican, Puerto Rican, and Cuban background groups. Little research exists on use of antidepression and antianxiety medications in these diverse groups. The Hispanic Community Health Study/Study of Latinos (HCHS/SOL), the largest most comprehensive study of the health of Hispanics/Latinos from six different national backgrounds, consists of a probability sample of 16,415 Hispanic/Latino persons aged 18 to 74 years in four different communities across the United States. HCHS/SOL provides a unique opportunity to examine depressive and anxiety symptomatology and use of antidepressant and antianxiety medications in Hispanic/Latino groups of different national backgrounds, by age, sex, and in relation to CVD and risk factors for CVD.

Section snippets

Design overview, setting and participants

The HCHS/SOL enrolled 16,415 self-identified Hispanic/Latino participants aged 18 to 74 years in four defined communities in the US: Bronx, New York; San Diego, California; Miami, Florida; and Chicago, Illinois to describe and study prospectively health and disease in Hispanic/Latinos from diverse origins, including Mexican, Puerto Rican, Dominican, Cuban, Central American, and South American. The cohort was selected and enrolled between 2008 and 2011 through stratified multistage area

Results

The self-reported background of the analytic cohort is 40% Mexican, 16% Puerto Rican, 14% Cuban, 11% Central American, 9% Dominican, and 7% South American. Women comprised 60%; the vast majority was not born in the 50 United Sates (83%) with the greatest proportion immigrating as young adults (aged 20–44 years). Spanish was the preferred language for questionnaires completion for 80.1% of the analytic cohort. The description of the analytic cohort shows raw percentages of actual participants

Discussion

In the most comprehensive study of Hispanics/Latinos of different national backgrounds conducted to date (the HCHS/SOL), we found an overall prevalence of depression of 27%. Being US born or second or higher generation, immigrant was associated with higher levels of depression and anxiety. Antidepressant and antianxiety medication was used by 5% and 2.5% of the cohort, respectively, and varied widely by Hispanic/Latino background group as well by age and sex and presence of CVD.

Those of Puerto

Acknowledgments

The authors thank the staff and participants of HCHS/SOL for their important contributions.

Investigators website: http://www.cscc.unc.edu/hchs/.

The Hispanic Community Health Study/Study of Latinos was carried out as a collaborative study supported by contracts from the National Heart, Lung, and Blood Institute (NHLBI) to the University of North Carolina (N01-HC65233), University of Miami (N01-HC65234), Albert Einstein College of Medicine (N01-HC65235), Northwestern University (N01-HC65236), and

References (28)

  • K.J. Salaycik et al.

    Depressive symptoms and risk of stroke: the Framingham Study

    Stroke

    (2007)
  • B.D. Thombs et al.

    Prevalence of depression in survivors of acute myocardial infarction

    J Gen Intern Med

    (2006)
  • M. Alegria et al.

    Prevalence of psychiatric disorders across Latino subgroups in the United States

    Am J Public Health

    (2007)
  • L.S. Radloff

    The CES-D scale: a self-report depression scale for research in the general population

    Appl Psychol Meas

    (1977)
  • Cited by (0)

    All authors report no conflict of interest.

    1

    Present address: Office of Biostatistics, Center for Drug Evaluation and Research, US FDA.

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