African American
U.S. Born Caribbean Black
Foreign Born Caribbean Black
Lifetime Major Depressive Episode
Lifetime Major Depressive Disorder
Depressive Symptoms
Lifetime Major Depressive Episode
Lifetime Major Depressive Disorder
Depressive Symptoms
Lifetime Major Depressive Episode
Lifetime Major Depressive Disorder
Depressive Symptoms
%
SE
%
SE
Mean
SE
%
SE
%
SE
Mean
SE
%
SE
%
SE
Mean
SE
n = 3434
n = 3433
n = 3578
n = 432
n = 432
n = 432
n = 1141
n = 1141
n = 1141
Age
18–34
12.7c,d
1.1
10.1c,d
0.8
7.4b,c,d
0.2
21.7
6.3
20.3
6.5
7.3d
0.8
15.3
4.7
13.2
4.7
7.0a
0.7
35–54
14.1e,f,g
1.1
11.9 f
1.1
6.7e,f
0.3
18.6
5.5
18.1
5.5
8.3g
2
8.7
2
8
1.9
5.2
0.4
55–64
9i
1.6
8.4i
1.5
5.6
0.4
42
17.8
42
17.8
7.8
2.4
3.4
1.7
3.2
1.7
5.6
0.7
65–74
5.8
1.5
5.8j
1.5
5.1
0.3
2.5
2.6
2.5
2.6
4.9
1.4
6
4.6
6
4.6
5.2
1.5
≥75
2.2
0.9
1.6
0.7
4.7
0.5
7.4
8
7.4
8.1
2.2
1.7
6
3.6
6
3.6
6
0.8
Design-based F
7.1*
5.6*
1.7
1.7
1.9
1.3
There was no late late-life (75 years or older) advantage for US-born Caribbean Blacks for MDE and MDD. Instead, there was a small increase in prevalence rates for this group during late late life. However, there was an advantage for depressive symptoms which declined from the late life to late late-life periods. US-born Caribbean Blacks reported the lowest mean CES-D scores during the late late-life period among all groups observed in our analysis. Also, looking at patterns across groups revealed that the MDE and MDD patterns mimic each other depicting a similar graphical representation across the age periods examined (Figs. 10.1 and 10.2).
Fig. 10.1
Lifetime major depressive episode prevalence rates
Fig. 10.2
Lifetime major depressive disorder prevalence rates
Relative to foreign-born Caribbean Blacks, African Americans maintained higher MDE prevalence rates during the mid-adult (35–54 years) to early late-life (55–64 years) periods, with prevalence rates of 14.1 % compared to 8.7 % for foreign-born Caribbean Blacks during the mid-adult period and prevalence rates of 9.0 % as compared to 3.4 % for the early late-life period. An African American disadvantage was present during these same periods for MDD as well. Interestingly, during the early late-life (55–64 years) period, depressive symptoms for African Americans and foreign-born Caribbean Blacks converge with a mean CES-D score of 5.6; however, during the late late-life period, foreign-born Caribbean Blacks demonstrate the highest mean CES-D score among all Black groups at 6.0. Overall African Americans demonstrated a linear pattern of change across the age periods, in that depressive symptoms decreased from the mid-adult (35–54 years) period onward (Fig. 10.3).
Fig. 10.3
Mean CES-D scores
10.4.4.2 Patterns of Depressive Symptoms by Ethnicity, Nativity, and Gender
Aggregate measures of depressive symptoms, shown in Table 10.1 and graphically represented in Fig. 10.3, included both males and females of each ethnic group. Results showed higher US-born Caribbean Black mean CES-D scores for the early adult (35–54 years) and early late-life (55–64 years) periods, relative to all groups, followed by very similar depressive symptom patterns during the late-life period (65–74 years) for all groups and a foreign-born Caribbean Black disadvantage and US-born Caribbean Black advantage during late late life (75 years and older). US-born Caribbean Black mean CES-D scores were higher than their foreign-born counterparts throughout the age periods analyzed with the exception of the late life (65–74 years) and late late life (75 years and older).
An analysis of depressive symptoms by gender underscores US-born Caribbean Black men as the group experiencing more disadvantage with regard to the depressive symptoms when compared across all age periods studied (Fig. 10.4).5 The higher US-born Caribbean Black male CES-D scores drove up the mean CES-D scores for the group as a whole, essentially masking the lower female US-born Caribbean Black mean CES-D scores for all periods of the life course, relative to US-born Caribbean Black males (Fig. 10.2). US-born Caribbean Black men showed considerably higher mean CES-D scores than foreign-born Caribbean Blacks and African Americans. For example, focusing on the late-life period (65–74 years), US-born Caribbean Blacks had a mean CES-D score of 9.7, compared to 5.6 for African Americans and 5.2 for foreign-born Caribbean Blacks.
Fig. 10.4
Male mean CES-D scores by ethnicity
African American males had a lower mean CES-D score during the early late life (5.3) as compared to foreign-born Caribbean Blacks (5.9), losing this advantage during the late life (65–74 years) with a mean CES-D score of 5.6 compared to 5.2 for foreign-born Caribbean Black men and regaining this advantage during the late late life (75 years or older) with a mean CES-D score of 4.9 compared to 6.2 for foreign-born Caribbean Black men. US-born Caribbean Black females reported the highest mean CES-D score across all female groups during early late life (55–64 years) with a score of 6.9 as compared to 5.7 for African American females and 5.2 for foreign-born Caribbean Black females (Fig. 10.5). However, US-born Caribbean Black females reported the lowest depressive symptoms among all groups (both male and female) for the late-life (2.1) and late late-life (2.3) periods. The depressive symptom patterns for African American females during late life remained consistently between the mean CES-D scores for the US-born and foreign-born Caribbean Blacks.
Fig. 10.5
Female mean CES-D scores by ethnicity
10.5 Discussion and Implications
The purpose of this chapter was threefold. First, our aim was to provide a brief overview of the extant literature on depression correlates, symptoms, and prevalence for African American and Caribbean Blacks. Next, we provided an adult life course perspective to an examination of lifetime MDE, lifetime MDD, and depressive symptoms for African Americans and US- and foreign-born Caribbean Blacks in an effort to underscore the potential disparities among those in late life. Here, we will meet our final aim by discussing our findings in the context of their future research, practice, and policy implications. Overall, our findings suggest that while aging groups may share common experiences directly linked to aging, there are various social factors that differentiate the experiences of persons during late life. In the case of this chapter, we argue that ethnicity and nativity are important, yet oftentimes underreported factors that contribute to the mental health transitions for aging populations. Therefore, in order to gain a more nuanced understanding of patterns during the late-life period, it is important to consider how intersecting determinants such as ethnicity and nativity should be considered.
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