Depressive distress among homosexually active African American men and women

Autor: Susan D. Cochran, Vickie M. Mays
Rok vydání: 1994
Předmět:
Zdroj: American Journal of Psychiatry. 151:524-529
ISSN: 1535-7228
0002-953X
Popis: Surveys examining rates of psychiatric disorders among gay and lesbian populations are few (1), and the majority were conducted prior to the onset of the AIDS epidemic. These early studies (2–8), which focused predominately on the question of whether homosexuality per se was indicative of psychopathology, suggested only minor differences, if any, between the psychological status of homosexual and heterosexual populations. Although homosexuals were found to be as likely as heterosexuals to show normal psychological adjustment, some differences were found. Inconsistent findings of slightly higher lifetime prevalence rates of psychiatric help-seeking, alcohol and drug use, depressive distress, and suicide attempts in homosexual than in heterosexual samples (2, 4–7) have been attributed to the possible effect of chronic stress from negative societal attitudes toward homosexuality (9, 10). This conceptualization is consistent with psychosocial models of stress-induced distress (11). Since the onset of the AIDS epidemic and concerns that there may be psychiatric consequences of coping with this life-threatening chronic illness, a number of studies (12–15) have explored the possible psychiatric morbidity associated with HIV infection among gay and bisexual men. Several of these studies (16–20) used the Center for Epidemiologic Studies Depression Scale (CES-D Scale) (21), a brief screening instrument for depressive symptoms in nonpsychiatric populations. Results showed that depressive distress scores in homosexually active men seemed to be higher than U.S. population norms for males (22) (table 1), even among men who were not HIV infected. This suggests that gay men experience somewhat elevated levels of depressive distress, though still averaging below the standard CES-D Scale cutoff score (>15) used to identify individuals at higher risk for clinical depression. Whether this heightened distress is a result of HIV-associated stress or reflects the somewhat higher distress levels found in pre-AIDS studies is indeterminable. However, symptomatic HIV-infected men reported greater distress than asymptomatic or uninfected men (20), although these conclusions are not undisputed (16, 17, 28). TABLE 1 CES-D Scale Mean Scores From Previously Published Studies and Current Study of Depressive Distress in Community Subjectsa Although studies of gay, lesbian, or bisexual African Americans are extremely rare (3, 29), there is good reason to expect that homosexually active blacks might experience higher levels of depressive distress than homosexually active whites. In one study examining ethnic differences in CES-D Scale scores among gay and bisexual men (20), being African American was a significant predictor of higher scores on one of the four CES-D Scale subscales, even though these men represented only 2% of the sample and were recruited from primarily white gay social networks. More importantly, several large community surveys, unselected for sexual orientation, indicate higher crude prevalence rates of depressive distress among African Americans in general than among whites (22-27, 30). Using a cutoff score of >15 on the CES-D Scale, researchers have estimated an average depression prevalence rate of 25.9% in blacks, compared with only 16.5% in whites (23, 25, 27, 30, 31). Across these studies, African Americans consistently showed higher levels of depressive distress than white Americans (table 1). Although some research (32) would predict that black women might evidence higher levels of distress than black men, other studies have reported conflicting results (33). Researchers using psychiatric diagnostic criteria rather than measures of depressive distress have not found consistent differences between noninstitutionalized black and white adults in current prevalence or lifetime incidence of diagnosable depressive disorders (34). Thus, although blacks report higher levels of distress than whites, this does not translate into higher rates of psychiatric depressive disorders, a pattern similar to research findings comparing homosexual and heterosexual populations. The present study sought to document levels of depressive distress as measured by the CES-D Scale and the prevalence of suicidal thoughts in two large, nationally recruited study groups of homosexually active African Americans—a group of men and a group of women. Our purpose is to provide information about these two rarely studied populations, both of which might be especially vulnerable to depressive distress given earlier research findings. We predicted that our subjects would evidence higher than expected levels of depressive distress than those found in previous studies of white homosexually active men (there are no published CES-D Scale-based studies of lesbians to the best of our knowledge) and in community samples of black Americans who were presumably primarily heterosexual. Consistent with previous findings regarding sex differences (32), we also predicted that, within our study groups, black homosexually active women would report levels of depressive distress that were equal to or greater than those reported by black men. However, this prediction was somewhat tentative given the occurrence of the HIV epidemic that has disproportionately affected black gay and bisexual men (35) rather than lesbians (36, 37). We further predicted that men with symptomatic HIV infections would report greater depressive distress than the other men in this study, consistent with the overlap between common depressive symptoms and symptomatic HIV disease.
Databáze: OpenAIRE
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