Symptoms of depression and psychological distress among Hispanics with rheumatoid arthritis.
OBJECTIVE
To explore the roles played by Hispanic ethnic background and acculturation to the mainstream English language culture of the United States in the depressive symptoms and mental health of rheumatoid arthritis (RA) patients.


METHODS
Members of a consecutive cohort of patients with RA were studied cross-sectionally. All underwent a comprehensive clinical and psychosocial evaluation. Depressive symptoms were measured with the Center for Epidemiologic Studies Depression Scale (CES-D), and psychological distress was measured with the Medical Outcomes Study Short Form 36 (SF-36) mental health scale.


RESULTS
Two hundred thirty-six patients were studied. Women had significantly higher median CES-D scores than men (19 versus 14, P = 0.0004), Hispanics scored higher than non-Hispanics (14 versus 8, P = 0.0002), and foreign-born scored higher than US-born patients (14 versus 10, P = 0.009). Compared with those who were fully acculturated, patients who were partially acculturated were more likely to have a score > or = 16 on the RA-adjusted CES-D (odds ratio [OR] = 1.79, 95% confidence interval [95% CI] 1.37 to 2.35, P < or = 0.001). Among unacculturated patients, the likelihood of a score > or = 16 increased 6-fold (OR = 6.68; 95% CI 3.50 to 12.72; P < or = 0.001). A similar, inverse pattern was observed for the SF-36 mental health scale. In multivariate models accounting for age, sex, education, income, articular pain, deformity, and the level of disability, low acculturation was independently associated with high depressive symptoms, and a Hispanic background was independently associated with lower SF-36 mental health.


CONCLUSIONS
In this consecutive series of RA patients, Hispanics, particularly those who are not fully acculturated to the mainstream Anglo society, had more depressive symptoms and psychological distress than did non-Hispanics.
Escalante
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Division of Clinical Immunology and Rheumatology, University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive, San Antonio, TX 78284, USA.
del Rincón
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Mulrow
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D000069:Acculturation; D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D001172:Arthritis, Rheumatoid / Q000150:complications / Q000208:ethnology*; D003430:Cross-Sectional Studies; D003863:Depression / Q000175:diagnosis / Q000208:ethnology* / Q000209:etiology; D004522:Educational Status; D005260:Female; D006630:Hispanic or Latino / Q000208:ethnology*; D006801:Humans; D007182:Income; D008297:Male; D008603:Mental Health; D008875:Middle Aged; D008960:Models, Psychological; D015999:Multivariate Analysis; D011569:Psychiatric Status Rating Scales; D012111:Residence Characteristics; D012720:Severity of Illness Index; D017678:Sex Distribution; D013315:Stress, Psychological / Q000175:diagnosis / Q000208:ethnology* / Q000209:etiology; D013781:Texas / Q000453:epidemiology