title: Prevalence and correlates of depressive symptoms among rural older African Americans, Native Americans, and whites with diabetes.
abstract: OBJECTIVE
  Depression is associated with morbidity, mortality, and decreased quality of life and is a well-established complication among people with diabetes. Little is known about the prevalence and correlates of depressive symptoms among older adults living in rural communities, particularly among ethnic minority groups, who are at increased risk of developing diabetes and complications.
  
  
  METHODS
  Data were analyzed from the ELDER (Evaluating Long-term Diabetes Self-management Among Elder Rural Adults) diabetes study in which face-to-face interviews were conducted with 696 older (> or =65 years of age) African-American, Native American, and white men and women in two rural counties in central North Carolina.
  
  
  RESULTS
  Using a criterion of > or =9 on a modified CES-D (Center for Epidemiologic Study of Depression) scale, 15.8% of the sample had depressive symptoms. In bivariate analyses, depressive symptomatology was more common among women and individuals who were unmarried and had less than a high school education, fewer financial resources, more chronic conditions, more prescription medications, and lower physical functioning. In multivariate analyses, sex, education, living arrangement, BMI, number of prescription medications, number of chronic conditions, and physical functioning remained significant.
  
  
  CONCLUSIONS
  These results show that older rural adults with diabetes are at high risk for depressive symptoms, regardless of their ethnic group, and that certain demographic and health characteristics are important factors in this association. These findings add to the limited body of knowledge of comorbid depression in this population. Greater attention should be paid to diagnosing and treating this condition by those who provide care to these populations.
authors.affiliation: Department of Public Health Sciences, Wake Forest University School of Medicine, Medical Center Blvd., Winston-Salem, NC 27157-1063, USA. rbell@wfubmc.edu
authors.forename: Ronny A
authors.initials: RA
authors.lastname: Bell
authors.forename: Shannon L
authors.initials: SL
authors.lastname: Smith
authors.forename: Thomas A
authors.initials: TA
authors.lastname: Arcury
authors.forename: Beverly M
authors.initials: BM
authors.lastname: Snively
authors.forename: Jeanette M
authors.initials: JM
authors.lastname: Stafford
authors.forename: Sara A
authors.initials: SA
authors.lastname: Quandt
mesh_terms: D000328:Adult; D044383:Black People; D015992:Body Mass Index; D003866:Depressive Disorder / Q000453:epidemiology*; D048909:Diabetes Complications / Q000453:epidemiology / Q000523:psychology* / Q000534:rehabilitation; D004522:Educational Status; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D007198:Indians, North American; D008297:Male; D009657:North Carolina / Q000453:epidemiology; D011203:Poverty; D015995:Prevalence; D012424:Rural Population; D012648:Self Care; D012959:Socioeconomic Factors; D044465:White People; D001741:Black or African American
chemical_list: D006442:Glycated Hemoglobin