title: A flexible item to screen for depression in inner-city minorities during palliative care symptom assessment.
abstract: OBJECTIVE
  There is inconsistent evidence for the validity of a single item to screen depression. In inner-city minority populations, the "yes/no" forced-response option may encourage bias, especially in elders and men, who view depression as stigmatizing or the healthcare system as untrustworthy. In contrast, an open-choice format with a category for ambivalent and missing responses could be acceptable if administered during the legitimized context of a physical symptom assessment.
  
  
  METHODS
  Retrospective data were analyzed from 146 black and Latino inner-city patients receiving palliative care for various physical conditions. Bivariate analyses and ordinal regressions are based on the most recent comprehensive patient assessment conducted by a black female nurse and a bilingual Latina social worker.
  
  
  RESULTS
  The depression item (no, unknown, yes) predicts pain and symptom attitude, which is more "hopeful" in older men with unknown depression status than in younger and older women with unknown depression status or no depression.
  
  
  CONCLUSIONS
  The more "hopeful" pain and symptom attitudes by older men in the unknown category for depression suggest that depression, apathy, and resignation in older minority men may be hidden from clinicians in the absence of the open-choice depression item.
authors.affiliation: Columbia University School of Social Work, New York, NY, USA. rf201@columbia.edu
authors.forename: Richard Benoit
authors.initials: RB
authors.lastname: Francoeur
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D044383:Black People / Q000523:psychology* / Q000706:statistics & numerical data; D003866:Depressive Disorder / Q000175:diagnosis* / Q000453:epidemiology; D005260:Female; D006630:Hispanic or Latino / Q000523:psychology* / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D009042:Motivation; D009519:New York City; D010146:Pain / Q000175:diagnosis / Q000523:psychology; D010166:Palliative Care / Q000523:psychology*; D010552:Personality Assessment / Q000706:statistics & numerical data*; D011594:Psychometrics / Q000706:statistics & numerical data; D015203:Reproducibility of Results; D012737:Sex Factors; D012803:Sick Role; D013223:Statistics as Topic; D014505:Urban Population; D001741:Black or African American