title: What precipitates depression in African-American cancer patients? Triggers and stressors.
abstract: OBJECTIVE
  This study examined general and cancer-related stressors of depression that are unique to African-American cancer patients.
  
  
  METHODS
  The study used cohort design and mixed methods. Seventy-four breast and prostate cancer survivors including 34 depressed and 23 non-depressed African-Americans and 17 depressed whites were interviewed. Qualitative data analysis identified themes. The thematic codes were converted to a SPSS data set numerically. The Fisher's exact test was performed to examine group differences in the experience of stress.
  
  
  RESULTS
  Significantly more depressed African-Americans experienced a dramatic reaction to a cancer diagnosis (p = 0.03) or had concerns about functional decline (p = 0.01), arguments with relatives or friends (p = 0.02), and unemployment status (p = 0.03) than did non-depressed African-Americans, who reacted to the cancer diagnosis as a matter of reality (p = 0.02). Significantly more depressed African-Americans talked about feeling shocked by a cancer diagnosis (p = 0.04) and being unable to do things that they used to do (p = 0.02) than did depressed whites. Qualitative analysis shed light on the extent of such group differences.
  
  
  CONCLUSIONS
  Distress from the initial cancer diagnosis and functional decline were likely to have triggered or worsened depression in African-American cancer patients. This study highlighted racial differences in this aspect. It is critical to screen African-American cancer patients for depression at two critical junctures: immediately after the disclosure of a cancer diagnosis and at the onset of functional decline. This will enhance the chance of prompt diagnosis and treatment of depression in this underserved population.
authors.affiliation: Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, Ohio.
authors.forename: Amy Y
authors.initials: AY
authors.lastname: Zhang
authors.affiliation: Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, Ohio.
authors.forename: Faye
authors.initials: F
authors.lastname: Gary
authors.affiliation: Department of Urology, School of Medicine, Case Western Reserve University, Cleveland, Ohio.
authors.forename: Hui
authors.initials: H
authors.lastname: Zhu
mesh_terms: D001741:Black or African American / Q000523:psychology*; D000368:Aged; D001943:Breast Neoplasms / Q000208:ethnology* / Q000523:psychology; D016022:Case-Control Studies; D003866:Depressive Disorder / Q000208:ethnology* / Q000209:etiology; D005260:Female; D054624:Health Status Disparities; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D009820:Ohio; D011471:Prostatic Neoplasms / Q000208:ethnology* / Q000523:psychology; D036301:Qualitative Research; D013315:Stress, Psychological / Q000208:ethnology* / Q000209:etiology; D014481:United States; D044465:White People / Q000523:psychology