title: Racial Variation in Depression Risk Factors and Symptom Trajectories among Older Women.
abstract: To assess racial variation in depression risk factors and symptom trajectories among older women.
  
  
  
  Using Nurses' Health Study data, participants (29,483 non-Hispanic white and 288 black women) aged 60 years or older, free of depression in 2000, were followed until 2012. Data on race and risk factors, selected a priori, were obtained from biennial questionnaires. Incident depression was defined as depression diagnosis, antidepressant use, or presence of severe depressive symptoms. Group-based trajectories of depressive symptoms were determined using latent variable modeling approaches.
  
  
  
  Black participants had lower risk (hazard ratio: 0.76; 95% confidence interval: 0.57-0.99) of incident late-life depression compared with whites. Although blacks had higher prevalence than whites of some risk factors at study baseline, distributions of major contributors to late-life depression risk (low exercise, sleep difficulty, physical/functional limitation, pain) were comparable. There was evidence of effect modification by race for relations of region of birth (Southern birthplace), smoking, and medical comorbidity to depression risk; however, wide confidence intervals occurred among blacks because of smaller sample size. Four trajectories were identified: minimal symptoms-stable (58.3%), mild symptoms-worsening (31.4%), subthreshold symptoms-worsening (4.8%), and subthreshold symptoms-improving (5.5%). Probabilities of trajectory types were similar for blacks and whites.
  
  
  
  Although overall trajectories of late-life depressive symptoms were comparable by race, there was racial variation in depression risk estimates associated with less-studied factors, such as U.S. region of birth. Future work may address unmeasured health and resilience determinants that may underlie observed findings and that could inform clinical assessment of late-life depression risk factors.
authors.affiliation: Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA.
authors.forename: Shun-Chiao
authors.initials: SC
authors.lastname: Chang
authors.affiliation: Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA.
authors.forename: Wei
authors.initials: W
authors.lastname: Wang
authors.affiliation: School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China.
authors.forename: An
authors.initials: A
authors.lastname: Pan
authors.affiliation: Aging Brain Center, Hebrew SeniorLife, Institute for Aging Research, Boston, MA; Department of Psychiatry and Human Behavior, Warren Alpert Medical School, Brown University, Providence, RI.
authors.forename: Richard N
authors.initials: RN
authors.lastname: Jones
authors.affiliation: Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, Boston, MA.
authors.forename: Ichiro
authors.initials: I
authors.lastname: Kawachi
authors.affiliation: Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA; Department of Psychiatry, Brigham and Women's Hospital and Harvard Medical School, Boston, MA; Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA. Electronic address: ookereke@partners.org.
authors.forename: Olivia I
authors.initials: OI
authors.lastname: Okereke
mesh_terms: D001741:Black or African American / Q000706:statistics & numerical data*; D000368:Aged; D000928:Antidepressive Agents / Q000627:therapeutic use; D015897:Comorbidity; D003866:Depressive Disorder / Q000188:drug therapy / Q000208:ethnology* / Q000523:psychology; D018450:Disease Progression; D004522:Educational Status; D005260:Female; D054624:Health Status Disparities; D006801:Humans; D007182:Income / Q000706:statistics & numerical data; D000067562:Late Onset Disorders / Q000188:drug therapy / Q000208:ethnology / Q000523:psychology; D008875:Middle Aged; D009765:Obesity / Q000453:epidemiology; D015995:Prevalence; D016016:Proportional Hazards Models; D012111:Residence Characteristics / Q000706:statistics & numerical data; D012307:Risk Factors; D012944:Social Support; D044465:White People / Q000706:statistics & numerical data*
chemical_list: D000928:Antidepressive Agents
keywords: depression; epidemiology; geriatric; longitudinal; mood; race; trajectory