Discrimination and Depressive Symptom Trajectories of Middle-aged and Older Adults with Chronic Diseases

Abstract

Depression is a serious health concern for adults who have been diagnosed with cancer or diabetes. In addition to the challenges associated with chronic disease management, perceived discrimination has been identified as a factor that increases the risk of depressive symptoms. However, empirical evidence using longitudinal data to test the association between perceived discrimination and depressive symptoms of those with cancer or diabetes is limited. Using Andersen’s Behavioral Model and the Theory of Fundamental Causes as guiding frameworks, this three-paper dissertation study presents a scoping review (Study 1) and two quantitative studies (Studies 2 and 3) to investigate the association between perceived discrimination and depressive symptoms among middle-aged and older adults with a cancer history or diabetes. In Study 1, an assessment of 23 peer-reviewed journal articles provides strong empirical evidence for statistically significant direct or indirect relationships between discrimination/stigma and depressive symptoms. In Studies 2 and 3, latent growth modeling using data from the Health and Retirement Study indicates that cancer survivors had an increasing linear trajectory of depressive symptoms and people with diabetes had a decreasing linear trajectory of depressive symptoms over a 4-year period (Study 2: 2010–2014, Study 3: 2014-2018). Findings from these studies support the need for social workers and other members of the health care team to offer tailored assessment and treatment approaches to address depressive symptoms for cancer survivors and people with diabetes, especially those who may perceive discrimination based on their race, ethnicity, socioeconomic status, culture, language, and having a medical diagnosis. Implications for future investigations are discussed.