Racial differences on association of depressive symptoms with combined basic and instrumental activities of daily living

J Gerontol A Biol Sci Med Sci. 2014 Feb;69(2):215-22. doi: 10.1093/gerona/glt074. Epub 2013 May 30.


Background: Depressive symptoms are predictive of multiple degenerative diseases in older age adults. However, the association of depressive symptoms with onset and progression of disability have not been studied.

Methods: In a cohort of community-dwelling, older black and white adults, 5,446 initially nondisabled subjects were followed annually for disability between 2000 and 2008. Depressive symptoms were assessed at baseline using a summary measure of 10-item version of the Center for Epidemiologic Survey-Depressive symptoms scale. The disability outcome was based on a summary measure of 13 basic and instrumental activities of daily living, and analyzed using a two-part regression model for onset and progression of disability.

Results: During follow-up, 44% of blacks and 35% of whites reported onset of disability. After adjusting for confounders, depressive symptoms were associated with increased odds of disability onset in blacks (odds ratio = 1.12, 95% confidence interval, 1.07-1.18) and whites (odds ratio = 1.21, 95% confidence interval, 1.08-1.36). The odds of disability onset associated with depressive symptoms also increased significantly over time in whites (odds ratio = 1.06, 95% confidence interval, 1.04-1.09), but not in blacks. In addition, depressive symptoms were associated with an increasing rate of progression of disability in whites (rate ratio = 1.08, 95% confidence interval, 1.06-1.09), but not in blacks.

Conclusions: Depressive symptoms increased the risk of onset of disability in blacks and whites. This risk tended to increase over time only among whites. A similar race-specific pattern was observed for time-dependent changes due to depressive symptoms in the rate of progression in disability after onset.

Keywords: Activities of daily living; Depressive symptoms.; Instrumental activities of daily living; Onset of disability; Progression of disability; Racial/Ethnic differences.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Activities of Daily Living / psychology*
  • African Americans / psychology*
  • Age of Onset
  • Aged
  • Aged, 80 and over
  • Cohort Studies
  • Depression / ethnology*
  • Disability Evaluation
  • Disease Progression
  • Female
  • Health Status Disparities*
  • Humans
  • Male
  • Socioeconomic Factors
  • Whites / psychology*