Depressive Symptoms, Alcohol Use, and Diabetes Risk among Older Foreignborn and USborn Mexican Ameri

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Depressive Symptoms, Alcohol Use, and Diabetes
Risk among Older Foreign-born and US-born Mexican
Americans

• Kai McKeever Bullard, PhD1
• Mary N. Haan, DrPH PhD2
• Harold W. Neighbors, PhD2
• Sandro Galea, MD PhD2
• Debashis Ghosh, PhD2

1Division of Diabetes Translation, CDC - Atlanta,
GA 2University of Michigan School of Public
Health - Ann Arbor, MI
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CDC Disclaimer

• The findings and conclusions in this report are
  those of the authors and do not necessarily
  represent the views of the Centers for Disease
  Control and Prevention.

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BACKGROUND

• Depressive symptoms and diabetes are common among
  older Mexican adults 1 in 4 have significant
  levels of depressive symptoms and 1 in 3 have
  diabetes
• Symptoms of depression are more common among
  older foreign-born Mexican Americans compared to
  their US-born counterparts.

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BACKGROUND

• Adapting to a new culture or coping with two
  cultures simultaneously is stressful
• This may increase behavioral risk factors for
  diabetes, such as alcohol consumption
• Foreign-born and US-born Mexican Americans may
  have different coping mechanisms that may
  influence their diabetes risk

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RESEARCH QUESTIONS

• Are depressive symptoms positively associated
  with increased incidence of Type 2 diabetes among
  both older foreign-born Mexican Americans and
  US-born Mexican Americans?
• Does alcohol consumption modify this association?

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METHODS
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Sacramento Area Latino Study on Aging (SALSA)
- Population-based cohort study of 1,789 Latino
residents of Sacramento, California -
Representative sample of Latino residents age gt
60 years in 1998
Subsample (n1,160) - Individuals without
diabetes at baseline - 625 Foreign-born 535
US-born
Diabetes Baseline fasting plasma glucose lt 126
mg/dL, no history of diagnosed diabetes and, not
taking diabetes medication)
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METHODS Data Collection

• Sacramento Area Latino Study on Aging (SALSA)
• Home interviews were administered in English and
  Spanish at baseline and follow-up
• Survey (demographics, depressive symptom survey,
  medical history)
• Clinical assessment (blood draw, body
  measurement)
• Laboratory assay (blood glucose, liver enzymes,
  CRP)
• Follow-up through 2007 (annual home interviews
  6-month telephone interviews)

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METHODS - Measures

• Depressive symptom assessment
• The Centers for Epidemiologic Studies Depression
  (CES-D) Scale
• CES-D is valid and reliable in Spanish-speaking
  populations and elderly Mexican Americans
• High depressive symptoms CES-D score 16

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METHODS - Measures

• Incident diabetes defined as
• Self-report of physicians diagnosis of diabetes
  or,
• Fasting plasma glucose 126 mg/dL or,
• Use of diabetes medication or,
• Diabetes listed anywhere on death certificate

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METHODS - Analysis

• Cox proportional hazards models to estimate the
  association between depressive symptoms at
  baseline and incident diabetes
• Performed models for foreign-born and US-born
  separately
• Controlled for effect modification by alcohol
  consumption
• Adjusted for age, sex, marital status, education,
  income, and physical activity

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RESULTS
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Characteristics of 625 foreign-born Mexican
Americans age 60 years by CES-D

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Hazard ratios for the association between
depressive symptoms and incident diabetes among
foreign-born Mexican Americans age 60 years
Model 1 ß1 (CES-D) Model 2 ß1 (CES-D) ß2
(Age) ß3 (Sex) ß4 (Education) ß5 (Marital
Status) ß6 (Income) ß7 (Physical Activity)
Model 3 Model 2 CRP
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Hazard ratios for depressive symptoms predicting
incident diabetes among foreign-born Mexican
Americans age 60 years (n625)
Covariates Age, sex, education, income, marital
status, physical activity
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Characteristics of 535 US-born Mexican Americans
age 60 years by CES-D

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Hazard ratios for the association between
depressive symptoms and incident diabetes among
US-born Mexican Americans age 60 years
Covariates Age, sex, education, income, marital
status, physical activity
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Hazard ratios for depressive symptoms predicting
incident diabetes among US-born Mexican Americans
age 60 years (n535)
Covariates Age, sex, education, income, marital
status, physical activity
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SUMMARY

• Among older foreign-born Mexican Americans
• High depressive symptoms are associated with a
  58 increase in the incidence of diabetes.
• This association was partially explained by
  sociodemographic, behavioral, and clinical
  factors.
• Ever drinkers with high depressive symptoms had a
  2-fold increased risk of diabetes compared to
  those with lower depressive symptoms.

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SUMMARY

• Among US-born Mexican Americans
• High depressive symptoms were not associated with
  incident diabetes.
• This finding may be due to limited power because
  of the relatively small number of people with
  high depressive symptoms

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Public Health Implications

• Assessment of older Mexican Americans,
  particularly the foreign-born, to identify
  depressive symptoms
• Older foreign-born Mexican Americans with high
  depressive symptoms are a high risk population
  for developing diabetes
• Alcohol consumption in association with high
  depressive symptoms in older Mexican Americans is
  of particular concern

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Public Health Implications

• Results of this study may not be generalizable to
  the wider older Mexican American population or
  other racial/ethnic groups
• Therefore, this study needs to be replicated in a
  more representative sample of the US population

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Thank You
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LIMITATIONS

• Generalizability may be limited to only older
  Mexican Americans
• Self-reported depressive symptoms
• Self-reported alcohol use
• Attrition
• Individuals who did not complete the study were
  more likely to have higher levels of symptom
  severity, which would most likely lead to an
  underestimation in the effect of depressive
  symptoms on diabetes incidence
• Accounted for attrition due to death by using a
  competing risks modeling approach