Predictors of Depression in African Americans being Treated for Cancer Pain 1 1 2 Allysa Rueschenberg, BS, BSN, RN ; Kate Yeager, RN, PhD ; Sarah Haight, BA
1Emory University, Nell Hodgson Woodruff School of Nursing; 2Emory University, Rollins School of Public Health
Methods
Background • Depressive symptoms, found in as many as 15-25% of people with cancer, can appear at diagnosis and last throughout the lifeAme of a person with cancer. • People with cancer and depressive symptoms are less likely to be adherent to medical treatment and have higher rates of mortality. • Few studies specifically examine the prevalence and predicAve factors of depressive symptoms in AA with cancer and no studies have specifically focused on individuals being treated with opiates for pain.
Purpose Aim 1: Measure the prevalence of depressive symptoms in African Americans with cancer pain. Aim 2: Explore the individual (pain , age, gender, income, symptoms) and interpersonal (social support, religious social support) factors that influence depressive symptoms.
Methods
Measures/Instruments
Dependent variable
Depressive Symptom Score: Pa#ent Health Ques#onnaire-8 (PHQ8) Range 0-24, ≥10 indicates the presence of depressive symptoms
Independent variables
Age, gender, income (self report) Symptoms: Anxiety, shortness of breath, nausea, consApaAon, wellbeing from the Edmonton Symptom Assessment Scale (scale of 1-10 with 10=worst) Pain Severity: Brief Pain Inventory: 4 items on scale of 1-10 (10=worst) Pain interference: Brief Pain Inventory: 7 items on scale of 1-10 (10=worst) Social support: MulAdimensional Scale of Perceived Social Support: 12 items with 7 answer opAons (very strongly disagree-very strongly agree), range 0-84 Religious Social Support: 4-item Mul#dimensional Measure of Religiousness/ Spirituality: 4 items with 4 answer opAons indicaAng the frequency of each item, range 0-32. QuesAons describe relaAonships with people in a religious congregaAon.
Sample
Study Design • •
Cross-secAonal descripAve correlaAve study (N=95) Secondary analysis of data from a larger study looking at opiate adherence in AA being treated for cancer pain.
•
All parAcipants resided in the 10-county greater metropolitan area of Atlanta, Georgia, USA, and were recruited from medical oncology, palliaAve care, and radiaAon oncology clinics. This study obtained IRB approval and all paAents gave informed consent.
At the compleAon of the one hour interview, parAcipants were given a $15 gig card
Eligibility ü ü ü ü ü
Reside in Atlanta metropolitan area African American by self report Cancer diagnosis Being treated for cancer pain with an around the clock opiate 21 years of age or older
Data Management and Analysis • •
Univariate analysis was used to explore the variables and gather descripAve staAsAcs. Independent variables that were significantly correlated with depressive symptom score were included in a mulA-linear regression. Independent variables that were significantly correlated with depressive symptom score (anxiety, gender, pain interference) were included in a mulAlinear regression.
Results
Demographics Age Mean Age (years) Age Range (years) Gender Female Male Income Mean income Income range Education College degree or higher High school or less Religious Preference Baptist Christian (nonspecific) No religious preference
N (%) 56.6±10.4 35-87 56 (58.9%) 39 (41.1%) $18,274 ± $12,399 $2,328 - $60,780 29 (30.5%) 42 (44.2%) 44 (46.3%) 18 (18.9%) 2 (2.1%)
Conclusions
Descriptive Statistics Depression (0-24) Anxiety (0-10) Wellbeing (0-10) Constipation (0-10) Nausea (0-10) Shortness of breath (0-10) Pain interference (0-10) Pain severity (0-10) Social support (0-84)
Mean (SD) 8.40 (5.4) 1.99 (2.81) 3.51 (2.72) 2.86 (3.28) 1.11 (2.44) 1.48 (2.48) 4.87 (3.02) 4.42 (2.29) 77.81 (7.12)
Religious support (0-32) Depressive Symptoms No Depressive Symptoms (10 PHQ8 Score)
26.28 (5.62) N (%) 59 (62.1%)
In this study, the prevalence of depressive symptoms in African Americans with cancer pain was 36.8%, higher than both the general populaAon and previous studies of this group. Pain interference, anxiety, and gender explained 34.5% of the variance in Depressive Symptom Scores. The presence of depressive symptoms in paAents with cancer may have profound effects on adherence to treatment, quality of life, and mortality. These results suggest that many AAs with cancer pain experience depressive symptoms and may experience specific challenges and barriers during the course of care. Social support and religious social support were not significantly related to depressive symptoms. Future research with more sensiAve tests is needed to determine the role of these variables.
35 (36.8%)
Increased pain interference, increased anxiety, and female gender were associated with increased depressive symptom score (F(3,90)=15.82, p