A qualitative comparison of DSM depression criteria to language used by older church-going African-Americans^*

* Name of institution where research was conducted: University of Michigan.

ABSTRACT

Objective: Depression in late life is associated with substantial suffering, disability, suicide risk, and decreased health-related quality of life. According to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV), a depression diagnosis is derived from a constellation of symptoms that may be described differently by different people. For example, the DSM language may be inadequate in capturing these symptoms in certain populations such as African-Americans, whose rates of depression misdiagnosis is high.

Methods: This study reports the findings from a church-based, qualitative study with older African-Americans (n = 50) regarding the language they use when discussing depression and depression treatment, and how this compares to the DSM-IV depression criteria. Content analyses of the in-depth discussions with African-American male and female focus group participants resulted in a deeper understanding of the language they used to describe depression. This language was then mapped onto the DSM-IV depression criteria.

Results: While some words used by the focus group participants mapped well onto the DSM-IV criteria, some of the language did not map well, such as language describing irritability, negative thought processes, hopelessness, loneliness, loss of control, helplessness, and social isolation.

Conclusions: The focus group setting provided insight to the language used by older, church-going African-Americans to describe depression. Implications include the advantages of using qualitative data to help inform clinical encounters with older African-Americans.

KEYWORDS:

• Depression
• African-Americans
• spirituality
• DSM
• older adults

View correction statement:

Correction

Acknowledgments

The authors would like to acknowledge the following for the research, authorship, and/or publication of this article: the National Institutes of Health, 5P30 AG015281 Michigan Center for Urban African American Aging Research; the Program for Positive Aging in the Department of Psychiatry at the University of Michigan (U-M), and the U-M Depression Center's Phil Jenkins Award for Innovation in Depression Treatment.

Disclosure statement

No potential conflict of interest was reported by the authors.

Notes

* Name of institution where research was conducted: University of Michigan.

Additional information

Funding

This project was supported by the Program for Positive Aging in the Department of Psychiatry at the University of Michigan, and the original study was titled ‘Attitudes, perceptions, and beliefs pertaining to mental health, depression, and depression care of elder African-American church attendees’ (Principal Investigator: Helen Kales, MD, UM Department of Psychiatry).