Psychiatric Epidemiology: Racial Disparities among Vulnerable Populations with De

描述(由申请人提供摘要)：人们对降低非裔美国人患抑郁症和糖尿病共病风险的保护性因素知之甚少。特别是，在非裔美国人中，服务使用和降低风险之间的联系从未通过具有全国代表性的样本得到证明，特别是考虑到种族差异的样本。缺乏对非裔美国人抑郁症和糖尿病共病研究的主要原因是现有数据集中的美国黑人样本相当少，可以从中得出有意义的结论。拟议的研究计划旨在全面检查社会经济地位(SES)以及已知的风险和保护因素是否与抑郁症和糖尿病共病风险的降低相关，并特别关注具有全国代表性的5191名非裔美国人和加勒比黑人样本中的低收入人群。公共卫生的意义在于明确哪些人口因素与较低的合并症风险有关，这将为后续的卫生社会服务预防干预措施和战略提供信息。目前的研究计划旨在增进对非裔美国人抑郁和糖尿病共病文献的认识，并对文献作出五项重要贡献，即：(1)利用具有全国代表性的大型数据集--美国全国生活调查[NSAL]的优势；(2)确定自闭症是否与黑人所研究的并存疾病的风险降低有关；(3)考察医疗保险状况对自闭症与抑郁和糖尿病共病之间关系的中介作用；(4)调查共病状态对福利受助者就业结果的相对影响；以及(5)描述被诊断为患有疾病并与之并存的医疗保健管理的文化意义。使用的数据分析方法包括Logistic回归、多名义Logistic回归和定性主题分析技术。项目叙述抑郁症和糖尿病并存被认为是一种对医疗保健系统来说代价高昂的疾病，是公共卫生关注的一个重要话题。值得注意的是，很少有调查关注患有这种并存疾病的非裔美国人使用服务和降低风险之间的联系。此外，还没有研究表明与具有全国代表性的非裔美国人样本之间存在不同的联系，特别是在这项研究之前，还没有考虑到种族差异的样本。卫生局局长的报告(2001)《精神健康：文化、种族和民族--精神健康的补充》强调了理解黑人共病的保护和风险因素，作为紧急公共卫生研究的优先事项

DESCRIPTION (Abstract Provided by Applicant): Remarkably little is known about protective factors that reduce African Americans' risk for depression and diabetes comorbidity. In particular, the link between service use and risk reduction in African Americans has never been demonstrated with a nationally representative sample, particularly one that also takes into account ethnic groups' differences. The lack of research on depression and diabetes comorbidity research among African Americans is due primarily to rather small samples of Black Americans in available data sets from which to draw meaningful conclusions. The proposed research plan aims to provide a comprehensive examination of whether socioeconomic status (SES) and known risk and protective factors are correlated with reductions in the risk for comorbid depression and diabetes with special attention to low income populations in a nationally representative sample of 5,191 African Americans and Caribbean Blacks. The public health significance lies in specifying which demographic factors related to lower comorbidity risk, which will inform subsequent health social service prevention interventions and strategies. The present study plan is designed to advance knowledge and make five important contributions to the literature on depression and diabetes comorbidity among African Americans, namely by: (1) capitalizing on the strengths of a large, nationally representative data set, the National Survey of American Life [NSAL]; (2) determining whether SES is associated with reductions in the risk for the studied comorbid condition by Blacks; (3) examining the mediation effects of health insurance status on the relationship between SES and comorbid depression and diabetes conditions; (4) investigating the relative effects of comorbid status on employment outcomes for welfare recipients; and (5) describing the cultural meaning of being diagnosed with and managing health care with a comorbid diagnosis. The data analytic approaches to be used include logistic regression, multi-nominal logistic regression, and qualitative theme analyses techniques. Project Narrative Comorbid depression and diabetes is recognized as a condition that is costly to the health care system and is a vital topic of public health concern. Remarkably, few investigations focus on the link between service use and risk reduction in African Americans with this comorbid condition. Moreover, no studies have demonstrated variable linkages with a nationally representative African American sample, particularly one that also takes into account ethnic groups' differences until this one. The Surgeon General's report (2001), "Mental Health: Culture, Race, and Ethnicity - A supplement to mental health," highlighted understanding the protective and risk factors for comorbid conditions among Blacks, as an emergent public health research priority