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Influence of Cognitive Impairment, Illness, Gender, and African-American Status on Psychiatric Ratings and Staff Recognition of Depression

Received December 14, 2000; revised April 4, 2001; accepted April 16, 2001. From the Hebrew Home for the Aged at Riverdale, Riverdale, NY (JAT,DH,MR,CS,JPE), Columbia University Stroud Center and New York State Psychiatric Institute, Department of Geriatrics (JAT), the Department of Psychiatry, Weill Medical College of Cornell University (RA), and Columbia University College of Physicians and Surgeons (DH). Address correspondence to Dr. Teresi, Research Division, Hebrew Home for the Aged at Riverdale, 5901 Palisade Ave., Riverdale, NY 10471.

OBJECTIVE: The authors examined the multivariate relationships between depression recognition by staff members and characteristics of nursing home residents. METHODS: Analyses used a simple random sample of 270 residents, drawn from six randomly selected nursing homes, who were evaluated by psychiatrists for depression and depressive symptomatology. RESULTS: African Americans were generally seen by psychiatrists as having less depressive symptomatology than residents from other ethnic groups. The data suggest that nurse aides, perhaps because they see residents more often or because they are less influenced by demographic characteristics, may be the most valid source of information about residents' depression. In contrast, after partialing out the degree of depression severity, nurses tended to overrecognize depression among African-American residents. Social workers underrecognized depression among residents with cognitive impairment and/or Parkinson disease and among women, and overrecognized depression among African Americans. CONCLUSION: The results underline the need for more training in depression recognition, particularly in distinguishing social from clinical phenomena and in distinguishing symptoms of dementia from those of depression. Equally important is further investigation of the potential biases associated with diagnosis and recognition of depression among African Americans.

Key Words: Diagnostic Criteria • Depression • Demographic Factors

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