Bidirectional associations between chronic medical conditions, disability, and depressive symptoms over 25 years: Black- White differences

Background and aims: Blacks have a higher rate of chronic medical conditions (CMC), disability, and depressive symptoms compared to Whites. The present study compared Blacks and Whites for bidirectional associations between CMC, disability, and depressive symptoms over a 25-year period. Methods: Data came from all five waves (1986, 1989, 1994, 2001, and 2011) of the Americans’ Changing Lives Study (ACL). This study followed 3,497 Whites and Blacks for up to 25 years. Number of CMC, disability, and depressive symptoms [Center for Epidemiological Studies-Depression (CES-D)] were measured at all waves. Multi-group crossed lag modeling was used to test four models, where race defined the groups. Results: Based on Models 1 and Model 2, cross-sectional associations between CMC and depressive symptoms at 1989, 2001, and 2011 were significant among Whites but not Blacks. Based on Model 3, lagged effect of CMC in 2001 on depressive symptoms in 2011 was only significant for Whites. Based on Model 4, cross-sectional associations between disability and depressive symptoms in 1989 were found among Whites but not Blacks. Conclusion: Compared to Whites, Blacks show fewer cross-sectional and longitudinal associations between CMC, disability, and depressive symptoms over time. These findings are robust, regardless of whether we conceptualize disability or depressive symptoms as the outcome.