Correlates of elevated depressive symptoms among rural African American adults with type 2 diabetes.

OBJECTIVE The study objective was to examine the health-related and sociocontextual correlates of elevated depressive symptoms among rural African American adults with type 2 diabetes mellitus. DESIGN Cross sectional, observational study. SETTING Rural communities in central Georgia, United States. PARTICIPANTS African American patients with type 2 diabetes mellitus (N = 200) were recruited from eight rural counties in Georgia by using community-based procedures. METHODS Participants were assessed on demographics (age, sex, and education), diabetes-related characteristics (health status, time since diagnosis, blood glucose control problems, and hemoglobin A1C level), and psychosocial variables (financial stress, community disadvantage, community support, social support, and patient-healthcare provider relationship quality). Elevated depressive symptoms, as assessed via the Center for Epidemiologic Studies-Depression scale, constituted the dependent variable. RESULTS Elevated depressive symptoms were present in 30% of the sample. Multiple logistic analysis of the contributors to depression predicted 57% of the variability in depression. Sex, neighborhood disadvantage, health status, hyperglycemic symptoms, social support, and patient-healthcare provider relationship quality predicted depression in multivariate analyses. CONCLUSIONS Both health-related and psychosocial stressors contribute to depressive symptoms among rural African Americans. Problems in patient-healthcare provider relationships may impede identification of depressive symptoms among these patients. Providers require training and support to identify and treat depression among rural African Americans.