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Original Investigation
February 10, 2021

Evaluating Depressive Symptoms Among Low-Socioeconomic-Status African American Women Aged 40 to 75 Years With Uncontrolled Hypertension: A Secondary Analysis of a Randomized Clinical Trial

Author Affiliations
  • 1Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
  • 2Howard University College of Medicine, Washington, DC
  • 3Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public, Baltimore, Maryland
  • 4University of Maryland Global Campus (UMGC)
  • 5Johns Hopkins Center for Health Disparities Solutions, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
  • 6American Institutes for Research, Washington, DC
  • 7Department of Psychology, University of Rhode Island, Kingston, Rhode Island
  • 8Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
  • 9Division of General Internal Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland
  • 10The Gaston and Porter Health Improvement Center Inc, Washington, DC
  • 11Baraka and Associates, Largo, Maryland
JAMA Psychiatry. Published online February 10, 2021. doi:10.1001/jamapsychiatry.2020.4622
Key Points

Question  What is the prevalence of depressive symptoms among African American women with uncontrolled hypertension who use a federally qualified health center as their medical home?

Findings  In this secondary analysis of a randomized clinical trial, 57.0% of the participants scored 10 or greater on the 10-item Center for Epidemiological Studies Depression Scale Revised score. Women with less than a high school diploma and women who smoked with chronic health conditions had a higher prevalence of depressive symptoms.

Meaning  Health care clinicians serving low-income, midlife African American women with hypertension should screen for depressive symptoms and provide and/or refer patients to adequate mental health services.


Importance  Depression is one of the leading causes of disability in the United States. African American women of low socioeconomic status with uncontrolled hypertension are at risk of having severe depressive symptoms, yet there is limited research about the mental health of this vulnerable population. Data from the Prime Time Sister Circles randomized clinical trial (PTSC-RCT) study can shed light on the prevalence of depressive symptoms among low-socioeconomic-status older African American women with hypertension.

Objective  To determine the prevalence of depressive symptoms among low-socioeconomic-status African American women aged 40 to 75 years with uncontrolled hypertension who receive their care from a federally qualified health center (FQHC) and to identify risk factors associated with depressive symptoms.

Design, Setting, and Participants  Cross-sectional analysis of data from the PTSC-RCT of depressive symptomology, measured using an adapted version of the 10-item Center for Epidemiological Studies Depression Scale Revised (CES-D-10). Descriptive statistics were used to characterize the study population. We used logistic regression models to investigate the factors associated with participants with or without symptoms of depression. We used baseline data from the PTSC-RCT study, including 316 African American English-speaking women between ages 40 and 75 years with hypertension (systolic blood pressure ≥140 mm Hg or diastolic ≥90 mm Hg), who received their primary care at a FQHC in Washington, DC, in 2017 and 2018 and were flagged by the FQHC as uncontrolled.

Main Outcomes and Measures  We used the CES-D-10 from the Center for Epidemiologic Studies Depression Scale to measure presence of depressive symptoms.

Results  A total of 57.0% of the women in the study (180 of 316) scored greater than or equal to 10 on the CES-D-10. Depressive symptoms had a negative association with a postsecondary education (adjusted odds ratio [aOR], 0.492; 95% CI, 0.249-0.968) and a positive association with the number of chronic conditions (aOR, 1.235; 95% CI, 1.046-1.460) and smoking (aOR, 1.731; 95% CI, 1.039-2.881).

Conclusions and Relevance  In this study of low-income African American women with uncontrolled hypertension, more than half had symptoms of depression that was associated with less than high-school education, chronic conditions, and smoking. Low-income African American women with uncontrolled hypertension should be screened and adequately treated for depressive symptoms.

Trial Registration  ClinicalTrials.gov Identifier: NCT04371614

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