J Natl Med Assoc
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Depression is a common mental disorder that presents with depressed mood. It can become chronic or recurrent and lead to substantial impairment in an individual's ability to function. At this level, it is identified as major depressive disorder (MDD). ⋯ Understanding patient, physician, and treatment setting factors as contributing barriers that impede effective diagnosis and treatment of depression and MDD in African Americans is critical to effective patient management and discovery. Greater African American participation in clinical research trials also is needed to effectively improve, diagnose, and treat depression in African Americans. This article examines depression among African Americans in the context of gender, culture, and psychosocial determinants, and their engagement in clinical trials.
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Comparative Study
Racial differences in symptoms, comorbidity, and treatment for major depressive disorder among black and white adults.
Racial differences in the clinical nature of major depressive disorder (MDD) could contribute to treatment disparities, but national data with large samples are limited. Our objective was to examine black-white differences in clinical characteristics and treatment for MDD from one of the largest, national community samples of US adults. ⋯ We found few racial differences in depressive symptoms, psychiatric comorbidity, and disability after adjusting for sociodemographic factors. Blacks' lower utilization of ambulatory treatment for MDD and greater medical comorbidity, emergency department use, and hospitalization suggests that management of MDD among blacks should be emphasized in primary care or other settings where treatment is more accessible.
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Posttraumatic stress disorder (PTSD) is a common, potentially disabling, underdiagnosed, and under-treated illness. Primary care physicians assume a critical role in the diagnosis, treatment, and referral of African Americans with PTSD since mental health access is limited for this population. This study is an examination of PTSD treatment of African Americans in the primary care setting. Actual treatment provision is contrasted with existing evidence-based PTSD treatment guidelines. ⋯ Most African American adult primary care patients with PTSD were either undiagnosed or undertreated in this inner-city setting. These results demonstrate a clear need to improve screening and treatment services. Both individual (provider and patient) and system-based changes will be required to meet the demonstrated clinical need.
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The health and well-being of all individuals, independent of race, ethnicity, or gender, is a significant public health concern. Despite many improvements in the status of minority health, African American males continue to have the highest age-adjusted mortality rate of any race-sex group in the United States. Such disparities are accounted for by deaths from a number of diseases such as diabetes, human immunodeficiency virus (HIV), cancer, and cardiovascular disease, as well as by many historical and present social and cultural constructs that present as obstacles to better health outcomes. ⋯ However, African American males, across all age groups, continue to report a lack of trust as a primary reason for their unwillingness to participate in biomedical research. There is an ongoing need to continue to seek advice, improve communication, and design research studies that garner trust and improve participation among African American males as a targeted underrepresented population. Such communication and dialogues should occur at all age levels of research development to assess. current attitudes and behaviors of African American males around participation.
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Oral squamous cell carcinoma, traditionally a disease of elderly men with a history of chronic exposure to the carcinogenic effects of tobacco and alcohol, is presently being more frequently diagnosed both in a younger patient population and in those not exposed to these carcinogenic substances. At our center, most patients with oral squamous cell carcinoma are not involved in the use of tobacco or alcoholic beverages and are mainly of a low socioeconomic class. This hospital-based case-control study was designed to assess if the risk of developing intraoral squamous cell carcinoma in Ibadan, Nigeria, was associated with the use of tobacco, alcohol, or socioeconomic status. ⋯ Only 26% of patients gave a positive history of exposure to tobacco, alcohol, or both; of this number, 20.3% used tobacco, while 18.8% consumed alcohol and 13% used both. Although 24.6% of the cases were of high socioeconomic class, there was no significant difference in the distribution of oral cancer patients in the 2 socioeconomic classes. This study revealed an important deviation from expected amongst the oral squamous cell carcinoma patients diagnosed at Ibadan, thus raising the possibility of a different etiology for oral cancer in our population and the need for research focused on identifying possible risk factors.