Psychosocial Predictors of Depression Among Older African American Patients With Cancer

Jill B. Hamilton

Allison M. Deal

Angelo D. Moore

Nakia C. Best

Kayoll V. Galbraith

Hyman Muss

psychosocial, depression, African American, aged
ONF 2013, 40(4), 394-402. DOI: 10.1188/13.ONF.394-402

Purpose/Objectives: To determine whether psychosocial factors predict depression among older African American patients with cancer.

Design: A descriptive correlational study.

Setting: Outpatient oncology clinic of a National Cancer Institute-designated cancer center in the southeastern United States.

Sample: African American patients with cancer aged 50-88 years.

Methods: Fisher's exact and Wilcoxon rank-sum tests were used to evaluate differences between patients who were possibly depressed (Geriatric Depression Scale) or not. Multivariate linear regression statistics were used to identify the psychosocial factors that predicted higher depression scores. Education and gender were included as covariates.

Main Research Variables: Religiosity, emotional support, collectivism, perceived stigma, and depression.

Findings: Participants (N = 77) had a mean age of 61 years (SD = 8.4), and a majority were well-educated, insured, religiously affiliated, and currently in treatment. Participants who were in the lowest income category, not married, or male had higher depression scores. The multivariable model consisting of organized religion, emotional support, collectivism, education, and gender explained 52% (adjusted R2) of the variation in depression scores. Stigma became insignificant in the multivariable model.

Conclusions: Psychosocial factors are important predictors of depression. Emotional support and organized religious activities may represent protective factors against depression, whereas collectivism may increase their risk.

Implications for Nursing: Nurses need to be particularly aware of the potential psychological strain for patients with collectivist values, experienced stigma, disruptions in church attendance, and lack of emotional support. In addition, the treatment plans for these patients should ensure that family members are knowledgeable about cancer, its treatment, and side effects so they are empowered to meet support needs.

Knowledge Translation: Among older African American patients with cancer, emotional support and reassurance from family and friends that they will not abandon them decreases the likelihood of depressive symptoms and minimizes the impact of stigmatizing responses, but the perception that the illness is placing a strain on the family increases the likelihood of such symptoms. Emotional support likely is a stronger predictor of depressive symptoms than religious service attendance.

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    Adler, N. E., & Page, A. E. K. (Eds.). (2008). Cancer care for the whole patient: Meeting psychosocial health needs. Washington, DC: National Academies Press.
    Agarwal, M., Hamilton, J. B., Moore, C. E., & Crandell, J. L. (2010). Predictors of depression among older African American cancer patients. Cancer Nursing, 33, 156-163. doi:10.1097/NCC.0b013e3181bdef76
    Akincigil, A., Olfson, M., Walkup, J. T., Siegel, M. J., Kalay, E., Amin, S., … Crystal, S. (2011). Diagnosis and treatment of depression in older community-dwelling adults: 1992-2005. Journal of the American Geriatric Society, 59, 1042-1051. doi:10.1111/j.1532-5415.2011.03447.x
    Almeida, J., Molnar, B. E., Kawachi, I., & Subramanian, S. V. (2009). Ethnicity and nativity status as determinants of perceived social support: Testing the concept of familism. Social Science and Medicine, 68, 1852-1858. doi:10.1016/j.socscimed.2009.02.029
    Billingsley, A. (1992). Climbing Jacob's ladder: The enduring legacy of African-American families. New York, NY: Simon and Schuster.
    Block, S. D. (2010). Diagnosis and treatment of depression in patients with advanced illness. Social Psychiatry and Psychiatric Epidemology, 19, 103-109.
    Boyd, C. A., Benarroch-Gampel, J., Sheffield, K. M., Han, Y., Kuo, Y. F., & Riall, T. S. (2012). The effect of depression on stage at diagnosis, treatment, and survival in pancreatic adenocarcinoma. Surgery, 152, 403-413. doi:10.1016/j.surg.2012.06.010
    Bradshaw, M., & Ellison, C. G. (2010). Financial hardship and psychological distress: Exploring the buffering effects of religion. Social Science and Medicine, 71, 196-204.
    Burki, T. (2010). Cancer and cultural differences. Lancet Oncology, 11, 1125-1126. doi:10.1016/S1470-2045(10)70286-2
    Carlton-LaNey, I. (1992). Elderly Black farm women: A population at risk. Social Work, 37, 517-523.
    Chatters, L. M., Levin, J. S., & Taylor, R. J. (1992). Antecedents and dimensions of religious involvement among older Black adults. Journal of Gerontology, 47, S269-S278. doi:10.1093/geronj/47.6.S269
    Chen, M. L., Chen, M. C., & Yu, C. T. (2011). Depressive symptoms during the first chemotherapy cycle predict mortality in patients with advanced non-small cell lung cancer. Supportive Care in Cancer, 19, 1705-1711. doi:10.1007/s00520-010-1005-8
    Chu, L. C. (2012). The effects of cultural values on mental health among the Taiwanese people: Mediating of attitudes toward emotional expression. Asia-Pacific Journal of Public Health. Advance online publication. doi:10.1177/1010539512443975
    Deimling, G. T., Wagner, L. J., Bowman, K. F., Sterns, S., Kercher, K., & Kahana, B. (2006). Coping among older-adult, long-term cancer survivors. Psycho-Oncology, 15, 143-159. doi:10.1002/pon.931
    DeJesus, S. A., Diaz, V. A., Gonsalves, W. C., & Carek, P. J. (2011). Identification and treatment of depression in minority populations. International Journal of Psychiatry in Medicine, 42(1), 69-83. doi:10.2190/PM.42.1.e
    Else-Quest, N. M., LoConte, N. K., Schiller, J. H., & Hyde, J. S. (2009). Perceived stigma, self-blame, and adjustment among lung, breast and prostate cancer patients. Psychology and Health, 24, 949-964. doi:10.1080/08870440802074664
    Fann, J. R., Fan, M. Y., & Unützer, J. (2009). Improving primary care for older adults with cancer and depression. Journal of General Internal Medicine, 24(Suppl. 2), S417-S424. doi:10.1007/s11606-009-0999-4
    Gonzalez, B. D., & Jacobsen, P. B. (2012). Depression in lung cancer patients: The role of perceived stigma. Psycho-Oncology, 21, 239-246. doi:10.1002/pon.1882
    Graca Pereira, M., Figueiredo, A. P., & Fincham, F. D. (2012). Anxiety, depression, traumatic stress and quality of life in colorectal cancer after different treatments: A study with Portuguese patients and their partners. European Journal of Oncology Nursing, 16, 227-232. doi:10.1016/j.ejon.2011.06.006
    Gullatte, M. M., Phillips, J. M., & Gibson, L. M. (2006). Factors associated with delays in screening of self-detected breast changes in African-American women. Journal of National Black Nurses' Association, 17(1), 45-50.
    Gutman, H. G. (1974). The black family in slavery and freedom: 1750-1925. New York, NY: Vintage.
    Hamilton, J. B., Crandell, J. L., Carter, J. K., & Lynn, M. R. (2010). Reliability and validity of the perspectives of Support From God Scale. Nursing Research, 59, 102-109.
    Hamilton, J. B., Moore, C. E., Powe, B. D., Agarwal, M., & Martin, P. (2010). Perceptions of support among older African American cancer survivors. Oncology Nursing Forum, 37, 484-493. doi:10.1188/10.ONF.484-493
    Hamilton, J. B., Stewart, B. J., Crandell, J. L., & Lynn, M. R. (2009). Development of the Ways of Helping Questionnaire: A measure of preferred coping strategies for older African American cancer survivors. Research in Nursing and Health, 32, 243-259. doi:10.1002/nur.20321
    Heiney, S. P., Hazlett, L. J., Weinrich, S. P., Wells, L. M., Adams, S. A., Underwood, S. M., & Parrish, R. S. (2011). Antecedents and mediators of community connection in African American women with breast cancer. Research and Theory for Nursing Practice, 25, 252-270. doi:10.1891/1541-6577.25.4.252
    Holt, C. L., Caplan, L., Schulz, E., Blake, V., Southward, P., Buckner, A., & Lawrence, H. (2009). Role of religion in cancer coping among African Americans: A qualitative examination. Journal of Psychosocial Oncology, 27, 248-273. doi:10.1080/07347330902776028
    Jones, J. (1995). Labor of love, labor of sorrow. New York, NY: Vintage.
    Kagawa-Singer, M., Dadia, A. V., Yu, M. C., & Surbone, A. (2010). Cancer, culture, and health disparities: Time to chart a new course? CA: A Cancer Journal for Clinicians, 60, 12-39. doi:10.3322/caac.20051
    Kane, K. D., Yochim, B. P., & Lichtenberg, P. A. (2010). Depressive symptoms and cognitive impairment predict all-cause mortality in long-term care residents. Psychology and Aging, 25, 446-452. doi:10.1037/a0019032
    Kleiboer, A., Bennett, F., Hodges, L., Walker, J., Thekkumpurath, P., & Sharpe, M. (2011). The problems reported by cancer patients with major depression. Psycho-Oncology, 20, 62-68. doi:10.1002/pon.1708
    Koenig, H. G., King, D. E., & Carson, V. B. (2012). Handbook of religion and health. New York, NY: Oxford University Press.
    Kroenke, K., Theobald, D., Wu, J., Loza, J. K., Carpenter, J. S., & Tu, W. (2010). The association of depression and pain with health-related quality of life, disability, and health care use in cancer patients. Journal of Pain Symptom Management, 40, 327-341. doi:10.1016/j.jpainsymman.2009.12.023
    Lawler-Row, K. A., & Elliott, J. (2009). The role of religious activity and spirituality in the health and well-being of older adults. Journal of Health Psychology, 14(1), 43-52. doi:10.1177/1359105308097944
    Lebel, S., Castonguay, M., Mackness, G., Irish, J., Bezjak, A., & Devins, G. M. (2011). The psychosocial impact of stigma in people with head and neck or lung cancer. Psycho-Oncology, 22, 140-152.
    Lo, C., Zimmermann, C., Rydall, A., Walsh, A., Jones, J. M., Moore, M. J., … Rodin, G. (2010). Longitudinal study of depressive symptoms in patients with metastatic gastrointestinal and lung cancer. Journal of Clinical Oncology, 28, 3084-3089. doi:10.1200/JCO.2009.26.9712
    LoConte, N. K., Else-Quest, N. M., Eickhoff, J., Hyde, J., & Schiller, J. H. (2008). Assessment of guilt and shame in patients with non-small-cell lung cancer compared with patients with breast and prostate cancer. Clinical Lung Cancer, 9, 171-178. doi:10.3816/CLC.2008.n.026
    Lukwago, S. N., Kreuter, M. W., Bucholtz, D. C., Holt, C. L., & Clark, E. M. (2001). Development and validation of brief scales to measure collectivism, religiosity, racial pride, and time orientation in urban African American women. Family and Community Health, 24(3), 63-71.
    Mbiti, J. S. (1999). African religions and philosophy. Portsmouth, NH: Heinemann.
    Mills, T. L., Lichtenberg, P. A., Wakeman, M. A., & Scott-Okafor, H. (2002). Correlates of rehabilitation hospital length of stay among older African-American patients. Journal of the National Medical Association, 94, 846-855.
    Nelson, C. J., Weinberger, M. I., Balk, E., Holland, J., Breitbart, W., & Roth, A. J. (2009). The chronology of distress, anxiety, and depression in older prostate cancer patients. Oncologist, 14, 891-899. doi:10.1634/theoncologist.2009-0059
    Perkins, E. A., Small, B. J., Balducci, L., Extermann, M., Robb, C., & Haley, W. E. (2007). Individual differences in well-being in older breast cancer survivors. Critical Reviews in Oncololgy/Hematology, 62(1), 74-83. doi:10.1016/j.critrevonc.2006.11.002
    Phelan, S. M., Griffin, J. M., Jackson, G. L., Zafar, S. Y., Hellerstedt, W., Stahre, M., … van Ryn, M. (2013). Stigma, perceived blame, self-blame, and depressive symptoms in men with colorectal cancer. Psycho-Oncology, 22, 65-73. doi:10.1002/pon.2048
    Poussaint, A. F., & Alexander, A. (2000). Lay my burden down: Unraveling suicide and the mental health crisis among African Americans. Boston, MA: Beacon Press.
    Raboteau, A. J. (2001). Canaan land. New York, NY: Oxford University Press.
    Reese, A. M., Thorpe, R. J., Jr., Bell, C. N., Bowie, J. V., & LaVeist, T. A. (2012). The effect of religious service attendance on race differences in depression: Findings from the EHDIC-SWB study. Journal of Urban Health, 89, 510-518. doi:10.1007/s11524-011-9659-1
    Reyes-Gibby, C. C., Anderson, K. O., Morrow, P. K., Shete, S., & Hassan, S. (2012). Depressive symptoms and health-related quality of life in breast cancer survivors. Journal of Women's Health, 21, 311-318. doi:10.1089/jwh.2011.2852
    Sahgal, N., & Smith, G. (2009). The Pew Forum on Religion and Public Life: A religious portrait of African-Americans. Retrieved from
    Sayles, J. N., Hays, R. D., Sarkisian, C. A., Mahajan, A. P., Spritzer, K. L., & Cunningham, W. E. (2008). Development and psychometric assessment of a multidimensional measure of internalized HIV stigma in a sample of HIV-positive adults. AIDS and Behavior, 12, 748-758. doi:10.1007/s10461-008-9375-3
    Stack, C. (1974). All our kin: Strategies for survival in a Black community. New York, NY: Harper and Row.
    Swinney, J. E., & Dobal, M. T. (2011). Older African American women's beliefs, attitudes, and behaviors about breast cancer. Research in Gerontological Nursing, 4(1), 9-18. doi:10.3928/19404921-20101207-01
    Taylor, R. J., Chatters, L. M., & Levin, J. (2004). Religion in the lives of African Americans. Social, psychological, and heatlh perspectives. Thousand Oaks, CA: Sage.
    Tsigaroppoulos, T., Mazaris, E., Chatzidarellis, E., Skolarikos, A., Varkarakis, I., & Deliveliotis, C. (2009). Problems faced by relatives caring for cancer patients at home. International Journal of Nursing Practice, 15(1), 1-6. doi:10.1111/j.1440-172X.2008.01725.x
    U. S. Census Bureau. (2010). The Black alone population in the United States: 2010. Retrieved from
    van Olphen, J., Schulz, A., Israel, B., Chatters, L., Klem, L., Parker, E., & Williams, D. (2003). Religious involvement, social support, and health among African-American women on the east side of Detroit. Journal of General Internal Medicine, 18, 549-557. doi:10.1046/j.1525-1497.2003.21031.x
    Wells, A. A., Palinkas, L. A., Qiu, X., & Ell, K. (2011). Cancer patients' perspectives on discontinuing depression treatment: The "drop out" phenomenon. Patient Preference and Adherence, 5, 465-470. doi:10.2147/ppa.s24544
    White, D. G. (1985). Ar'n't I a woman? New York, NY: W. W. Norton.
    Wray, R. J., McClure, S., Vijaykumar, S., Smith, C., Ivy, A., Jupka, K., & Hess, R. (2009). Changing the conversation about prostate cancer among African Americans: Results of formative research. Ethnicity and Health, 14(1), 27-43. doi:10.1080/13557850802056448
    Yesavage, J. A., Brink, T. L., Rose, T. L., Lum, O., Huang, V., Adey, M., & Leirer, V. O. (1982). Development and validation of a geriatric depression screening scale: A preliminary report. Journal of Psychiatric Research, 17(1), 37-49. doi:10.1016/0022-3956(82)90033-4
    Yoo, G. J., Aviv, C., Levine, E. G., Ewing, C., & Au, A. (2010). Emotion work: Disclosing cancer. Supportive Care in Cancer, 18, 205-215. doi:10.1007/s00520-009-0646-y
    Zhang, A. Y., Gary, F., & Zhu, H. (2012). What precipitates depression in African-American cancer patients? Triggers and stressors. Palliative and Supportive Care, 1-8. doi:10.1017/s1478951511000861