Influence of cognitive impairment, illness, gender, and African-American status on psychiatric ratings and staff recognition of depression

Objective: The authors examined the multivariate relationships between depression recognition by staff members and characteristics of nursing home residents. Methods: Analyses used a simple random sample of 270 residents, drawn from six randomly selected nursing homes, who were evaluated by psychiatrists for depression and depression symptomatology. Results: African Americans were generally seen by psychiatrists as having less depressing symptomatology than residents from other ethnic groups. The data suggest that nurse aides, perhaps because they see residents more often or because they are less influenced by demographic characteristics, may be the most valid sources of information about residents depression. In contrast, after partialing out the degree of depression severity, nurses tended to over-recognize depression among African-American residents. Social workers under-recognized depression among residents with cognitive impairment and/or Parkinson disease and among women, and over-recogized depression among African Americans. Conclusion: The results underline the need for more training in depression recognition, particularly in distinguishing social from clinical phenomena and in distinguishing symptoms of dementia from those of depression. Equally important is further investigation of the potential biases associated with diagnosis and recognition of depression among African Americans.