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					G. DEPRESSION AND MEDICAL HEALTH COMPLAINTS                                        IN A   GROUP

                                                            Sharifa Aboumediene, MD; Mohamed Farrag, PhD, LP;
                                                                                          Mona Dakroub, AS

                                          INTRODUCTION                                    The national background information
                                                                                          for 10% of the subjects was unknown.
                                              Published research on the mental            Approximately 16% of the sample in-
                                          health of Arab Americans is rare. Pre-          cluded small numbers from other Arab
                                          vious research shows that depression was        countries (eg, Palestine, Egypt, Sudan,
                                          the most common problem among                   and Algeria).
                                          Arab-American mental health clients,1 a
                                          finding that is consistent with published        Measures
                                          epidemiological research. Depression                The study used the following mea-
                                          has become the leading cause of dis-            sures:
                                          ability in the United States and Europe.        —The HSCL-25 Depression Scale (Ar-
                                          It increases the risks of heart attacks and     abic version) that has 15 items5 proved
                                          is a frequent serious complicating factor       to be very helpful in assessing depression
                                          in stroke, diabetes, and cancer.2 A re-         among Arab Americans. This scale was
                                          cently published review of research on          found to be a sensitive case-finder of any
                                          the relationship between depression and         depressive disorder in elderly people; re-
                                          risk for coronary artery disease conclud-       search has indicated the validity of the
                                          ed that there is substantial evidence for       scale.6 The Cronbach Alpha reliability
                                          a relationship between depression and           of the depression scale was .92.
                                          adverse clinical outcomes. 3 Another            —A self-report checklist of health prob-
                                          study found that self-reports of depres-        lems.
                                          sive symptoms were greater among in-
                                          dividuals who also reported digestive
                                          system disorders, respiratory problems,         RESULTS
                                          and heart problems.4 The current study
                                          explored the relationships between de-              Table 1 shows that there were sig-
                                          pressive manifestations and physical or         nificant differences on the depression
                                          medical complaints in a group of Arab-          scale between women who have diag-
                                          American women.                                 nosed medical problems and women
                                                                                          who do not have medical problems.
                                                                                          These problems included heart disease,
                                          METHODS                                         fatigue, headaches, weight gain, and ap-
                                                                                          pitite and sleep irregularities.
                                          Study Participants
                                              The study included 100 Arab-Amer-
                                          ican women who came to ACCESS for               DISCUSSION
                                          different services. They consented to
                                          participate in the study after receiving            The results of this study showed sig-
                                          an explanation that non-participation           nificant differences between women
                                          would not have any negative conse-              with or without physical complaints.
                                          quences. Participants’ ages ranged from         These findings are consistent with re-
                                          18 to 70 years, with a mean of 34.94            search on the role of depression in the
   From the Arab Community Center for     and a standard deviation of 11.86. In           incidence, and negative effects on med-
Economic and Social Services, Dearborn,   the sample, 46% were from Lebanon,              ical problems. Recent research found
Michigan.                                 14% from Iraq, and 14% from Yemen.              depressed individuals appear to have in-

S1-106                                     Ethnicity & Disease, Volume 15, Winter 2005
                                                                                            MENTAL HEALTH - Aboumediene et al

                                                                                              pic medications, cognitive behavior
Means, standard deviations, and t test of differences on the depression scale
                           Problem             No Problem
                        Mean         SD      Mean          SD       t Test    Significance     REFERENCES
                                                                                              1. Farrag M. Needs and problems of Arab-Amer-
Heart disease           23.17      13.48      15.60      12.24       2.33         .02            ican mental health clients. Paper presented at:
                      (N    18)             (N    82)                                            First Biennial National Conference on the
Fatigue                 21.75      11.54      11.55      11.93       4.34         .00            Health of Arab Americans; 1999.
                      (N    53)             (N    47)                                         2. National Institute of Mental Health (NIMH).
Headaches               18.64      12.39      13.23      12.91       1.99         .05            The number count. 1999. NIH Publication
                      (N    69)             (N    31)                                            No. NIH 99–4584. Available at: http://
Appetite problems       20.97      12.67      14.39      12.20       2.592        .01            www.NIMH.NIH.gov/publicat/number. Feb-
                      (N    39)             (N    61)                                            ruary 9, 2004.
Weight gain             23.40      11.69      15.35      12.54       2.60         .01         3. Lett HS, Blumenthal JA, Babyak MA, et al.
                      (N    20)             (N    80)                                            Depression as a risk factor for coronary artery
Sleep problems          22.04      12.21      10.23      10.12       5.14         .00            disease: evidence, mechanisms, and treatment.
                      (N    57)             (N    43)                                            Psychosom Med. 2004;66(3):305–315.
                                                                                              4. Unutzer J, Katon W, Williams JW, et al. Im-
                                                                                                 proving primary care for depression in late life:
                                                                                                 the design of a multicenter randomized trial.
creased cortisol levels in response to      sive care that takes into consideration              Med Care. 2001:29(8):785–799.
stress, a finding that may explain the       the important role of psychological fac-          5. Mollica RF, Wyshak G, deMameffe D, Khuon
link between depression and osteopo-        tors. With this in mind, the restructur-             F, Lavelle J. Indochinese versions of the Hop-
                                                                                                 kins Symptom Checklist-25. A screening in-
rosis.7 Depression also may worsen the      ing of primary care and family medical               strument for psychiatric care of refugees. Am J
outcome of treatment for cardiovascular     care is warranted. The authors recom-                Psychiatry. 1987;144:497–500.
patients. Depression was such an im-        mend that, at the very least, every per-          6. Netterbladt P, Hansson L, Borgoquist L. Test
portant risk factor in one study that the   son served in primary care and every                 characteristics of the HSCL-25 in Sweden, us-
                                                                                                 ing the Present State Examination (PSE-9) as
ability of elevated C-reactive protein      person with severe medical problems                  a caseness criterion. Soc Psychiatry Psychiatr Ep-
(CRP) to predict cardiovascular events      will benefit from a brief psychological               idemiol. 1993;28(3):130–133.
lost its statistical significance when the   screening to assess problems of anxiety           7. Wachter K. Cortisol may mediate effect of de-
analysis was restricted to men without      and depression. Once a problem is iden-              pression on osteoporosis. Clin Psychiatry News.
signs of depression.8                       tified, an appropriate referral for treat-         8. Tucker M. Depression trumps high CRP level
    The findings of the current study        ment should be recommended and                       in cardiac risk. Clin Psychiatry News. 2004;
call for more integrated and comprehen-     would likely include, besides psychotro-             32(4):91.

                                              Ethnicity & Disease, Volume 15, Winter 2005                                                 S1-107