Knowing the Signs: Recognizing Depression in African Americans With Cancer

Amy Zhang, PhD

A new study has found that African American patients with cancer feel and describe depression differently than their Caucasian counterparts.

Findings from a pilot study, posted online in the Journal of Mental Health, found that many African American cancer patients use words such as “gloomy,” “feeling down,” “low,” or “blue,” to describe depression and are more likely to feel irritable and want to be alone.

Accurately assessing depression in cancer patients is difficult in general because the physical symptoms of cancer and depression, such as low energy, lack of sleep, and loss of appetite, are extremely similar. Identifying and treating depression in cancer patients is also crucial because those with a more optimistic outlook tend to live longer.

“African American cancer patients are often sicker and have more severe physical symptoms,” lead author Amy Zhang, PhD, a nurse scientist and associate professor at Case Western Reserve’s Frances Payne Bolton School of Nursing, said in a statement. “I wanted to see if something was missing in how and what we were asking patients.”

For the study, Zhang and her colleagues studied 34 depressed and 23 nondepressed African American cancer patients and 17 depressed Caucasian cancer patients at a Northeast Ohio medical center. All patients had been diagnosed with early-stage breast or prostate cancers within the previous 3 years and were at least 6 months from their last treatment.

The patients were asked a series of open-ended questions to measure depression.

Researchers found that depressed African American patients reported feeling irritable and wanting to be alone more frequently than nondepressed black patients. Notably, these symptoms are not described on the diagnostic test for depression.

The study also showed that depressed African American patients reported sad feelings less often than depressed Caucasian patients. African American patients were also less likely to use the word “depressed” to describe how they felt, opting for words such as “feeling down,” “gloomy,” “low,” or “blue.”

“Because we don’t use those words in standardized testing, we could be losing people with depression,” Zhang said.

The findings led Zhang and her colleagues to observe that standard psychological tests are mainly based on responses from white patients, and, therefore, more culturally sensitive depression measures that consider irritability, social isolation, and describing a down mood in ways other than “depressed” may benefit black patients with cancer.

Zhang hopes to test a larger number of participants to see if using these new culturally sensitive questions and descriptions of symptoms would result in better diagnosis and treatment of depression in these patients.