Aging & mental health · 2025
Cross-sectional examination of unmet health-related social needs and depression among low-income White and racially and ethnically minoritized older adults.
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Khemraj Uma Devi, Solomon Phyllis, Locascio Joseph J, Vleet Samuel Van, Mace Ryan A, Choi Namkee, Kugabalasooriar Saikrishna, De La Vega Pablo Buitrón, Ma Mingyue, Luo Peng, Dixon Camryn, Xie Alice, Wu Fei, Joo Jin Hui
Аннотация
OBJECTIVES: Social determinants of health (SDoH), including structural racism and economic marginalization, shape mental health outcomes but are frequently conceptualized at a level too broad for direct clinical intervention. In contrast, health-related social needs (HRSNs), such as food insecurity and housing instability, represent more proximal and actionable targets within clinical and community-based settings. Despite growing recognition of their importance, the relationship between HRSNs and depression among structurally marginalized older adults remains under explored. This study seeks to evaluate the association between HRSNs and depressive symptoms among low-income White as well as racially and ethnically minoritized older adults.
METHOD: Cross-sectional analysis of baseline data from a randomized controlled trial (Feb 2020-May 2022). Participants included 134 adults aged ≥50 years with depressive symptoms (PHQ-9 ≥ 5), cognitively intact, and either self-identified as a person of color or had income <200% of the federal poverty level.Depression was assessed via PHQ-9. HRSNs were measured using the CMS Accountable Health Communities screening tool. Multiple linear regression models adjusted for age, gender, race/ethnicity, and comorbidity.
RESULTS: Participants had a mean age of 70.8 years; 84.3% were female. Fifty-two percent were Black or African American; 41% were low-income White. Food insecurity (31.1%) and transportation barriers (22.7%) were common. Total HRSNs were associated with higher PHQ-9 scores in unadjusted models (p = 0.0035), but not after adjustment. Food insecurity remained independently associated with depression (B = 2.81, p = 0.001).
CONCLUSION: Food insecurity is linked to greater depressive symptoms. Implementing screening and referral systems for HRSNs may improve mental health care for marginalized older adults.
METHOD: Cross-sectional analysis of baseline data from a randomized controlled trial (Feb 2020-May 2022). Participants included 134 adults aged ≥50 years with depressive symptoms (PHQ-9 ≥ 5), cognitively intact, and either self-identified as a person of color or had income <200% of the federal poverty level.Depression was assessed via PHQ-9. HRSNs were measured using the CMS Accountable Health Communities screening tool. Multiple linear regression models adjusted for age, gender, race/ethnicity, and comorbidity.
RESULTS: Participants had a mean age of 70.8 years; 84.3% were female. Fifty-two percent were Black or African American; 41% were low-income White. Food insecurity (31.1%) and transportation barriers (22.7%) were common. Total HRSNs were associated with higher PHQ-9 scores in unadjusted models (p = 0.0035), but not after adjustment. Food insecurity remained independently associated with depression (B = 2.81, p = 0.001).
CONCLUSION: Food insecurity is linked to greater depressive symptoms. Implementing screening and referral systems for HRSNs may improve mental health care for marginalized older adults.