Depressive Symptoms Affect Cognitive Functioning from Middle to Late Adulthood: Ethnoracial Minorities Experience Greater Repercussions

Journal of Racial and Ethnic Health Disparities https://doi.org/10.1007/s40615-024-02121-x Depressive Symptoms Affect Cognitive Functioning from Middle to Late Adulthood: Ethnoracial Minorities Experience Greater Repercussions Michael J. Persin1 · Ameanté Payen2 · James R. Bateman3,4 · Maria G. Alessi2 · Brittany C. Price2 · Jeanette M. Bennett1,2 Received: 3 March 2024 / Revised: 27 July 2024 / Accepted: 2 August 2024 © The Author(s) 2024 Abstract Cognitive deficits, a diagnostic criterion for depressive disorders, may precede or follow the development of depressive symptoms and major depressive disorder. However, an individual can report an increase in depressive symptoms without any change in cognitive functioning. While ethnoracial minority group differences exist, little is known to date about how the relationship between depressive symptoms and cognitive function may differ by ethnoracial minority status. Utilizing data from the Midlife in the United States (MIDUS) study waves II (M2) and III (M3), this study examines the relationship between depressive symptoms and cognitive functioning concurrently and longitudinally in community-dwelling adults, as well as whether the results differed by ethnoracial minority status. Our participants included 910 adults (43.8% male, 80.8% White, 54.4 ± 11.5 years old at M2). Cross-sectionally, depressive symptoms, ethnoracial minority status, and their interaction had significant effects on cognitive function, consistent with previous investigations. Longitudinally, higher M2 depressive symptoms predicted poorer cognitive function at M3 over and above M2 cognitive functioning, but only within the ethnoracial minority sample. Our finding suggests that depressive symptoms predict cognitive functioning both concurrently and across time, and this relationship is moderated by ethnoracial identity, resulting in greater cognitive deficits among ethnoracial minority groups compared to their non-Hispanic White counterparts. Keywords Depressive symptoms · Midlife · Cognitive functioning · Ethnoracial differences Depression is a mood disorder that can occur at any age and typically classified as mild, moderate, or severe [1]. In adults, depression is defined by the presence of depressed mood and/or reduced interest or pleasure in most activities [anhedonia] and is often accompanied by changes in cognition that impede the ability to think or concentrate, * Jeanette M. Bennett 1 Department of Psychological Science, UNC Charlotte, 9201 University City Blvd, 4018 Colvard, Charlotte, NC 28223, USA 2 Health Psychology PhD Program, UNC Charlotte, Charlotte, USA 3 Department of Neurology, Wake Forest University School of Medicine, Winston‑Salem, USA 4 Alzheimer’s Disease Research Center, Wake Forest University School of Medicine, Winston‑Salem, USA impacting day-to-day functioning [2]. According to the World Health Organization (WHO), the depression burden worldwide is estimated to be 280 million cases, or ~ 5% of the global population and nearly 6% of those over 65 years old [3]. Data from the US Department of Health and Human Services report that the age groups 45–64 and 65 and over are tied for the second highest prevalence of depression at 18.4%, just behind the 18–29 age group [4]. This is particularly concerning when considering symptom severity,moderate and severe depression rates in the 45–64 age group are 4.5% and 3.1%, respectively [4]. Furthermore, depression is estimated to predict a 20% increase in the risk of dementia [5] and may account for 5–11% of Alzheimer’s disease cases [6]. Impaired cognition can include problems with cognitive functions such as executive control and attention [7]. Furthermore, cognitive impairment is a diagnostic criterion for major depressive disorder [8] and has been associated with greater vulnerability to developing depression and Vol.:(0123456789) Journal of Racial and Ethnic Health Disparities increased risk of symptom relapse [9]. An estimated 60% of individuals with depression display impaired cognition [10–12]. Moreover, persistent moderate to high and increasing depressive symptoms during adulthood appear to drive cognitive decline over time [13–15]. These data suggest that depression and cognitive impairments may bidirectionally increase the risk of one another. A major limitation in these cross-sectional and longitudinal studies is the limited ethnoracial diversity of their samples, as the majority of samples have been predominantly within White/Caucasian populations, resulting in questions regarding the universality of the relationship between depression and cognitive impairment and whether the association is variable across different sociodemographic groups. The prevalence rate of major depressive disorder is lower in African Americans than in their Caucasian counterparts at 10.4% and 17.9%, respectively [16, 17]. However, over 50% of cases among African Americans are chronic, lasting longer and reoccurring more frequently when compared to 39% in White individuals, suggesting that the burden of depression may fall heavier on the African American population and may result in more significant impairment across the functional spectrum [16]. Current prevalence rates may also underestimate the true incidence of depression in this population, as less than half of African Americans report seeking treatment for their disorder despite rating their depressive symptoms as severe and disabling [16, 18]. Similarly, the prevalence rate of major depression across other ethnoracial minorities is lower than in their Caucasian counterparts at 6.8% of Hispanics [19], and around 6.8% of Asian/ pacific islanders [20]. Another similarity is the disparity in treatment across these ethnoracial groups; specifically, among individuals with past year depressive episodes, over 50% of ethnoracial minorities did not access mental health treatment with Asians and Hispanics leading the way with 68.7% and 63.7%, respectively, compared to around 40% in the non-Hispanic Caucasian group [21]. Among individuals with severe subtype depression, ethnoracial minorities showed significantly lower rates of mental health service compared with Caucasians [22]. Consequently, these ethnoracial disparities in seeking mental health treatment result in different rates of antidepressant use [23–25]. Antidepressant use can have a positive effect on cognition functioning among individuals who have depression, while little to no effect has been observed on non-depressed populations [26]. However, antidepressants have also been shown to be of little use in combating the cognitive symptoms of depression such as poor concentration [27]. Given the wide use of antidepressants for depressive symptoms and other “off-label” conditions [28–30], examining the relationship between depressive symptoms and cognition function within this community-dwelling sample will be inclusive, regardless of antidepressant use. In general, cognition declines (...truncated)