I will not be taking new students into my lab next year (e.g., Fall 2008 to Spring 2009). Currently, I wish to focus my time and resources on my current graduates students before accepting new students into the lab.
Epidemiological Research
Depression:
Plant, E.A., Sachs-Ericsson, N. (2004). Racial and Ethnic Differences
in Depression: The Roles of Social Support and Meeting Basic Needs,
Journal of Consulting and Clinical Psychology, 72(1), 41-52.
The current work examined depressive symptoms and
prevalence of major depression for minority group members and Whites
from a large random sample. In general, minority group members' responses
indicated more depressive symptoms and a marginally higher prevalence
of major depression than White participants' responses did. These
effects were mediated by the degree to which participants had problems
meeting their basic needs. Specifically, minority group members tended
to have more problems meeting their basic needs, and these problems
were associated with an increased risk for depression and higher levels
of depressive symptoms. Household income was also a significant mediator
of the relationship between ethnicity and depressive symptoms. In
addition, minority group members tended to report a higher quality
of interpersonal functioning than White participants did, which appeared
to suppress the relationship between ethnicity and depression. These
findings suggest that interpersonal functioning may act as a protective
factor for minority group members against depressive symptoms and
major depression. The implications of the findings for treatment and
for improving understanding of the relationship between ethnicity
and depression are discussed.
Petty, C., Sachs-Ericsson, N. & Joiner, T. Interpersonal dysfunction:
Cause or Result of Depressive Disorders. Journal of Affective Disorders.
In Press.
Background: Interpersonal skill deficits are associated
with depression; however, the nature of the relationship is not clear.
This study examined whether interpersonal skill deficits are a temporary
symptom of depression or a stable characteristic of depression-prone
individuals, in a large adult general population sample (N = 4,749).
Methods: Interpersonal functioning (IF) was compared among never depressed
individuals and three groups of individuals with a history of depression:
current depressives, recently remitted, and remitted depressives.
Results: State effects of depression were clearly observed and a strong
association between IF difficulties and current depression was found.
Individuals with an early onset of depression showed some indication
of an "interpersonal scar"; but, in general, we did not
find evidence that repeated depression "scarred" the individual.
Limitations: The cross-sectional methodology limited our ability to
examine whether interpersonal deficits were more the result of a depressive
episode or were present beforehand. In addition, it would have been
more informative to follow participants over the course of several
months in order to examine the relation between depression and interpersonal
functioning deficits as it unfolded longitudinally. Conclusions: Our
findings suggest that interpersonal functioning deficits are in some
regards a stable feature among people with a history of depression;
however, they possess temporary features as well. Depression may scar
interpersonal functioning, but only if it occurs early in life.
Suicide:
Verona, E., Sachs-Ericsson, N., & Joiner, T. (2004). Analysis
of suicide attempts in connection to externalizing psychopathology
in an epidemiological sample. American Journal of Psychiatry, 161,
444-451.
OBJECTIVE: Borrowing from recent dimensional models
of psychopathology, the authors conducted analyses that optimized
the common variance shared by internalizing (depression, anxiety)
and externalizing (antisocial personality, substance dependence) disorders
in statistically predicting suicidal behaviors. These relationships
were analyzed in a large epidemiological sample, thus allowing for
the examination of gender differences in risk for suicide attempts
associated with psychopathology. METHOD: The data were obtained from
the Colorado Social Health Survey. Participants (N=4,745) were a community
sample recruited by household address. Structured clinical interviews
were used to obtain lifetime diagnostic and symptom count information.
Symptom counts were included in a factor analysis that yielded two
main dimensions of psychopathology: internalizing and externalizing.
These factors were used in hierarchical logistic regression analyses
to predict history of suicide attempts associated with the presence
of internalizing symptoms, externalizing symptoms, and comorbid internalizing
and externalizing symptoms. RESULTS: After the investigators controlled
for the presence of internalizing symptoms and the comorbidity of
internalizing and externalizing symptoms, externalizing symptoms were
related to suicidal behavior in both men and women, although comorbidity
was most predictive of suicide attempts among women, compared to men.
CONCLUSIONS: Suicidal behavior among individuals with externalizing
symptoms is not necessarily a result of comorbid depressive or other
internalizing disorder. Thus, persons exhibiting antisocial behaviors
should receive rigorous assessment for suicidal ideation and behavior.
Health:
Sachs-Ericsson, N, Blazer, D. Plant, E.A., Arnow, B. Childhood Sexual
and Physical Abuse and the One-Year Prevalence of Medical Problems
in the National Comorbidity Study. Health Psychology. In Press.
In a population sample (N = 5,877; ages 15 to 54)
we found childhood sexual and physical abuse to be associated with
the one-year prevalence of serious health problems for both men and
women, even after controlling for family-of-origin problems. We also
found that the participant's psychiatric disorders partially mediated
the effect of physical and sexual abuse on health. However, childhood
physical and sexual abuse continued to independently influence health
status after controlling for psychiatric disorders. Contrary to expectations,
individuals who experienced a combination of sexual and physical abuse
did not have a higher frequency of health problems than those who
experienced either type of abuse alone. Implications for these findings
are discussed including possible mechanisms that may account for the
association between childhood abuse and adult health problems.
Aging Research
Blazer, D., Sachs-Ericsson, N., & Hybels, C.F. Perceived inadequate
basic needs predicts mortality in a biracial elderly community sample.
American Journal of Public Health. In press.
Objectives: To determine if the perception
of basic needs not being met among community dwelling elders increased
mortality risk and to determine whether this risk varied by race.
Design: Survival analysis of an epidemiological longitudinal study
(EPESE) exploring factors predicting mortality over 16 years.
Setting: One urban and four rural counties in the Piedmont of North
Carolina
Participants: Four thousand one hundred and sixty two community dwelling
subjects aged 65+, approximately equally distributed between Whites
and African Americans in 1986 selected in a stratified random sample
of households in Piedmont of North Carolina.
Methods: Subjects were administered an in-depth questionnaire in 1986
that assessed demographic characteristics, income, cognitive functioning
(SPMSQ) and functional status (Rosow-Breslau). Subjects were also
asked about the adequacy of their basic needs being met, including
the adequacy of their income, quality of their housing including heat
during the winter, and safety of their neighborhoods.
Results: Over fourteen years of follow-up, 81.9% if the sample died,
the average number of days survived among those dying being 3, 494.
In uncontrolled bivariate analyses, older age, male sex, being unmarried,
lower education, lower income, cognitive dysfunction, physical functioning
impairment, and perception that basic needs were not being met were
associated with increased mortality. In a Cox proportional hazards
model that included each of the above variables, perception that basic
needs were not being met was a significant predictor of mortality
overall (p<.005) and for Whites (p<.01) but not African Americans.
Neither sex nor actual income modified the risk of perceived basic
needs on mortality.
Conclusion: A perception that basic needs are not being met, even
controlling for other known risks for increased mortality, is a strong
predictor of mortality over an extended period of follow-up among
White community dwelling elders.
Aging and Depression:
Sachs-Ericsson, N., Plant E.A., Blazer, D. Racial differences in the
frequency of depressive symptoms among community dwelling elders:
The role of socioeconomic factors. Aging and Mental Health.
In Press.
In a biracial sample of community dwelling elders
(n = 4,162, the Duke EPESE), African Americans endorsed more items
than Whites on a standardized depression scale, the CES-D, in unadjusted
analyses. However, several indices of socioeconomic status were found
to mediate the relationship between race and depression, including
education, problems meeting basic needs, and cognitive functioning.
When these mediating variables were included in cross-sectional and
longitudinal analyses, the association between depressive symptoms
and race reversed such that Whites were significantly more likely
to endorse depressive symptoms than African Americans. We conclude
that these socioeconomic variables influence racial differences in
the endorsement of depressive symptoms in community dwelling elders.
Sachs-Ericsson, N. & Blazer, D. Depression in Aging. In (Ed.)
M. S. Pathy. Principles & Practice of Geriatric Medicine 4
Edition. John Wiley & Sons, Ltd. West Sussex, England. In
Press.
Aging and Dementia:
Sachs-Ericsson, N., Joiner, T., Plant E.A., Blazer, D., The association
of depression to cognitive decline in a community sample of elderly
adults. American Journal of Geriatric Psychiatry. In Press.
An association between depression and cognitive decline
(CD) has been observed in cross-sectional and case controlled studies
of elderly populations. Whereas a handful of longitudinal community
studies have found depressive symptoms to predate the onset of CD,
others have found no association between depression and subsequent
cognitive dysfunction. In the current study of a longitudinal sample
of community dwelling elders (n = 4,162, the Duke EPESE), we examined
the temporal relationship of depressive symptoms and cognitive errors
measured three years apart. Depressive symptoms were associated with
subsequent CD even after controlling for baseline cognitive status
as well as demographic variables (e.g. race, gender age, and socioeconomic
status) and physical functioning variables. This was true for the
sample as a whole as well as for a sub-sample of participants who
evidenced no baseline cognitive difficulties. Theories regarding the
role of depression in the subsequent onset of cognitive difficulties
are discussed.
Sachs-Ericsson, N. & Blazer, D. Anxiety and Depression in Dementia.
In (ed.) Gabe Maletta. Geriatric Psychiatry: Evaluation and Management.
Lippincott Williams & Wilkins, PA. In press.
Gender and Psychopathology:
Sachs-Ericsson, N. & Ciarlo, J. (2000). Gender, Social Roles and
Mental health: An epidemiological perspective. Sex Roles A Journal
of Research, 43(9/10), 339-362.
Sachs-Ericsson, N. (2000). Gender, Social Roles and Suicidal Ideation
and Attempts in a General Population Sample. In (Eds.) T. Joiner &
M. Rudd. Suicide Science, Kluwer Academic Publishers, Norwell,
Mass. 201-220.
