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OBJECTIVE: To determine the impact of children's cognitive delay and behavior on maternal depressive symptoms using a large national cohort of US families. STUDY DESIGN: Data were drawn from 2 waves of the nationally representative Early Childhood Longitudinal Study, Birth Cohort (n = 7550). Cognitive delay was defined at age 24 months by the lowest 10th percentile of the Bayley Short Form-Research Edition. At age 4 years, the children's behavior was assessed using the Preschool and Kindergarten Behavior Scales, administered to mothers and primary nonparental child care providers, and maternal depressive symptoms with the Center for Epidemiological Studies Depression Scale. Weighted generalized estimating equation models examined whether the children's behavior mediated the relationship between their cognitive delay status at 24 months and 4-year maternal depressive outcomes. RESULTS: At age 4 years, 26.9% of mothers of children with cognitive delay reported high depressive symptoms, compared with 17.4% of mothers of typically developing children (P < .0001). When the children's behavior was accounted for, the effect of cognitive delay on maternal depressive symptoms decreased by 36% (P < .0001). These findings remained significant when the children's behaviors were assessed by their primary nonparental care providers. CONCLUSION: Caring for a child with a cognitive delay influences maternal depressive symptoms in part through the child's behavior problems. Preventive interventions to ameliorate adverse outcomes for children with cognitive delay and their families should consider the impact of the children's behavior.

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BACKGROUND: Health-related quality of life instruments (HRQoL) are widely used to produce measures that summarize population health and to inform decision-making and health policy. Although the literature about the relationship between health and race in the United States is quite extensive, there is a lack of studies that comprehensively examine the relationship between race and preference-based HRQoL. Given the widespread use of these measures, it becomes important to understand the extent of the race differences in HRQoL scores and factors associated with any such differences. METHODS: We examined the differences in HRQoL, between blacks and whites and associated factors, using the summary scores of the SF-6D, EQ-5D, QWB-SA, HUI2, HUI3, administered by telephone to a nationally representative sample of 3,578 black and white US adults between the ages of 35 and 89 in the National Health Measurement Study (NHMS). RESULTS: Black women had substantially lower HRQoL than white women. The difference was largely explained by sociodemographic and socioeconomic variables. Black men did not differ significantly from white men, except for the EQ-5D. HRQoL among black men was higher at higher income levels, while the HRQoL of black women was especially low compared to other groups at high income levels.

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Race differences in health have been extensively analyzed and documented in the literature, especially between African Americans or blacks and whites in the United States. Despite the vast literature in the area, the majority of studies that explore the relationship between race and health use outcomes such as self-rated health, mortality or morbidity, and disability, but very few use Health-Related Quality of Life (HRQoL) measures and their domains or dimensions. This narrative review aims to provide a better understanding of the relationship between race and health domains that are commonly used in preference-based HRQoL measures. We investigated the literature on race, physical health, mental health, pain and discomfort, cognition, neurologic spectrum domains, dexterity, ambulation, vitality and social functioning domains. We conducted a literature search and review using the key words race and the health domain of interest, using medical and social sciences databases, such as MEDLINE/Pubmed, Web of Science, and the Google Scholar portal.The majority of the studies identified in the literature show that African Americans or blacks in the United States tend to have lower scores than whites throughout a variety of health domains found in preference-based HRQoL measures. This review also emphasizes the scarcity of studies that investigate some health domains, such as social functioning, dexterity, vitality and neurologic spectrum domains, and therefore we identify the need for more studies focusing on race and measures that address such domains.

A literatura sobre raça nos Estados Unidos está repleta de estudos que documentam diferenças na saúde entre negros e brancos. Entretanto, a maioria dos trabalhos que exploram a relação entre raça e saúde utiliza medidas com saúde autorrelatada, mortalidade e morbidade, mas poucos empregam medidas de qualidade de vida relacionada à saúde e seus domínios específicos. Este artigo revisa a literatura sobre raça e qualidade de vida relacionada à saúde, especificamente examinando os domínios que constituem as principais medidas baseadas na teoria da utilidade: saúde física; saúde mental; dor e desconforto; cognição; domínios neurológicos; destreza; locomoção; vitalidade; e funcionamento social. Conduziu-se uma revisão da literatura usando as palavras-chave raça e o domínio da qualidade de vida de interesse nos Estados Unidos. Foram consultadas as bases de dados Medline/Pubmed, Web of Science e o portal Google Scholar. A maioria dos estudos sobre diversos domínios das medidas de qualidade de vida investigados sugere que negros têm pior qualidade de vida do que brancos nos Estados Unidos. A revisão salienta a escassez de estudos que exploram a relação entre raça e alguns domínios, como, por exemplo, funcionamento social, destreza, vitalidade e domínios de escopo neurológico, e, portanto, mostra a necessidade de que futuros estudos examinem a relação entre raça e estes domínios.

La literatura sobre raza en los Estados Unidos está repleta de estudios que documentan diferencias en la salud entre negros y blancos. No obstante, la mayoría de los trabajos que explotan la relación entre raza y salud utiliza medidas con salud autorrelatada, mortalidad y morbilidad, pero pocos emplean medidas de calidad de vida relacionada con la salud y sus dominios específicos. Este artículo revisa la literatura sobre raza y calidad de vida relacionada con la salud, específicamente, examinando los dominios que constituyen las principales medidas basadas en la teoría de la utilidad: salud física; salud mental; dolor y molestias; cognición; dominios neurológicos; agilidad; locomoción; vitalidad; y funcionamiento social. Se realizó una revisión de la literatura usando las palabras-clave raza y el dominio de la calidad de vida de interés en los Estados Unidos. Se consultaron las bases de datos Medline/Pubmed, Web of Science y el portal Google Scholar. La mayoría de los estudios sobre diversos dominios de las medidas de calidad de vida investigados sugiere que los negros tienen peor calidad de vida que los blancos en los Estados Unidos. La revisión resalta la escasez de estudios que explotan la relación entre raza y algunos dominios, como, por ejemplo, funcionamiento social, agilidad, vitalidad y dominios de objetivo neurológico, y, por tanto, muestra la necesidad de que futuros estudios examinen la relación entre raza y estos dominios.

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