Depression engulfs area's Puerto Ricans

Puerto Ricans in Greater Boston are in the midst of an epidemic of depression, researchers reported yesterday, with 58 percent of middle-aged women and 38 percent of middle-aged men diagnosed with the condition.

The findings emerged from a major ongoing study of Puerto Rican health conducted by researchers at Tufts and Northeastern universities who are using four-hour, in-person interviews and blood and urine tests to look at a range of health issues in the state's largest Hispanic group. The study, the most elaborate portrait ever of the medical status of Puerto Ricans in the Boston area, has also found alarmingly high rates of diabetes and obesity.

But researchers said it was the findings on depression that especially stunned them -- more than two-thirds of the Puerto Ricans who said they were diagnosed with depression reported taking medications to control the disease.

Researchers and specialists in the study of health disparities attribute the high rate of depression to the stress of poverty, social isolation, chronic disease, and poor diet.

The levels of depression among Puerto Ricans were higher than what the researchers had found in an earlier study, which also included white, non-Hispanics from the same neighborhoods. In that study, only 22 percent of the whites reported ever having been diagnosed with depression. The current research project is looking exclusively at Puerto Ricans, who number more than 27,000 in Boston alone.

Previous large studies have shown that depression is more common among members of ethnic and racial minority groups than among white, non-Hispanics.

"We were shocked when we looked at this data," said Katherine L. Tucker , the Tufts professor directing the research. "It's an epidemic, it's a crisis."

The findings spurred an immediate call to action by local Hispanic leaders, with one state representative promising to share the research on Beacon Hill. The executive director of a leading Hispanic social service agency, where clients regularly report struggling with depression, said the study provides statistical proof of something long recognized anecdotally.

"It is a wake-up call," said Janet Collazo , chief of La Alianza Hispana . "Now, we have facts that are showing a reality."

That reality is also evident to a physician at Massachusetts General Hospital not involved with the study. Dr. Joseph Betancourt , director of the hospital's Disparities Solutions Center , said that half of the Hispanic patients at the hospital's Chelsea diabetes clinic report bouts of depression.

An increasing body of medical evidence suggests that diabetes and depression are frequently linked, making it imperative to address both conditions, Betancourt said -- especially among Puerto Ricans, who face a daunting host of social, economic, and health woes.

"If you look at this population, they really have what I would consider the perfect storm for disparities for health and health care," said Betancourt, who spent five years of his childhood in Puerto Rico.

The health status of Hispanics has historically received scant attention from researchers, who have more often examined the divide between whites and blacks, said Betancourt, who is involved in a citywide drive to better understand racial and ethnic disparities in health. And on those few occasions when Latinos have been classified as a separate group by national researchers, those studies have rarely differentiated among different segments of the Hispanic community.

The preliminary results released yesterday include more than 1,000 Puerto Ricans between the ages of 45 and 75. The participants have lived in the mainland United States for an average of 36 years, and have a median income of $10,200. And a significant proportion said that they felt they had not adapted to the dominant, English-speaking culture.

Their depression, they said, was often fueled by the sight of relatives departing Boston for warmer climes.

"They constantly referred to their social networks being undermined by people picking up and leaving," said Northeastern researcher Luis Falcón .

The study also looked beyond depression at other health measures, including obesity, diabetes, and indicators of stress in the bloodstream, such as nutrient deficiencies.

The researchers found that 66 percent of the women in the study and 44 percent of the men were obese, compared, according to previous research, with 18 percent overall statewide. In a related finding, 41 percent of study participants said they had been diagnosed with diabetes; a 2006 state study reported that 6.4 percent of adults statewide indicated they suffered from the condition.

And Hispanic diabetics are three times more likely than the average diabetic to end up on dialysis, said Dr. Francisco Trilla , who practices at a clinic in Jamaica Plain.

"Let's try not to continue on the same path," Trilla said. "Let's take important data, let's be shocked by it.

"We need to do better."

The researchers at Tufts and Northeastern are trying to do exactly that.

To help address the underlying stress-related nutrient deficiencies, researchers are mailing vitamins and other supplements to 135 of the participants. Researchers will follow them -- as they will all of the study participants -- for two years to see if their health changes.

Hoping to relieve depression, researchers also have a pilot study designed to encourage Puerto Ricans to gather for social activities. But participants have dropped out in significant numbers, citing poor health, family emergencies, and difficulties communicating with taxi drivers.

Jenny Cintron , who participated in the study, is not depressed herself, but traces rampant depression in her community, in part, to a reluctance to leave the familiar confines of home.

"In the Puerto Rican community, I know people who don't go outside of the house -- they're taking care of the kids, their parents, their grandparents, the household chores," said Cintron, 46, who lives in Dorchester. "Who wouldn't go crazy?"

Raymond Rassi , then nearly 50, decided to participate in the study in 2005, after spying a poster advertising it at his local library. Though he does not suffer diabetes or other chronic conditions, he knew, as a Puerto Rican, that he is genetically at risk for them.

"And if I'm going to be predisposed to this, I wanted to know: 'What can I do to prevent it?' " said Rassi, who lives in Chelsea.

So the researchers started asking him questions about what he ate and how often he exercised. In a week, how often do you eat fruit? "Once," he told them. What about vegetables? "Twice."

"That told me something," he recalled. "And I found that doing simple things like changing a tire was exhausting me."

He was so sobered by the questioning that he decided to forgo trips to fast-food joints while adding more fiber to his diet. He increased his physical activity, too.

The result: Rassi, now 51, weights 178 pounds, down from 208. And he's training for the Boston Marathon.

Stephen Smith can be reached at stsmith@globe.com.