220402 Stressful life events, health behaviors, race, and depression: An interaction model

Monday, November 8, 2010 : 10:45 AM - 11:00 AM

Brian Mezuk, PhD , Department of Epidemiology and Community Health, Virginia Commonwealth University, Richmond, VA
Jane A. Rafferty, MA , Institute for Social Research, Ann Arbor, MI
Kiarri N. Kershaw, MPH , Department of Epidemiology, University of Michigan, Ann Arbor, MI
Darrell L. Hudson, MPH, PhD , Department of Family and Community Medicine, University of California, San Francisco, San Francisco, CA
Cleopatra Abdou, PhD , Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI
James S. Jackson, PhD , Survey Research Center, ISR, University of Michigan, Ann Arbor, MI
     
Background: Socioeconomic status (SES) is patterned by race in the US, with Blacks over-represented in low SES relative to Whites. Prevalence of Major Depressive Disorder (MDD), as with most physical health conditions, is inversely patterned by SES. The stress associated with social disadvantage is hypothesized to mediate the SES-MDD relationship. However, Blacks have similar or lower rates of MDD, but higher rates of most physical health conditions, relative to Whites. This study evaluated an etiologic model that accounts for this counterintuitive patterning by race.

Methods: We used the Baltimore ECA Study to evaluate the interaction between stress and poor health behaviors (PHB: smoking, alcohol, poor diet, BMI) on risk of depression 13 years later for Blacks (N = 341) and Whites (N = 601). Logistic regression models were adjusted for demographics, SES, and baseline depression.

Results: At baseline Blacks were more likely to endorse 2+ PHB (48.7% vs. 39.1%) and had lower prevalence of MDD (5.9% vs. 9.2%) relative to Whites. The interaction between PHB and stress was non-significant for Whites (OR: 1.04, 95%CI: 0.98 – 1.11). For Blacks the interaction term indicated that as stress increased, engaging in more PHB was associated with lower risk of developing depression (OR: 0.84, 95%CI: 0.73–0.97, p=0.018).

Conclusion: These findings are consistent with the proposed model that PHB act as means of effectively coping with the stress of social disadvantage and have implications for public health efforts to reduce the burden of risky health behaviors and chronic health conditions among disadvantaged groups.

Learning Areas:
Chronic disease management and prevention
Epidemiology
Social and behavioral sciences

Learning Objectives:
1. To describe the counter-intuitive patterning of depression among Blacks and Whites in the United States. 2. To evaluate an integrative etiologic model of the relationships linking social disadvantage, stress, and health behaviors with mental and physical health. 3. To discuss the implications of this etiologic model for public health efforts to reduce social disparities in health.

Keywords: Minority Health, Stress

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am qualified to present because I am faculty in Epidemiology and Community Health and I conduct research on social influences on mental and physical health.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.

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