Gendered race modification of the association between chronic stress and depression among Black and White U.S. adults.

Abstract

<div class="section"> <a class="named-anchor" id="S1"> <!-- named anchor --> </a> <h5 class="section-title" id="d1475236e132">Background</h5> <p id="P1">Chronic stress stemming from social inequity has long been recognized as a risk factor for poor physical and psychological health, yet challenges remain in uncovering the mechanisms through which such exposures affect health outcomes and lead to racial and gender health disparities. Examination of sociocultural influences on group identity, coping, and the expression of stress may yield relevant insight into potential pathways of inequity’s effect on risk for chronic disease. </p> </div><div class="section"> <a class="named-anchor" id="S2"> <!-- named anchor --> </a> <h5 class="section-title" id="d1475236e137">Objective</h5> <p id="P2">To examine the relationship between chronic stress as measured by allostatic load (AL) and depression, by gendered race group. </p> </div><div class="section"> <a class="named-anchor" id="S3"> <!-- named anchor --> </a> <h5 class="section-title" id="d1475236e142">Methods</h5> <p id="P3">Using NHANES 2005–2010 data, we included black and white US adults aged 18–64 years (n=6431). AL was calculated using 9 biomarkers; scores ≥4 indicated “high-risk”. Depression was assessed using the PHQ-9; scores ≥10 indicated likely clinical depression. Logistic models estimated odds of depression as a function of AL for each gendered race group, adjusting for age and family poverty-to-income ratio. Effect modification was assessed by ANOVA and RERI. </p> </div><div class="section"> <a class="named-anchor" id="S4"> <!-- named anchor --> </a> <h5 class="section-title" id="d1475236e147">Results</h5> <p id="P4">We observed modification on the multiplicative scale. High AL was more strongly associated with depression among white women (OR=2.1, 95% CI: 1.5, 3.0) and black men (OR=1.7 95% CI: 1.0, 2.9), than among black women (OR=1.1 95% CI: 0.6, 2.0) or white men (OR=1.4 95% CI: 0.8, 2.5). </p> </div><div class="section"> <a class="named-anchor" id="S5"> <!-- named anchor --> </a> <h5 class="section-title" id="d1475236e152">Conclusions</h5> <p id="P5">A potential manifestation of high chronic stress burden, depression, differs across gendered race groups. These disparities may be due to group-specific coping strategies which are shaped by unequal social contexts. </p> </div><div class="section"> <a class="named-anchor" id="S6"> <!-- named anchor --> </a> <h5 class="section-title" id="d1475236e157">Public policy implications</h5> <p id="P6">Strategies for coping with, and consequently pathological manifestation of, chronic stress may differ by race and gender as a result of social inequities, contributing to variation in disease burden across social groups. These results suggest a need for health policies targeted at mitigating group-level risk factors, such as socially-constructed identity, for maladaptive coping in addressing health disparities. Effective intervention on coping may enable greater resilience among disadvantaged groups in the context of persistent social inequity. </p> </div>