Coping With Chronic Stress by Unhealthy Behaviors: A Re-Evaluation Among Older Adults by Race/Ethnicity

Abstract

Objective: To assess the role of unhealthy behaviors in the relationship between chronic stress and significant depressive symptoms by race/ethnicity among older adults. Method: Participant data from the 2006 to 2008 Health and Retirement Study were analyzed. Unhealthy behaviors included current smoking, excessive/binge drinking, and obesity. Chronic stress was defined by nine previously used factors. The eight-item Center for Epidemiologic Studies Depression (CES-D) Scale measured depressive symptoms, where ≥4 symptoms defined significant. Multivariable logistic regression assessed the effects of chronic stress and unhealthy behaviors in 2006 on depressive symptoms in 2008. Results: A higher chronic stress index score predicted depressive symptoms in 2008 among African Americans, Latinos, and Whites (adjusted odds ratio [aOR] = 1.78, 95% confidence interval [CI] = [1.48, 2.15]; aOR = 1.54, 95% CI = [1.15, 2.05]; and aOR = 1.40, 95% CI = [1.26, 1.56], respectively). Unhealthy behaviors moderated this relationship among Latinos (aOR = 1.54, 95% CI = [1.02, 2.33]). Discussion: Unhealthy behaviors were not effective coping mechanisms for chronic stress in terms of preventing significant depressive symptoms. Instead, they strengthened the relationship between chronic stress and significant depressive symptoms among Latinos.

Relationships between allostatic load, unhealthy behaviors, and depressive disorder in U.S. adults, 2005–2012 NHANES

“…Our results also differed from prior studies that found unhealthy behaviors interacted with chronic stress to increase depressive symptoms among Latinos overall, specifically foreign-born Mexicans. 10,32 Other studies have failed to find signficant modification effects for unhealthy behaviors on the relationship between chronic stress and depression. 33,34 Inconsistency in findings could be due to differences in study designs (multiple cross-sectional samples compared to a longitudinal design) or measures of chronic stress (subjective versus physiologic).…”

“…These unhealthy behaviors may influence the relationship between chronic stress and depression. 9,10 Relationships between substance use or consumption of unhealthy foods and chronic stress have been explained partially by physiological mechanisms. 11–14 Also, chronic stress has been shown to negatively affect levels of physical activity.…”

“…9 Other research has shown that among Latino older adults, as chronic stress increased those who engaged in more unhealthy behaviors were more likely to experience significant depressive symptoms in the future. 10 A theoretical framework, named the Environmental Affordances model, has been proposed as an explanation of how chronic stress and risk behaviors may interact to affect health. 16 This framework postulates that engaging in unhealthy behaviors attenuates the effects of stress on depression among African Americans.…”

Race, Obesity, and Mental Health Among Older Adults in the United States: A Literature Review

“…Since this study, other researchers have tested the EA hypotheses using racially and ethnically diverse samples. Rodriquez and colleagues ( 20 ) used a sample of 6,479 middle-aged and older African Americans, Hispanics, and whites from the Health and Retirement Study to assess the role of unhealthy behaviors (i.e., current smoking, excessive and/or binge drinking, and obesity) in the relationship between chronic stress and depressive symptoms ( 20 ). Findings indicated that the interaction between chronic stress and unhealthy behaviors was significant for Hispanics, but not for African Americans or whites.…”

“…Collectively, these studies suggest that some behaviors defined as unhealthy might serve a protective function against stress and, thus, explain variation in findings for obesity and mental health outcomes across older racial and ethnic minority groups. There is some indication from this body of evidence that stress coping with “unhealthy behaviors” is more protective for the mental health of middle-aged and older African Americans ( 18 , 19 ) than among older whites and Hispanics ( 18 , 20 ). However, more research is needed to clarify the role of race and ethnicity in these relationships.…”