Exploring Causes of Depression and Anxiety Health Disparities (HD) by Examining Differences between 1:1 Matched Individuals

Abstract

Poor comparability of social groups is one of the major methodological problems that threatens the validity of health disparities (HD) research findings. We illustrate a methodological solution that can additionally unpack the mechanisms behind differential effects on depression and anxiety. We describe racial/ethnic differences in the prevalence of depression and anxiety scores between Black and White women using classic methods, and then we illustrate a 1:1 matching procedure that allows for building of individual-level difference scores, i.e., actual HD difference score variables, for each pair of comparable participants. We compare the prevalence of depression disorder between Black and White young women after matching them 1:1 on common socio-economic characteristics (age, employment, education, and marital status). In essence, we follow matching or stratification methods, but make a step further and match cases 1:1 on propensity scores, i.e., we create Black–White ‘dyads’. Instead of concluding from plain comparisons that 11% more White young women (18–30 years old) report a depressive disorder than Black young women, the matched data confirms the trend, but provides more nuances. In 27% of the pairs of comparable pairs the White woman was depressed (and the comparable Black woman was not), while in 15% of the pairs the Black woman was depressed (and the comparable White woman was not). We find that Black-to-White disparities in neighborhood disorder do not predict depression differences (HDs), while such an effect is evident for anxiety HDs. The 1:1 matching approach allows us to examine more complex HD effects, like differential mediational or resilience mechanisms that appear to be protective of Black women’s mental health.

Economic Strain Deteriorates While Education Fails to Protect Black Older Adults Against Depressive Symptoms, Pain, Self-rated Health, Chronic Disease, and Sick Days

“…Health insurance status was a dichotomous variable that reflected health some bias should be expected due to underreporting of some conditions. Self-Rated Health: Participants' self-rated health was assessed by a single-item health measure with five options 64,[98][99][100][101][102][103][104][105] . The item reads, "In general, would you say your health is: "very good," "good," "fair," "bad," and "very bad."…”

“…Responses were on an interval variable ranging from one to five, with a high score indicating poor selfrated health. Poor self-rated health predicts the risk of mortality 64,[98][99][100][101][102][103][104][105] .…”

Mood Disturbances Across the Continuum of Care Based on Self-Report and Clinician Rated Measures in the interRAI Suite of Assessment Instruments

“…They are experienced worldwide, can begin in early stages of life ( 7 – 14 ), and can persist throughout the life course ( 15 – 18 ). Although there are important biomedical factors that can affect mood, a broad array of psychosocial and environmental factors can also trigger, worsen, or prolong these symptoms to become more persistent problems related to depression ( 15 , 19 ).…”

Number of Chronic Medical Conditions and Quality of Life of Ethnic Minority Older Adults

“…The association between the number of chronic medical conditions and poorer mental well-being [ 5 , 6 , 7 ] may, however, vary by race/ethnicity [ 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 ]. This is in part because different populations utilize various coping mechanisms to deal with adversities, as some groups may have higher preparedness to face a new adversity or access to resources (e.g., healthcare) [ 16 ].…”

“…This is in part because different populations utilize various coping mechanisms to deal with adversities, as some groups may have higher preparedness to face a new adversity or access to resources (e.g., healthcare) [ 16 ]. Some studies suggest that the link between chronic medical conditions and mental well-being may be weaker for Black individuals compared to White individuals [ 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 ]. However, most available comparative studies have exclusively compared Black and White individuals.…”