Long-Term Reciprocal Associations Between Depressive Symptoms and Number of Chronic Medical Conditions: Longitudinal Support for Black–White Health Paradox

Abstract

Background Previous research has identified a Black-White health paradox, which can be defined as less frequent depression despite a higher prevalence of chronic medical conditions among Blacks compared to Whites in the USA. Based on this paradox, we would expect weaker associations between chronic medical conditions and depression among Blacks than Whites. However, the literature on this topic is mostly crosssectional and has provided findings that contradict the BlackWhite health paradox. The present longitudinal study extends prior research by assessing Black-White differences in reciprocal associations between number of chronic medical conditions and depressive symptoms over a 25-year period.Methods Data came from the Americans' Changing Lives Study that followed 1034 surviving Black and White respondents for 25 years from 1986 to 2011. Chronic medical conditions were measured based on a count of self-reported physician diagnoses including hypertension, diabetes, chronic lung disease, heart disease, stroke, cancer, and arthritis at baseline (1986) and follow-up (2011). Depressive symptoms were also measured at baseline and follow-up using a 10-item Center for Epidemiological Studies-Depression (CES-D) scale. Multi-group structural equation modeling was used to assess reciprocal associations between baseline and subsequent depressive symptoms and baseline and subsequent chronic medical conditions comparing Black and White respondents. Results Among White but not Black respondents, a higher number of chronic medical conditions at baseline predicted a greater increase in depressive symptoms over 25 years of follow-up. Among Whites but not Blacks, individuals with more depressive symptoms at baseline developed more chronic medical conditions over time. Conclusion Findings documented Black-White differences in reciprocal associations between chronic medical conditions and depressive symptoms over time. Our study provides longitudinal evidence for the Black-White health paradox across mid and later life, as reciprocal associations between depression and chronic medical conditions were weaker for Blacks compared to Whites.

History of Non-Fatal Physical Assault Is Associated with Premature Mortality for Whites but Not Blacks

“…Our finding regarding larger effects of history of non-fatal physical assault on risk of mortality in Whites compared to Blacks agrees with other research showing risk and protective factors have stronger effects for Whites than Blacks [20,55], a pattern which is frequently shown for physical and mental health outcomes ( [9,[11][12][13][14][15][16][17][18][19][56][57][58][59][60][61]; see References [20,55] for a review). Stronger effects of low education [17], unemployment [12], poor neighborhood quality [11], depression [16,18,19,62,63], hostility and anger [64], low sense of self efficacy [14], and low perception of control over life [65] were shown for Whites than Blacks.…”

“…Compared to their White counterparts who have not experienced the same level of adversities, one may hypothesize that Blacks may be more resilient to advertises such as non-fatal physical assault. This is in line with previous research showing weaker effects of social adversities for Blacks compared to Whites [9,[11][12][13][14][15][16][17][18][19].…”

“…Despite a higher exposure to a wide range of social stressors [3,9,10], Blacks may have higher expectations and preparedness for stress than Whites [11]. In the presence of chronic stress, a new stressor may be less disabling.…”

“…In the presence of chronic stress, a new stressor may be less disabling. This pattern may explain the weaker effects of social risk factors for Blacks compared to Whites [9,11]. Compared to their White counterparts who have not experienced the same level of adversities, one may hypothesize that Blacks may be more resilient to advertises such as non-fatal physical assault.…”

Racial differences in the predictive role of high depressive symptoms on incident heart disease over 18 years: Results from the health and retirement study

“…For example, we utilized depressive symptoms in wave 2, but future research could evaluate the impact of sustained depression. Future research could also test bidirectional links between depression and heart disease (21). Finally, our findings on a lack of effect of depressive symptoms on risk of incident heart disease for Whites and also a positive effect of depressive symptoms on risk of incident heart disease for Blacks should be interpreted with caution, as although the 95% CI included 1.00, the lower bound was very close to 1.00.…”