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

Abstract

Background: Studies have investigated racial differences in the relationship between depression and CVD mortality. Objectives: This study tested the hypothesis that race moderates the effect of baseline depressive symptoms on subsequent heart disease among a nationally representative sample of Black and White older Americans. Patients and Methods: Data came from ten waves of the health and retirement study (HRS), a nationally representative longitudinal study of US adults over age 50. The present study followed 7,444 Black and White individuals without a diagnosis of heart disease at baseline for up to 18 years for incident heart disease. Elevated depressive symptoms at baseline was the independent variable, time to incident heart disease was the dependent variable, while baseline sociodemographics, health risk behaviors, obesity, and chronic medical conditions were controls. We used Cox proportional hazards models in the pooled sample and stratified by race to test the effect of elevated depressive symptoms on the outcome net of other risk factors. Results: In the pooled sample, a significant positive interaction was found between the effect of elevated depressive symptoms and Black race (hazard ratio, 1.29; 95% CI = 1.01 -1.65), suggesting a stronger effect for Blacks compared to Whites. In fully adjusted racestratified models, elevated depressive symptoms increased the risk of developing heart disease for Blacks (hazard ratio, 1.47; 95% CI = 1.04 -2.07) but not Whites (hazard ratio, 1.13; 95% CI = 0.97 -1.32). Conclusions: Black and White older adults differ in the effect of depressive symptoms on subsequent heart disease over a long period of follow up. Elevated depressive symptoms are associated with a larger risk of incident heart disease among Black but not White older individuals.

The Link between Mastery and Depression among Black Adolescents; Ethnic and Gender Differences

“…In agreement with the differential effect (susceptibility) theory [1,2,3,8], a number of recent studies have found evidence suggesting differential effect of depression on mastery and self-esteem (dysfunctional attitudes about self) across race and ethnic groups [10,12,13,21]. Racial and ethnic group differences have also been found in the effects of depression on hopelessness (dysfunctional attitudes about future) [22].…”

Arterial stiffness is associated with depression in middle-aged men — the Maastricht Study

“…Although we adjusted for multiple confounders, residual confounding due to other chronic medical conditions, such as asthma, chronic obstructive pulmonary disease, cancer, or arthritis, which may be comorbid to depression 56 and which could lead to arterial stiffening, cannot be ruled out. Finally, the association between CVD markers and depression may differ according to race; [57][58][59][60] however, our study population consisted mainly of white people, therefore we could not investigate such effects.…”

Reciprocal Associations between Depressive Symptoms and Mastery among Older Adults; Black-White Differences

“…Built on the differential effect hypothesis (Assari, 2016b,d; Assari and Lankarani, 2016b; Assari and Sonnega, 2016), we conducted the current study to compare Black and White American older adults for the reciprocal longitudinal associations between depressive symptoms and mastery over time. This hypothesis is in line with what Belsky and others have called ‘differential susceptibility to environmental influences’ or ‘differential susceptibility to the context’ (Belsky, 1997; Boyce and Ellis, 2005; Belsky et al, 2007; Belsky and Pluess, 2009).…”