Reconsidering the Role of Social Disadvantage in Physical and Mental Health: Stressful Life Events, Health Behaviors, Race, and Depression

Abstract

Prevalence of depression is associated inversely with some indicators of socioeconomic position, and the stress of social disadvantage is hypothesized to mediate this relation. Relative to whites, blacks have a higher burden of most physical health conditions but, unexpectedly, a lower burden of depression. This study evaluated an etiologic model that integrates mental and physical health to account for this counterintuitive patterning. The Baltimore Epidemiologic Catchment Area Study (Maryland, 1993-2004) was used to evaluate the interaction between stress and poor health behaviors (smoking, alcohol use, poor diet, and obesity) and risk of depression 12 years later for 341 blacks and 601 whites. At baseline, blacks engaged in more poor health behaviors and had a lower prevalence of depression compared with whites (5.9% vs. 9.2%). The interaction between health behaviors and stress was nonsignificant for whites (odds ratio (OR = 1.04, 95% confidence interval: 0.98, 1.11); for blacks, the interaction term was significant and negative (β: -0.18, P < 0.014). For blacks, the association between median stress and depression was stronger for those who engaged in zero (OR = 1.34) relative to 1 (OR = 1.12) and ≥2 (OR = 0.94) poor health behaviors. Findings are consistent with the proposed model of mental and physical health disparities.

Panic Disorder Among African Americans, Caribbean Blacks, and Non-Hispanic Whites

“…NSAL data indicate that binge eating disorder is the most common eating disorder among blacks in America [49]. This finding is consistent with the argument that African Americans may use food as a coping mechanism to deal with the high levels of environmental stressors they experience [45][46][47]. Furthermore, having a diagnosis of binge eating disorder has been associated with elevated risk of PD [50].…”

“…An equally promising explanation for the lower levels of psychiatric disorders among African Americans has recently been put forth by Jackson and colleagues [45][46][47]. They argue that mental and physical health disorders are functionally related and that lower rates of psychiatric disorders in African Americans may come at the expense of higher rates of physical disorders.…”

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

“…Jackson and colleagues have argued that Blacks' low rates of depression despite of high rates of medical conditions compared to Whites may be due to their engagement in negative health behaviors (e.g., smoking or overeating) that may be associated with low psychological but high physiological damages [38][39][40][41]. Jackson's hypothesis suggests that the association between psychological and medical conditions among Blacks may not be as strong as Whites.…”

Chronic Psychological Stress and Racial Disparities in Body Mass Index Change Between Black and White Girls Aged 10–19

“…There may be differential response to stress behaviorally, as we know that some people respond to stress with loss of appetite and some respond with eating. Jackson and colleagues, for example, have suggested that Black individuals may use eating to cope with stress at a higher rate than White individuals [51,52]. In adults, those of higher initial BMI tend to gain weight under stress, whereas those who are lean tend to lose weight [53].…”