Reconsidering the role of social disadvantage in physical and mental health: stressful life events, health behaviors, race, and depression.
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.
Mezuk
Briana
B
Department of Epidemiology and Community Health, Virginia Commonwealth University, Richmond, Virginia 23298, USA. bmezuk@vcu.edu
Rafferty
Jane A
JA
Kershaw
Kiarri N
KN
Hudson
Darrell
D
Abdou
Cleopatra M
CM
Lee
Hedwig
H
Eaton
William W
WW
Jackson
James S
JS
D015142:Baltimore / Q000453:epidemiology; D044383:Black People / Q000706:statistics & numerical data*; D002908:Chronic Disease / Q000208:ethnology; D003863:Depression / Q000208:ethnology*; D005260:Female; D015438:Health Behavior / Q000208:ethnology*; D054624:Health Status Disparities; D006801:Humans; D007182:Income / Q000706:statistics & numerical data; D008016:Life Change Events; D016015:Logistic Models; D008297:Male; D008603:Mental Health / Q000706:statistics & numerical data*; D008875:Middle Aged; D011159:Population Surveillance; D015995:Prevalence; D012307:Risk Factors; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D044465:White People / Q000706:statistics & numerical data*; D001741:Black or African American