title: Hispanic residential ethnic density and depression in post-acute coronary syndrome patients: Re-thinking the role of social support.
abstract: BACKGROUND
  The ethnic density hypothesis suggests that ethnic density confers greater social support and consequently protects against depressive symptoms in ethnic minority individuals. However, the potential benefits of ethnic density have not been examined in individuals who are facing a specific and salient life stressor.
  
  
  OBJECTIVE
  We examined the degree to which the effects of Hispanic ethnic density on depressive symptoms are explained by socioeconomic resources and social support.
  
  
  METHODS
  Patients with acute coronary syndrome (ACS, N = 472) completed the Beck Depression Inventory (BDI) and measures of demographics, ACS clinical factors and perceived social support. Neighborhood characteristics, including median income, number of single parent households and Hispanic ethnic density, were extracted from the American Community Survey Census (2005-2009) for each patient using his or her geocoded address.
  
  
  RESULTS
  In a linear regression analysis adjusted for demographic and clinical factors, Hispanic ethnic density was positively associated with depressive symptoms (β = .09, standard error (SE) = .04, p = .03). However, Hispanic density was no longer a significant predictor of depressive symptoms when neighborhood characteristics were controlled. The relationship of Hispanic density on depressive symptoms was moderated by nativity status. Among US-born patients with ACS, there was a significant positive relationship between Hispanic density and depressive symptoms and social support significantly mediated this effect. There was no observed effect of Hispanic density to depressive symptoms for foreign-born ACS patients.
  
  
  CONCLUSIONS
  Although previous research suggests that ethnic density may be protective against depression, our data suggest that among patients with ACS, living in a community with a high concentration of Hispanic individuals is associated with constrained social and economic resources that are themselves associated with greater depressive symptoms. These data add to a growing body of literature on the effects of racial or ethnic segregation on health outcomes.
authors.affiliation: Department of Psychology, College of Staten Island, The City University of New York, Staten Island, NY, USA ellenge.denton@csi.cuny.edu.
authors.forename: Ellen-Ge D
authors.initials: EG
authors.lastname: Denton
authors.affiliation: Department of Medicine, Columbia University Medical Center, New York, NY, USA.
authors.forename: Jonathan A
authors.initials: JA
authors.lastname: Shaffer
authors.affiliation: Department of Medicine, Columbia University Medical Center, New York, NY, USA.
authors.forename: Carmela
authors.initials: C
authors.lastname: Alcantara
authors.affiliation: Department of Medicine, Columbia University Medical Center, New York, NY, USA.
authors.forename: Lynn
authors.initials: L
authors.lastname: Clemow
authors.affiliation: Department of Psychology, St. John's University, Jamaica, NY, USA.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Brondolo
mesh_terms: D054058:Acute Coronary Syndrome / Q000523:psychology*; D000368:Aged; D019352:Censuses; D003863:Depression / Q000208:ethnology*; D005260:Female; D006630:Hispanic or Latino / Q000706:statistics & numerical data*; D006801:Humans; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D008913:Minority Groups; D009515:New Jersey / Q000208:ethnology; D009519:New York City / Q000208:ethnology; D011569:Psychiatric Status Rating Scales; D012944:Social Support; D012959:Socioeconomic Factors; D013315:Stress, Psychological
keywords: Ethnic density; United States; cardiovascular disease; depression; post–acute coronary syndrome; residential racial segregation; social support