Allostatic Load Biomarker Associations with Depressive Symptoms Vary among US Black and White Women and Men

Abstract

The prevalence and severity of depression differ in women and men and across racial groups. Psychosocial factors such as chronic stress have been proposed as contributors, but causes of this variation are not fully understood. Allostatic load, a measure of the physiological burden of chronic stress, is known to be associated with depression. Using data from the National Health and Nutrition Examination Survey 2005–2010, we examined the associations of nine allostatic load biomarkers with depression among US black and white adults aged 18–64 years (n = 6431). Depressive symptoms were assessed using the Patient Health Questionaire-9; logistic models estimated adjusted odds of depression based on allostatic load biomarkers. High-risk levels of c-reactive protein were significantly associated with increased odds of depression among white women (adjusted odds ratio (aOR) = 1.7, 95% CI: 1.1–2.5) and men (aOR = 1.8, 95% CI: 1.1–2.8) but not black women (aOR = 0.8, 95% CI: 0.6–1.1) or men (aOR = 0.9, 95% CI: 0.5–1.5). Among black men, hypertension (aOR = 1.7, 95% CI: 1.1–2.7) and adverse serum albumin levels (aOR = 1.7, 95% CI: 1.0–2.9) predicted depression, while high total cholesterol was associated with depression among black women (aOR = 1.6, 95% CI: 1.0–2.7). The associations between allostatic load biomarkers and depression varies with gendered race, suggesting that, despite consistent symptomatology, underlying disease mechanisms may differ between these groups.

Intersectional effects of racial and gender discrimination on cardiovascular health vary among black and white women and men in the CARDIA study

“…Extant epidemiological literature in accordance with the IP framework has identified gendered racial differences among black and white women and men in lung cancer treatment and mortality (Williams et al, 2012); in the protective effects of income on depression (Assari, 2018a, Assari, 2018b); in the association of depression with mortality (Assari, 2018a, Assari, 2018b); in the association of discrimination with CVD risk factors (Borrell, Diez-Roux, Kiefe, Williams, & Gordon-Larsen, 2013); and in the link between chronic stress and depression (Bey et al, 2016, 2018b); among other exposure-health combinations. These studies suggest that the contribution of discrimination to disparities in CVH may extend beyond gendered racial variation in exposure to gendered racial differences in the effect of perceiving interpersonal discrimination.…”

Health Disparities at the Intersection of Gender and Race: Beyond Intersectionality Theory in Epidemiologic Research

“…As a function of their subordinate social status, those who identify (and are identified) as female are therefore at increased risk for the identity threat which can cause sustained activation of the immune system's inflammatory response. In accordance with this theory, women and black persons are consistently found to have higher levels of inflammation than men and white persons, respectively [49,50]. These racial and gender disparities in inflammation may underlie the increased risk for conditions such as depression, which has been increasingly linked to chronic inflammation [43,48,49,51], among women (see Table 1).…”

“…In accordance with this theory, women and black persons are consistently found to have higher levels of inflammation than men and white persons, respectively [49,50]. These racial and gender disparities in inflammation may underlie the increased risk for conditions such as depression, which has been increasingly linked to chronic inflammation [43,48,49,51], among women (see Table 1). In conjunction with increasing psychological susceptibility through socialized helplessness, socially constructed subordinance can thus also act physiologically to increase female vulnerability to disorders that may be better classified as internalizing symptomatology.…”

“…Likewise, for some white women, gender discrimination impedes access to the full perceived benefits of whiteness, leading to social marginalization, identity threat, and the cognitions and health behaviors that predispose members of this group to inflammatory-based depressive disorders. These hypotheses are supported by emerging evidence of a link between cardiovascular disease and depression [48,74,75], making a case for the assertations that (a) black men and white women may share identity pathologies that manifest distinctly based on sociocultural contexts, and (b) ostensibly dissimilar symptoms of illness may stem from shared disease origins [49,76].…”

“…In support of this hypothesis, research demonstrates that allostatic load, a measure of cumulative physiological dysregulation stemming from chronic stress that precedes and correlates highly with many chronic diseases [86], is associated with depression among black men and white women, but not black women or white men ( Table 3) [64]. Furthermore, there is indication that the underlying neurobiology of depression differs among black women compared with black men, white women, and white men ( Table 1) [49,87]. The depressive response to deprivation among black women, rather than being a function of a perceived threat to deeply held selfconcepts that promotes sustained inflammation, as IP theory argues is more likely to be the case among black men and white women, may be based more in a situation-appropriate response to the uniquely disadvantaged social conditions in which black women are disproportionately situated.…”