Race and Unhealthy Behaviors: Chronic Stress, the HPA Axis, and Physical and Mental Health Disparities Over the Life Course

Abstract

Objectives We sought to determine whether unhealthy behaviors play a stress-buffering role in observed racial disparities in physical and mental health. Methods We conducted logistic regressions by race on data from the first 2 waves of the Americans’ Changing Lives Survey to determine whether unhealthy behaviors had buffering effects on the relationship between major stressors and chronic health conditions, and on the relationship between major stressors and meeting the criteria for major depression. Results Among Whites, unhealthy behaviors strengthened the relationship between stressors and meeting major-depression criteria. Among Blacks, however, the relationship between stressors and meeting major-depression criteria was stronger among those who had not engaged in unhealthy behaviors than among those who had. Among both race groups there was a positive association between stressors and chronic health conditions. Among Blacks there was an additional positive association between number of unhealthy behaviors and number of chronic conditions. Conclusions Those who live in chronically stressful environments often cope with stressors by engaging in unhealthy behaviors that may have protective mental-health effects. However, such unhealthy behaviors can combine with negative environmental conditions to eventually contribute to morbidity and mortality disparities among social groups.

Incorporating Persistent Pain in Phenotypic Frailty Measurement and Prediction of Adverse Health Outcomes

“…Nevertheless, participants who remained classified as frail or intermediately frail when adding persistent pain to the model had greater risk of adverse outcomes, suggesting that persistent pain captures some meaningful aspects of risk unexplained by other frailty indicators or covariates. Previous studies suggest that persistent pain and other frailty indicators may be signs of dysfunction in the hypothalamic-pituitary-adrenal axis and stress response (23,24), which are widely associated with poor mental and physical health outcomes (25)(26)(27)(28). Alternatively, persistent pain may represent a critical level of dysregulation severity, leading to age-related changes in pain Notes: ADL = activities of daily living; CESD = Centers for Epidemiologic Studies Depression; CI = confidence interval; HR = hazard ratio; IADL = instrumental activities of daily living.…”

Depressive symptomatology after spinal cord injury: A multi-center investigation of multiple racial-ethnic groups

“…To accomplish this goal, we oversampled underserved racial-ethnic groups, including Hispanic and non-Hispanic Black participants. Because health behaviors, pain, and fatigue not only impact mental health but also are associated with race-ethnicity, 36,37 we included smoking, binge drinking, fatigue, and pain interference as important correlates in our study to obtain unbiased estimation of the relationship between independent variables and depressive symptoms.…”

Ministers’ Perceptions of Church-Based Programs to Provide Depression Care for African Americans

“…Consistent with prior studies, ministers attributed depression among African Americans to harsh socioeconomic conditions. 37,[62][63][64] As such, interventions that solely target depressive symptoms may be insufficient to address the broader issues of chronic stress and suffering. 62 More research is needed to identify effective, interdisciplinary interventions which address the numerous factors contributing to suffering in many African American communities.…”

“…37,[62][63][64] As such, interventions that solely target depressive symptoms may be insufficient to address the broader issues of chronic stress and suffering. 62 More research is needed to identify effective, interdisciplinary interventions which address the numerous factors contributing to suffering in many African American communities. 58,65 One possible solution is to promote "collective recovery," a process of rebuilding social connections in under-served communities that lead to individual and group recovery.…”