Disentangling the effects of race and SES on arthritis-related symptoms, coping, and well-being in African American and White women

This study examined both unique and interactive effects of race and socioeconomic status (SES) on arthritis-related symptoms, coping, and well-being in African American and White women. Participants included 77 African American and 98 White women, aged 45 to 90, who completed structured, face-to-face interviews. A series of 2 x 2 MANCOVAs examined race (African American, White) and SES (high/low education or high/low occupational status) differences in arthritis-related symptoms, coping, and well-being. African Americans used more religious coping, wishful-thinking, seeking social support, and emotional expression than Whites. Individuals with low SES reported worse arthritis-related symptoms, poorer well-being, and greater use of coping strategies that tend to be maladaptive. Race x SES interactions revealed higher depressive symptoms in African Americans with low versus high education and coping differences in African Americans with low versus high occupational status; however differences in depressive symptoms and coping based on SES were not evident for Whites. Results demonstrate unique and interactive race and SES differences for arthritis-related symptoms, coping, and well-being showing the complexity of race and SES in the realm of physical and mental health.     

Race differences in the association of spiritual experiences and life satisfaction in older age

Objectives: The primary objective of this study was to examine an African American ‘faith advantage’ in life satisfaction. Specifically, we sought to test the hypothesis that the positive relationship between spiritual experiences and life satisfaction is stronger among older African Americans than among older Whites.

Method: The data came from 6864 community-dwelling persons aged 65+ (66% African American) who participated in the Chicago Health and Aging Project. Life satisfaction was measured using a five-item composite and we used a five-item version of the Daily Spiritual Experiences scale.

Results: In a regression model adjusting for age, sex, marital status, education, income and worship attendance, we found that African American race was associated with lower life satisfaction. We also found a positive association between spiritual experiences and life satisfaction. In an additional model, a significant race by spiritual experiences interaction term indicates that spiritual experiences are more positively associated with life satisfaction among African Americans.

Conclusion: The data suggest that at higher levels of spiritual experiences, racial differences in life satisfaction are virtually non-existent. However, at lower levels of spiritual experiences, older African Americans show modestly lower levels of life satisfaction than do older Whites. This pattern suggests that spiritual experiences are a positive resource – distinct from worship attendance – that enable older African Americans to overcome decrements in life satisfaction and, in fact, that lower spiritual experiences may be especially harmful for older African American's life satisfaction.     

Self-system Processes as a Mediator of School Connectedness and Depressive Symptomatology in African American and European American Adolescents

School connectedness, or how much an adolescent feels supported and accepted at their school, can protect children negative adolescent mental health outcomes, including depressive symptoms. One potential explanatory mechanism for the relationship between school connectedness and depressive symptoms may be organized views of the self, called self-system processes. Self-system processes were conceptualized in this study as a composite of self-esteem, coping efficacy, and perceived competence. The present study tested self-system processes as a mediator of the relationship between school connectedness and depressive symptoms in a sample of 260 African American and European American adolescents aged 13–19 years. Self-system processes partially mediated the relationship between school connectedness and depressive symptoms for African American adolescents and fully mediated this relationship for European American adolescents. These findings underscore the need for a better understanding of how school-related variables differentially impact mental health outcomes for specific racial groups.     

Brief report: Explaining differences in depressive symptoms between African American and European American adolescents

African American adolescents report more depressive symptoms than their European American peers, but the reasons for these differences are poorly understood. This study examines whether risk factors in individual, family, school, and community domains explain these differences. African American and European American adolescents participating in the Birmingham Youth Violence Study (N = 594; mean age 13.2 years) reported on their depressive symptoms, pubertal development, aggressive and delinquent behavior, connectedness to school, witnessing violence, and poor parenting. Primary caregivers provided information on family income and their education level, marital status, and depression, and the adolescents' academic performance. African American adolescents reported more depressive symptoms than European American participants. Family socioeconomic factors reduced this difference by 29%; all risk factors reduced it by 88%. Adolescents' exposure to violence, antisocial behavior, and low school connectedness, as well as lower parental education and parenting quality, emerged as significant mediators of the group differences in depressive symptoms.     

The influence of social support on depressive symptoms in cancer patients: age and gender differences

PURPOSE: The relationship between social support and depressive symptomatology in cancer patients is well established, yet the extent to which patient variables impact this relationship is not well known. The purpose of this study was to examine whether the relationship of social support to the severity of depressive symptoms varies by patient age and gender. DESCRIPTION OF THE STUDY: A sample of 342 cancer outpatients were administered self-report measures of depressive symptoms, perceived adequacy of social support, satisfaction with family functioning, and the size of their social support network. RESULTS: There were no significant differences by gender or age in the relationship of the social support variables to depressive symptoms. Although not statistically significant, interesting differences did emerge: a larger social support network was associated with less severe depression for female patients and for younger patients but not for male patients or older patients. For the entire sample, greater perceived adequacy of support and more satisfaction with family functioning were related to less severe depression. CONCLUSIONS: The findings of the study suggest that interventions to alleviate depressive symptoms in cancer patients may be designed with consideration of demographic characteristics such as age and gender to maximize the beneficial impact on quality of life.     

Social support and cognitive functioning as resources for elderly persons with chronic arthritis pain

Objective: Arthritis pain and depression are prevalent physical and psychological disorders in late life and co-occur frequently. We explored the stability and covariation of arthritis pain and depressive symptoms. We also addressed the influence of cognitive functioning and social support on the relationship between pain and depressive symptoms among community-dwelling older individuals.

Method: This longitudinal study utilized a sample of 299 residents of Florida retirement communities who participated in a long-term panel study using yearly assessments across 4 years. Using multilevel modeling, we modeled the individual differences as well as stability in arthritis pain and depressive symptoms simultaneously. Further, we tested the role of cognitive functioning and social support in the association between arthritis pain and depressive symptoms.

Results: We found substantial within-person variation in both pain and depressive symptoms (between 58% and 65%) across 4 years even after controlling for a time effect. After controlling for arthritis pain, persons with higher social support and higher cognitive functioning reported lower levels of depressive symptoms.

Discussion: Findings suggest that fluctuations in pain and depressive symptoms are common for older adults. Furthermore, social support and intact cognitive functioning may serve as useful resources, as they buffer the negative impact of arthritis pain on depressive symptoms.     

Mental health and diurnal salivary cortisol patterns among African American and European American female dementia family caregivers.

Using a sociocultural stress and coping model, this pilot study examines the influence of depressive symptoms and stress on diurnal salivary cortisol patterns among African American (N=30) and European American (N=24) female dementia caregivers and noncaregivers (African American, N=48; European American, N=15). Caregiving participants completed the Center for Epidemiological Studies Depression Scale (CES-D), Perceived Stress Scale (PSS), and Stress-Related Growth Scale (SRGS) as respective measures of depressive symptoms, stress, and stress resilience. Participants also collected five saliva samples daily for two consecutive days. African American caregivers scored significantly higher than European American caregivers on the SRGS, but they did not differ on the PSS and CES-D scales. Regression analyses with age, ethnicity, caregiving status, and depressive symptoms as predictors, and cortisol slope as criterion, showed that only age and ethnicity predicted cortisol slope. African Americans had flatter slopes than the European Americans sampled, regardless of caregiving status. Findings highlight the role of cultural beliefs and of ethnicity in explaining cortisol function.     

Is the association between social network types,depressive symptoms and life satisfaction mediated by the perceived availability of social support? A cross-sectional analysis using the Canadian Longitudinal Study on Aging

Abstract

Objectives: The objectives of this study were to examine: 1) whether the relationship between social network types, depressive symptoms and life satisfaction is mediated by different types of perceived social support; and, 2) whether social support plays a mediational role for married versus unmarried older adults.

Methods: The study was based on national, baseline data (Tracking Cohort) from the Canadian Longitudinal Study on Aging for participants aged 65 to 85 (N?=?8782). Five social network types derived from cluster analysis were used as predictors in the mediation analyses, with the four social support subscales of the Medical Outcomes Survey (MOS) Social Support Survey (tangible, emotional, positive social interactions, and affectionate) included as mediators, and depressive symptoms and life satisfaction as outcome variables. Socio-demographic and physical health variables were included as covariates.

Results: Significant indirect effects emerged, with less diverse social network structures generally associated with less social support which, in turn, was related to more depressive symptoms and lower life satisfaction. However, different findings emerged for different types of social support, for participants who were married and unmarried, and for depressive symptoms versus life satisfaction.

Conclusion: Our findings suggest that restricted social networks that are reflective of social isolation, as well as those that are intermediate in terms of their diversity can create gaps in perceived social support and, consequently, can negatively impact mental health and life satisfaction.     

Suicidality and depression among african american adolescents: the role of family and peer support and community connectedness

Rates of suicide are increasing among African American adolescents and pose a significant public health concern. One area that has received little attention is the relationship between various types of social support and suicide, and the extent to which support moderates the relationship between depressive symptoms and suicidality. A total of 212 African American adolescents completed in-school surveys on three types of social support: family support, peer support, and community connectedness. The survey also addressed depressive symptoms and suicidality, as measured by reasons for living, a cognitive measure of suicide risk. Hierarchical multiple regression analyses were used to examine direct and moderating relationships between types of social support and suicidality. The results indicated that increased family support and peer support are associated with decreased suicidality, and peer support and community connectedness moderated the relationship between depressive symptoms and suicidality. Over a third of the variability in reasons for living was predicted by family support, peer support, and community connectedness. Implications for research and preventative interventions for African American adolescents are discussed.     

Spouses' quality of life 1 year after stroke: prediction at the start of clinical rehabilitation

BACKGROUND AND PURPOSE: The purpose of this prospective study was to identify early predictors of spouses' quality of life at 1 year after stroke. METHODS: At the start of clinical rehabilitation patient and caregiver characteristics, psychological factors, harmony in the relationship and social support were assessed. One year after stroke, caregiver burden (Caregiver Strain Index), life satisfaction (Life Satisfaction Checklist) and depressive symptoms (Goldberg Depression Scale) were assessed in 187 participants. Multiple regression analyses were performed. RESULTS: About 80% of the spouses reported low quality of life on one or more of the measures; 52% reported depressive symptoms, 54% significant strain and only 50% was satisfied with life as a whole. The regression analysis identified 'passive coping strategy of the caregiver' as the most important predictor. ADL dependency was the only baseline patient characteristic significantly related to burden and life satisfaction, but explained just 0-4% of the variance. CONCLUSIONS: A large proportion of caregivers perceive impaired quality of life 1 year after stroke. Caregivers at risk should be identified at the start of rehabilitation by means of coping measurement instruments or selected anamneses on coping.     

Epstein-Barr virus reactivation during pregnancy and postpartum: Effects of race and racial discrimination

ObjectiveAdverse pregnancy outcomes, including preterm birth, are markedly higher among African–Americans versus Whites. Stress-induced immune dysregulation may contribute to these effects. Epstein-Barr virus (EBV) reactivation provides a robust model for examining cellular immune competence. This study examined associations of EBV virus capsid antigen immunoglobulin G (VCA IgG) with gestational stage, race, and racial discrimination in women during pregnancy and postpartum.MethodsFifty-six women (38 African–American, 18 White) were included. African–Americans and Whites did not differ in age, education, income, parity, or body mass index (ps ? .51). During the 1st, 2nd, and 3rd trimester and ～5 weeks postpartum, women completed measures of racial discrimination, perceived stress, anxiety, depressive symptoms and health behaviors. EBV VCA IgG antibody titers were measured via ELISA in serum collected at each visit.ResultsIn the overall sample, EBV VCA IgG antibody titers were lower in the 3rd versus 1st trimester (p = .002). At every timepoint (1st, 2nd, 3rd trimester and postpartum), African–American women exhibited higher serum EBV VCA IgG antibody titers than Whites (ps < .001). This effect was most pronounced among African–Americans reporting greater racial discrimination [p = .03 (1st), .04 (2nd), .12 (3rd), .06 (postpartum)]. Associations of race and racial discrimination with EBV VCA IgG antibody titers were not accounted for by other measures of stress or health behaviors.ConclusionsCompared to Whites, African–American women showed higher EBV VCA IgG antibody titers, indicative of impaired cellular immune competence, across pregnancy and postpartum. This effect was particularly pronounced among African–American women reporting greater racial discrimination, supporting a role for chronic stress in this association. In women overall, EBV antibody titers declined during late as compared to early pregnancy. This may be due to pregnancy-related changes in cell-mediated immune function, humoral immune function, and/or antibody transfer to the fetus in late gestation. As a possible marker of stress-induced immune dysregulation during pregnancy, the role of EBV reactivation in racial disparities in perinatal health warrants further attention.     

Psychosocial predictors of first-onset depression in Chinese Americans

Background: This study examines the longitudinal and concurrent risk factors associated with first-onset major depression in a community sample of 1747 Chinese Americans in Los Angeles. Methods: The relative contributions of demographic, health, psychiatric, psychosocial, and cultural variables were assessed in a series of longitudinal and concurrent hierarchical multivariable analyses. Results: Results of the longitudinal analyses indicated that the risk for experiencing a first major depressive episode at 18-months follow-up was higher for those who initially rated their health as poor, reported higher depressive symptoms, and perceived higher levels of social support. After controlling for prior health and psychiatric and psychosocial status at time 1, the results of the concurrent analyses indicated that the risk for experiencing a first major depressive episode at time 2 was higher for those who rated their health as poor, had at least one other psychiatric disorder, were bilingual, experienced high levels of life stress, and perceived themselves as having low and/or decreased social supports. Conclusions: The results of this study confirm previous evidence that psychosocial vulnerabilities, including higher acculturation, greater stress exposure and reduced social supports, are important predictors of risk for first-onset depressive episodes. Prevention and treatment implications are addressed, and future directions for research are offered. Accepted: 1 October 1999     

Reciprocal relationship between social support and depressive symptoms among Chinese elderly

For many Hong Kong Chinese elderly, depression is a quite common occurrence. This study examines the reciprocal relationship between social support and depressive symptoms. The data came from a longitudinal study of a representative community sample of the elderly population in Hong Kong. Using multiple regression models, the authors found that elderly persons who reported depressive symptoms more frequently were likely to receive higher levels of social support from family members living with elders, but lower levels of social support from friends three years later, even after controlling for socio-demographic and physical health status variables. In addition, elderly people who received more social support from family members not living with elders reported fewer depressive symptoms three years later.     

Racial differences in cognitive decline in a sample of community-dwelling older adults: the mediating role of education and literacy.

OBJECTIVE: The authors examined racial differences in cognitive decline (CD) and the role of education and literacy in mediating this relationship. METHODS: The relationship between race and CD was examined over a 3-year period in a biracial community sample of older adults (N = 3,097) living in North Carolina. RESULTS: African Americans, as compared with White participants, had fewer years of education and were more likely to be assessed by the interviewer as not literate. Race predicted CD such that African Americans had higher rates than Whites. When education and literacy were entered into the analysis, the association between race and CD, although remaining statistically significant, was reduced and was of relatively weak magnitude. Also, physical functioning problems also predicted CD and were found to be greater in African Americans than in Whites. CONCLUSIONS: Education and literacy may be protective factors against CD. Socioeconomic disadvantages experienced by older African Americans in the South early in life, leading to poorer educational opportunities, may explain, in part, the increased rates of CD in older African Americans versus Whites.     

Social skills and behavior problems of urban, African American preschoolers: role of parenting practices, family conflict, and maternal depression

This study examined the role of parenting, family routines, family conflict, and maternal depression in predicting the social skills and behavior problems of low-income African American preschoolers. A sample of 184 African American mothers of Head Start children completed participant and child measures in a structured interview. Results of regression analyses revealed that mothers who utilized more positive parenting practices and engaged in more family routines had children who displayed higher levels of total prosocial skills. Positive parenting and lower levels of maternal depressive symptoms were predictive of fewer externalizing and internalizing child behavior problems. Lower family conflict was linked with fewer externalizing problems. Implications of the study for future research and intervention are discussed.     

Ethnic and racial differences in clinically relevant symptoms in active duty military personnel with posttraumatic stress disorder

Previous research has shown racial/ethnic differences in Vietnam veterans on symptoms related to posttraumatic stress disorder (PTSD). The current study explored racial/ethnic differences in PTSD symptoms and clinically relevant symptoms. Resilience and social support were tested as potential moderators of racial/ethnic differences in symptoms. The sample included 303 active duty male service members seeking treatment for PTSD. After controlling for age, education, military grade, and combat exposure, Hispanic/Latino and African American service members reported greater PTSD symptoms compared to non-Hispanic White service members. Higher alcohol consumption was endorsed by Hispanic/Latino service members compared to non-Hispanic White or African American service members, even after controlling for PTSD symptom severity. No racial/ethnic differences were found with regard to other variables. These results suggest that care should be made to thoroughly assess PTSD patients, especially those belonging to minority groups, for concurrent substance use problems that may impede treatment utilization or adherence.     

Racial differences in the frequency of depressive symptoms among community dwelling elders: the role of socioeconomic factors

In a biracial sample of community dwelling elders (n=4162, the Duke EPESE), African-Americans endorsed more items than Whites on a standardized depression scale, the CES-D, in unadjusted, cross-sectional analyses. However, indices of socioeconomic status (e.g., education and problems meeting needs) were found to mediate the relationship between race and depression. When these socioeconomic variables were included in cross-sectional analyses, the association between depressive symptoms and race reversed such that Whites were significantly more likely to endorse depressive symptoms than African-Americans. Further, whereas in unadjusted, longitudinal analyses, race was unrelated to changes in depressive symptoms over time, with the inclusion of the socioeconomic variables Whites were found to endorse more depressive symptoms than African-Americans. We conclude that socioeconomic variables influence the size and direction of racial differences in the endorsement of depressive symptoms in community dwelling elders.     

Ethnic/racial differences in weight-related concerns and behaviors among adolescent girls and boys: findings from Project EAT

OBJECTIVE: To compare weight-related concerns and behaviors across ethnicity/race among a population-based sample of adolescent boys and girls. METHODS: The study population included 4746 adolescents from urban public schools in the state of Minnesota who completed surveys and anthropometric measurements as part of Project EAT (Eating Among Teens), a population-based study focusing on eating patterns and weight concerns among teenagers. Main outcome measures included measured body mass index (BMI), weight-related concerns (perceived weight status, weight disparity, body satisfaction and attitudes about weight control) and weight-related behaviors (general/specific weight control behaviors and binge eating). RESULTS: In comparison to White girls, African American girls tended to report fewer weight-related concerns/behaviors, while Hispanic, Asian American and Native American girls tended to report similar or more concerns/behaviors. Among boys, weight-related concerns/behaviors were equally or more prevalent among all non-Whites than among Whites. In particular, African American and Asian American boys were at greater risk for potentially harmful weight-related concerns/behaviors than White boys. CONCLUSIONS: Weight-related concerns and behaviors are prevalent among adolescents, regardless of their ethnic/racial background, indicating a need for prevention and treatment efforts that reach adolescents of different ethnic backgrounds. However, ethnic differences demonstrate a need for ensuring that the specific needs of different groups are addressed in the development of such interventions.     

Association between incongruence about survivor function and outcomes among stroke survivors and family caregivers

Background: Stroke survivors and family caregivers often have incongruent appraisals of survivor cognitive, physical, and psychosocial function. Partner incongruence contributes to poor outcomes for survivors and caregivers.

Objectives: This study explored whether partner incongruence: (1) differs by function domain; (2) increases or decreases over time, and; (3) is associated with self-rated health, distress, stress, and depressive symptoms.

Methods: Structured surveys were administered to 32 survivors and caregivers at approximately 3 (enrollment) and 7 months (follow-up) post-stroke. Paired t-tests were used to examine partners’ ratings of survivor function at enrollment and follow-up, and changes in incongruence over time. Partial correlations were used to examine the association between incongruence at enrollment and outcomes at follow-up.

Results: Survivors consistently rated their own memory and thinking as significantly better than caregivers rated their memory and thinking. At follow-up, survivors rated their own communication as significantly better than caregivers rated their communication. Incongruence about survivor memory and thinking was associated with survivor distress, as well as caregiver distress, stress, and depressive symptoms. Incongruence about survivor ADLs was associated with caregiver stress and depressive symptoms. Incongruence about survivor social participation was associated with caregiver distress.

Conclusions: Findings from this study suggest that survivors and caregivers often have incongruent appraisals of survivor function, that incongruence does not improve naturally over time, and that incongruence may be detrimental for survivor and caregiver outcomes. Further research should be directed at the mitigation of incongruence and strategies to improve outcomes for both survivors and family caregivers.     

Gender differences in sexual behaviors of AD patients and their relationship to spousal caregiver well-being

Objectives: Little is known about gender differences in sexuality among community-dwelling heterosexual couples in which one partner has Alzheimer's disease (AD). Few studies have examined gender differences in specific sexual behaviors or their associations with caregiver well-being. This study evaluated the impact of gender differences on intimacy and sexual satisfaction in marital relationships in which one partner has AD.

Method: Baseline measures were collected from 162 AD patients and their partners enrolled in a multi-site study between 2001 and 2009 to evaluate gender differences in measures of intimacy, caregiver well-being, and patient sexual behaviors.

Results: While over 70% of all patients initiated physically intimate activities (i.e., kissing, hugging, and intercourse), most did not initiate intercourse specifically. Female caregivers reported higher levels of stress and depressive symptoms than male caregivers (p?r?=??0.29, p?p's?

Conclusion: The majority of couples dealing with AD reported engaging in intimacy, suggesting its importance in the relationship. Female caregivers who reported less sexual satisfaction reported more frequent stress and depressive symptoms. Caregiver gender, satisfaction with intimacy, and the AD patient's level of cognitive functioning significantly contributed to caregiver well-being. Gender-specific therapies to address patient sexual difficulties and caregiver well-being could potentially maintain or improve the marital relationship.