By Erik J. Rodriquez, Ph.D., M.P.H.
We have all experienced stress at some point in time. For brief periods of stress, we may figure out a temporary way to cope which would limit the impact of the stressor on our health. However, stress that is brought on by taxing life events that accumulate over time (i.e., chronic stress) can have a significant influence on the mental health of older adults.
Depression among older adults can lead to fatal consequences through a number of pathways, such as illness or disease; decreased physical, cognitive, and/or social functioning; increased self-neglect; and higher risk of suicide. Some researchers hypothesize that stress from inequalities in social, economic, and environmental opportunities may cause worse mental health among racial/ethnic minorities, such as African Americans.
The relationship between chronic stress and depression may differ for Latinos
However, the relationship between chronic stress and depression may differ for Latinos. The prevalence of major depression is higher among Latinos (7.9–8.6 percent) than African Americans (4.2–5.6 percent) or whites (3.9–5.3 percent). This higher prevalence may be partially the result of a differential effect that chronic stress and unhealthy behaviors have on depression for Latinos. Unhealthy behaviors—such as cigarette smoking, obesity, and excessive alcohol drinking—differ by race/ethnicity, and several biological mechanisms have been identified to explain the use of unhealthy behaviors to cope with chronic stress. These same mechanisms may help explain the role of unhealthy behaviors in the relationship between chronic stress and depression.
Prevalence of major depression is higher among Latinos than African Americans and Whites
Past research has observed that among African American adults, as chronic stress increased, those who engage in unhealthy behaviors were able to prevent a future episode of clinical depression to some degree. Dr. Erik J. Rodriquez and his colleagues at the University of California, San Francisco (UCSF), decided to investigate whether unhealthy behaviors modified the effect of chronic stress on subsequent depression among Latinos as well as African American and white populations.
They hypothesized that engaging in one or more unhealthy behaviors would strengthen the relationship between chronic stress and depressive symptoms for Latinos and weaken this relationship among African Americans. Funding for their research was supported in part by the UCSF Clinical and Translational Science Institute, the National Institute on Aging, and the National Cancer Institute.
Dr. Rodriquez analyzed longitudinal, nationally representative data from the 2006 to 2008 Health and Retirement Study to assess the role of unhealthy behaviors in the relationship between chronic stress and significant depressive symptoms. Unhealthy behaviors included current smoking, excessive/binge drinking, and obesity. Chronic stress was defined by nine previously used factors.
Depressive symptoms were measured by the eight-item Center for Epidemiologic Studies Depression scale, with four or more symptoms defined as significant. Multivariable logistic regression assessed the effects of chronic stress and unhealthy behaviors in 2006 on significant depressive symptoms in 2008 among Latinos, African Americans, and white populations. An interaction term between the number of unhealthy behaviors and the number of chronic stressors was constructed and tested for each racial/ethnic group.
As chronic stress increased, Latinos who engaged in unhealthy behaviors more likely to report significant depressive symptoms
Their results showed that higher levels of chronic stress in 2006 increased the risk of depressive symptoms in 2008 among Latinos by 54 percent, African Americans by 78 percent, and white populations by 40 percent. Unhealthy behaviors modified this relationship among Latinos. More specifically, as chronic stress increased, Latinos who engaged in one or more unhealthy behaviors were more likely to report significant depressive symptoms in the future. Unhealthy behaviors did not change the relationship between chronic stress and significant depressive symptoms for either African Americans or white populations.
These findings revealed that unhealthy behaviors were not an effective coping mechanism for chronic stress in terms of preventing significant depressive symptoms. Some researchers have hypothesized that the relatively low prevalence of depression observed among African Americans may be the result of effective, yet unhealthy, behaviors that alleviate the symptoms of chronic stress. Some hypothesized that this form of coping works through the same biological mechanisms that contribute to some mental disorders. However, the results of Dr. Rodriquez and colleagues did not confirm this hypothesis.
While there is debate as to whether unhealthy behaviors are coping mechanisms for chronic stress among African Americans, limited published research has been able to either support or refute the relationships between chronic stress, unhealthy behaviors, and depression. Findings from their research add to some previous research that failed to confirm the association of coping with chronic stress through unhealthy behaviors using longitudinal, nationally representative data and clinical diagnoses of major depression. They concluded that unhealthy behaviors, cumulatively, may strengthen the relationship between chronic stress and depression among certain racial/ethnic groups such as Latinos.
The results of Dr. Rodriquez and colleagues add to our understanding of the role of unhealthy behaviors in the relationship between chronic stress and significant depressive symptoms as well as expand our knowledge from past research to another racial/ethnic group: Latinos. Their findings may also be used to inform the decisions of clinicians to screen and provide recommendations for stress and unhealthy behaviors among older aged Latinos who report symptoms of depression.
About the Author
Dr. Erik J. Rodriquez is an epidemiologist and research specialist in the Division of General Internal Medicine at UCSF. He specializes in behavior-related health disparities among racial/ethnic minority and immigrant populations. His research has investigated relationships between migration-, stress-, mental health–, and age-related factors and unhealthy behaviors.
Some of his current research includes: (1) determining whether smoking, drinking, being overweight or obese, and physical inactivity modify the relationship between biomarkers of stress and depressive symptomatology among middle and older aged Latino, African American/Black, and white adults; (2) investigating changes in cigarette consumption over time among Latinos and non-Latinos by birth cohort as well as among Latino national background groups; and (3) investigating the effect of nativity, acculturation, and socioeconomic status on smoking among Latino national background groups.
