Racial/ethnic disparities in midlife depressive symptoms: The role of cumulative disadvantage across the life course

Perceived neighborhood disorder and type 2 diabetes disparities in Hispanic, Black, and White Americans

Introduction

Approximately 32 million Americans have type 2 diabetes, and that number continues to grow. Higher prevalence rates are observed among certain subgroups, including members of marginalized racial/ethnic groups as well as residents of disordered neighborhoods (i.e., those with more trash and vandalism). Institutionalized discriminatory practices have resulted in disproportionate representation of marginalized racial/ethnic groups in disordered neighborhoods compared to non-Hispanic Whites. These neighborhood disparities may partially contribute to health disparities, given that signs of neighborhood disorder often relate to a general withdrawal from the neighborhood, minimizing opportunities for both physical and social engagement. Yet, research suggests variability across racial/ethnic groups both in reporting rates of neighborhood disorder and in the extent to which neighborhood disorder is interpreted as posing a threat to health and well-being.

Methods

Using 2016-2018 Health and Retirement Study data (n = 10,419, mean age = 67 years), a representative sample of older US adults, this study examined the possibility of racial/ethnic differences in associations between perceived neighborhood disorder and type 2 diabetes risk. Participants reported their perceptions of neighborhood disorder and type 2 diabetes status. Weighted logistic regression models predicted type 2 diabetes risk by perceived neighborhood disorder, race/ethnicity, and their interaction.

Results

Non-Hispanic Blacks and Hispanics had higher type 2 diabetes risk; these two groups also reported more disorder in their neighborhoods compared to non-Hispanic Whites. Perceiving more neighborhood disorder was associated with increased type 2 diabetes risk, but the interaction between race/ethnicity and disorder was not significant.

Discussion

Findings from the current study suggest that the negative effects of perceiving neighborhood disorder, a neighborhood-level stressor, extend to increased type 2 diabetes risk.

Depressive Symptom Subgroups and Their Association with Prevalent and Incident Cardiovascular Risk Factors in the Coronary Artery Risk Development in Young Adults (CARDIA) Study

BACKGROUND

We sought to identify depressive symptom subgroups in a community sample of young adults, investigate their stability over time, and determine their association with prevalent and incident cardiovascular disease (CVD) risk factors.

METHOD

Participants were 3377 adults from the Coronary Artery Risk Development in Young Adults study. Using latent class and latent transition analysis, we derived subgroups based on items of the 20-item version of the Center for Epidemiologic Studies Depression Scale in 1990, and examined patterns of change over a 10-year period (1990-2000). Cox regression models were used to examine associations between subgroup membership and prevalent (2000) and incident (2000 to 2016) obesity, hypertension, and diabetes.

RESULTS

Three baseline subgroups were identified and labeled: "No Symptoms" (63.5%), "Lack of Positive Affect" (PA, 25.6%), and "Depressed Mood" (10.9%). At 10-year follow-up, individuals in "No Symptoms" subgroup had the highest probability (0.84) of being classified within the same subgroup. Participants classified as "Lack of PA" were likely (0.46) to remain in the same subgroup or be classified as "No Symptoms." Participants in the "Depressed Mood" were most likely to transition to the "Lack of PA" subgroup (0.38). Overall, 30.5% of participants transitioned between subgroups, with 11.4% classified as "Worsening" and 19.1% as "Improving." Relative to the "No Symptoms Stable," other subgroups ("Depressed Stable," "Worsening," and "Improving") were associated with prevalent obesity and hypertension.

CONCLUSION

We identified distinct depressive symptom subgroups that are variably stable over time, and their change patterns were differentially associated with CVD risk factor prevalence.

Racial biases in healthcare: Examining the contributions of Point of Care tools and unintended practitioner bias to patient treatment and diagnosis

Sophisticated algorithms are used daily to search through hundreds of medical journals in order to package updated medical insights into commercial databases. Healthcare practitioners can access these searchable databases-called Point of Care (PoC) tools-as downloadable apps on their smartphones or tablets to comprehensively and efficiently inform patient diagnosis and treatment. Because racist biases are unintentionally incorporated into the search reports that the companies generate and that practitioners regularly access, the aim of this article is to examine how healthcare practitioners' "pre-existing" racial stereotypes interact with pithy conclusions about race and ethnicity in PoC tools. I use qualitative research methods (content analysis, discourse analysis, open-ended semi-structured interviews, and role play) to frame the analysis within the Public Health Critical Race Praxis (PHCRP). This approach facilitates an understanding of how biological racism-the use of scientific evidence to support inherent differences between races-that is embedded in PoC algorithms informs a practitioner's assessment of a patient, and converges with persistent racial bias in medical training, medical research and healthcare. I contextualize the study with one semi-structured interview with an Editor of a leading PoC tool, MedScope (pseudonomized), and 10 semi-structured interviews with healthcare practitioners in S.E. Ontario, Canada. The article concludes that PoC tools and practitioners' personal biases contribute to racial prejudices in healthcare provision. This warrants further research on racial bias in medical literature and curriculum design in medical school.

Evolution of smoking rates among immigrants in France in the context of comprehensive tobacco control measures, and a decrease in the overall prevalence

BACKGROUND

The evolution of smoking rates according to migrant status has not been examined in France, despite a recent reduction in overall smoking rates.

METHODS

DePICT is a two waves (2016: n = 4356; 2017: n = 4114) nationwide telephone survey, representative of the French adult population. We compared smoking-related behaviors before and after implementation of tobacco-control measures (2017), according to the geographical region of birth.

RESULTS

Compared to 2016, individuals originating from Africa or the Middle East had a slightly higher smoking prevalence in 2017 (34.7% vs 31.3%), despite a higher intention to quit or attempt in the preceding year (adjusted OR(ORa) = 2.72[1.90; 3.90]) compared to non-immigrants. They were also less likely to experience an unsuccessful quit attempt (ORa = 1.76[1.18; 2.62]).

CONCLUSION

Tobacco-control measures could have widened smoking inequalities related to migrant status. The evolution of smoking-related behaviors among immigrants should be examined when studying the long-term effects of such policies.

Stressful social environment and financial strain drive depressive symptoms, and reveal the effects of a FKBP5 variant and male sex, in African Americans living in Tallahassee

OBJECTIVES

The World Health Organization estimates that almost 300 million people suffer from depression worldwide. African Americans are understudied for depression-related phenotypes despite widespread racial disparities. In our study of African Americans, we integrated information on psychosocial stressors with genetic variation in order to better understand how these factors associated with depressive symptoms.

METHODS

Our research strategy combined information on financial strain and social networks with genetic data to investigate variation in symptoms of depression (CES-D scores). We collected self-report data on depressive symptoms, financial strain (difficulty paying bills) and personal social networks (a model of an individual's social environment), and we genotyped genetic variants in five genes previously implicated in depressive disorders (HTR1a, BDNF, GNB3, SLC6A4, and FKBP5) in 128 African Americans residing in Tallahassee, Florida. We tested for direct and gene-environment interactive effects of the psychosocial stressors and genetic variants on depressive symptoms.

RESULTS

Significant associations were identified between high CES-D scores and a stressful social environment (i.e., a high percentage of people in participants' social network who were a source of stress) and high financial strain. Only one genetic variant (rs1360780 in FKBP5) was significantly associated with CES-D scores and only when psychosocial stressors were included in the model; the T allele had an additive effect on depressive symptoms. Sex was also significantly associated with CES-D score in the model with psychosocial stressors and genetic variants; males had higher CES-D scores. No significant interactive effects were detected.

CONCLUSIONS

A stressful social environment and material disadvantage increase depressive symptoms in the study population. Additional associations with FKBP5 and male sex were revealed in models that included both psychosocial and genetic data. Our results suggest that incorporating psychosocial stressors may empower future genetic association studies and help clarify the biological consequences of social and financial stress.

Lifetime Exposure to Conversion Therapy and Psychosocial Health Among Midlife and Older Adult Men Who Have Sex With Men

BACKGROUND AND OBJECTIVES

Conversion therapies to minimize same-sex attractions are classified as a dangerous practice by numerous scientific institutions in the United States. These practices may contribute to poor long-term psychosocial health, thereby interrupting processes of healthy aging. Few studies have examined psychosocial differences between persons with and without prior experiences of conversion therapy. We assessed associations between prior conversion therapy experiences and psychosocial health among midlife and older men who have sex with men (MSM; age 40+ years).

RESEARCH DESIGN AND METHODS

Participants included a multicity sample of MSM (N = 1,156) enrolled in the Multicenter AIDS Cohort Study who completed health surveys (2016-2019) as part of their biannual study visits. Using multivariable regressions, we investigated the associations of prior conversion therapy with current depressive symptoms, internalized homophobia, post-traumatic stress, and cumulative psychosocial conditions. Using a trait-level measure (e.g., life purpose and perseverance), we tested whether resilience moderated these associations.

RESULTS

The full sample was predominantly non-Hispanic white with a mean age of 62.6 years. Fifteen percent of men (n = 171/1,156) reported prior conversion therapy. In multivariable models, men exposed to conversion therapy were more likely to have depressive symptoms and above-average internalized homophobia. Men exposed to conversion therapy had 2-2.5 times the odds of reporting 1 and ≥2 psychosocial conditions, respectively, compared with those who reported 0 conditions. Resilience did not moderate these associations.

DISCUSSION AND IMPLICATIONS

Conversion therapies are nonaffirming social stressors for MSM and may compromise critical psychosocial aspects of healthy aging among MSM.

Intersectionality in quantitative health disparities research: A systematic review of challenges and limitations in empirical studies

RATIONALE

Quantitative health disparities research has increasingly employed intersectionality as a theoretical tool to investigate how social characteristics intersect to generate health inequality. Yet, intersectionality was not designed to quantify, predict, or identify health disparities, and, as a result, multiple criticisms against its misapplication in health disparities research have been made. As such, there is an emerging need to evaluate the growing body of quantitative research that aims to investigate health disparities through an intersectional lens.

METHODS

We conducted a systematic review from earliest records to January 2020 to (i) describe the scope of limitations when applying intersectionality to quantitative health disparities research, and (ii) identify recommendations to improve the future integration of intersectionality with this scholarship. We identified relevant publications with electronic searches in PubMed and CA Web of Science. Studies eligible for inclusion were English-language publications that used quantitative methodologies to investigate health disparities among adults in the U.S. while explicitly claiming to adopt an intersectional perspective. Out of 1279 articles reviewed, 65 were eligible for inclusion.

RESULTS

Our review found that, while the value of intersectionality to the study of health disparities is evident, the existing research struggles with meeting intersectionality's fundamental assumptions. In particular, four limitations were found to be widespread: narrowing the measurements of intersectionality, intersectional groups, and health outcomes; placing primacy on the study of certain intersectional groups to the neglect of others; overlooking underlying explanatory mechanisms that contribute to the health disparities experienced by intersectional groups; and, lacking in the use of life-course perspectives to show how health disparities vary across different life stages.

CONCLUSION

If the goal of health equality is to be achieved among diverse intersectional groups, future research must be assisted by the collection and examination of data that overcomes these limitations.

Experiences of Racial and Ethnic Discrimination Are Associated with Food Insecurity and Poor Health

This study examines the associations of mothers’ experiences of discrimination (EODs) with household food insecurity (HFI), physical health, and depressive symptoms, while taking into account the influence of mothers’ Adverse Childhood Experiences (ACEs) and public assistance participation. Mothers (N = 1372) of young children under age 4 who self-identified as Latinx, Non-Latinx Black/African American and Non-Latinx white answered questions for a cross-sectional survey in an emergency room in a large children’s hospital in Philadelphia between 2016 and 2018. Logistic regression was used to model associations of EODs in specific settings with HFI, depressive symptoms, and physical health. Compared to those without EODs, mothers with EODs from police/courts and in workplaces had higher odds of HFI, AOR =2.04 (95% CI: 1.44–2.89) and AOR = 1.57 (95% CI: 1.18–2.11), respectively. Among Latinx mothers, EODs in school were associated with nearly 60% higher odds of HFI and nearly 80% higher odds of depressive symptoms. Latinx and Black mothers with EODs in workplaces had higher odds of HFI (AOR = 1.76, 95% CI: 1.21–2.56 and AOR = 1.46, 95% CI: 1.05–2.36, respectively), compared to mothers without EODs. Discrimination is associated with HFI, depressive symptoms, and poor health. Public health interventions intended to improve food security and health may be only partially effective without simultaneously addressing racism and discrimination.

Exploring Causes of Depression and Anxiety Health Disparities (HD) by Examining Differences between 1:1 Matched Individuals

Poor comparability of social groups is one of the major methodological problems that threatens the validity of health disparities (HD) research findings. We illustrate a methodological solution that can additionally unpack the mechanisms behind differential effects on depression and anxiety. We describe racial/ethnic differences in the prevalence of depression and anxiety scores between Black and White women using classic methods, and then we illustrate a 1:1 matching procedure that allows for building of individual-level difference scores, i.e., actual HD difference score variables, for each pair of comparable participants. We compare the prevalence of depression disorder between Black and White young women after matching them 1:1 on common socio-economic characteristics (age, employment, education, and marital status). In essence, we follow matching or stratification methods, but make a step further and match cases 1:1 on propensity scores, i.e., we create Black–White ‘dyads’. Instead of concluding from plain comparisons that 11% more White young women (18–30 years old) report a depressive disorder than Black young women, the matched data confirms the trend, but provides more nuances. In 27% of the pairs of comparable pairs the White woman was depressed (and the comparable Black woman was not), while in 15% of the pairs the Black woman was depressed (and the comparable White woman was not). We find that Black-to-White disparities in neighborhood disorder do not predict depression differences (HDs), while such an effect is evident for anxiety HDs. The 1:1 matching approach allows us to examine more complex HD effects, like differential mediational or resilience mechanisms that appear to be protective of Black women’s mental health.

[Inequities in mental health: admissions for psychosis in public hospitals of the Comunitat Valenciana (2008-2015)]

OBJECTIVE

The prevalence of mental health problems is increasing throughout the world. Certain population groups have more probability to suffer mental disorders, which may generate inequities in health. The main of this paper is analyze the differences in the frecuency of hospital admissions according to different inequities dimensions (age, sex and country of birth) of the populaion between 15 and 49 years old between 2008 and 2015 in the Comunitat Valenciana (Spain).

METHODS

Transversal study based on all admissions for Diagnosis-related group "Psychosis" in public centers in the Comunitat Valenciana. Sources of information were Minimum Basic Data Set and Population Information System. Descriptive analysis of clinical and social variables was conducted, and differences among subgroups were analyzed by t-Student test for the comparison of a quantitative variable and χ2 test for the comparison of a qualitative variable, as well as the exact Wilcoxon and the Fisher test when application conditions were not satisfied.

RESULTS

there were studied 23869 admissions for psychosis generated by 11265 patients. Most of these admissions were because of schizophrenia disorders (39.44%). When comparing by sex, differences in diagnosis were observed, being more frequent psychotic mood disorders in women (39.3%). There also observed differences when comparing by country of birth, being more frequent "Other non-organic psychosis" in foreign people (40.5%). Differences were found regarding mortality during admission, being higher in men (5.1% vs. 4%) and in foreign people (5.3% vs. 3.8%).

CONCLUSIONS

There have been detected inequities in the frequency of psychosis admissions in the Comunitat Valenciana. These differences are observed around different dimensions such as age, gender and country of origin.

Examining Differential Resilience Mechanisms by Comparing 'Tipping Points' of the Effects of Neighborhood Conditions on Anxiety by Race/Ethnicity

Exposure to adverse environmental and social conditions affects physical and mental health through complex mechanisms. Different racial/ethnic (R/E) groups may be more or less vulnerable to the same conditions, and the resilience mechanisms that can protect them likely operate differently in each population. We investigate how adverse neighborhood conditions (neighborhood disorder, NDis) differentially impact mental health (anxiety, Anx) in a sample of white and Black (African American) young women from Southeast Texas, USA. We illustrate a simple yet underutilized segmented regression model where linearity is relaxed to allow for a shift in the strength of the effect with the levels of the predictor. We compare how these effects change within R/E groups with the level of the predictor, but also how the "tipping points," where the effects change in strength, may differ by R/E. We find with classic linear regression that neighborhood disorder adversely affects Black women's anxiety, while in white women the effect seems negligible. Segmented regressions show that the Ndis → Anx effects in both groups of women appear to shift at similar levels, about one-fifth of a standard deviation below the mean of NDis, but the effect for Black women appears to start out as negative, then shifts in sign, i.e., to increase anxiety, while for white women, the opposite pattern emerges. Our findings can aid in devising better strategies for reducing health disparities that take into account different coping or resilience mechanisms operating differentially at distinct levels of adversity. We recommend that researchers investigate when adversity becomes exceedingly harmful and whether this happens differentially in distinct populations, so that intervention policies can be planned to reverse conditions that are more amenable to change, in effect pushing back the overall social risk factors below such tipping points.