Stress, coping, and depression: testing a new hypothesis in a prospectively studied general population sample of U.S.-born Whites and Blacks

The Cumulative Influence of Perceived Discrimination, Stress, and Coping Responses on Symptoms of Depression Among Young African American Mothers

BACKGROUND

African American women have an elevated risk for experiencing depressive symptoms, and discrimination, stress, and coping contribute to symptoms of depression.

AIMS

We aimed to examine the associations between discrimination, stress, and coping on symptoms of depression among young African American mothers.

METHODS

In this retrospective study, we utilized a hierarchical linear regression to explore the effects of perceived racial discrimination, stress, and general and discrimination-related coping responses on depressive symptoms in a sample of African American mothers (N = 250). The data were drawn from the Intergenerational Impact of Genetic and Psychological Factors on Blood Pressure study (InterGEN), a study conducted between 2014 and 2019 and based in Connecticut.

RESULTS

After accounting for maternal age, level of education, and income, greater perceived racial discrimination (p = .03), higher levels of stress (p < .001), greater engagement in avoidance coping (p < .001), and use of passive coping responses to discrimination (p = .04) were uniquely associated with increased depressive symptoms. Other forms of coping, specifically, problem-solving and support seeking, did not appear to influence depressive symptoms in this sample.

CONCLUSION

The findings highlight the negative impact of discrimination, heightened stress, and maladaptive coping on the emotional health of young African American mothers.

Investigating a Paradox: Toward a Better Understanding of the Relationships Between Racial Group Membership, Stress, and Major Depressive Disorder

Epidemiologic studies in the United States routinely report a lower or equal prevalence of major depressive disorder (MDD) for Black people relative to White people. Within racial groups, individuals with greater life stressor exposure experience greater prevalence of MDD; however, between racial groups this pattern does not hold. Informed by theoretical and empirical literature seeking to explain this "Black-White depression paradox," we outline 2 proposed models for the relationships between racial group membership, life stressor exposure, and MDD: an effect modification model and an inconsistent mediator model. Either model could explain the paradoxical within- and between-racial group patterns of life stressor exposure and MDD. We empirically estimated associations under each of the proposed models using data from 26,960 self-identified Black and White participants in the National Epidemiologic Survey on Alcohol and Related Conditions III (United States, 2012-2013). Under the effect modification model, we estimated relative risk effect modification using parametric regression with a cross-product term, and under the inconsistent mediation model, we estimated interventional direct and indirect effects using targeted minimum loss-based estimation. We found evidence of inconsistent mediation (i.e., direct and indirect effects operating in opposite directions), suggesting a need for greater consideration of explanations for racial patterns in MDD that operate independent of life stressor exposure. This article is part of a Special Collection on Mental Health.

Examining Racial/Ethnic Disparities in Coping and Stress Within an Environmental Riskscape

Existing research on racial/ethnic differences in stress and coping is limited by small samples, single-item measures, and lack of inclusion of Mexican Americans. We address these gaps by analyzing data from the Texas City Stress and Health Study, a cross-sectional sample of Black (N = 257), White (N = 304), US-born (N = 689), and foreign-born (N = 749) Mexican Americans residing in proximity to a petrochemical complex. We compared active and avoidant coping by race/ethnicity and explored multivariable associations between coping and perceived stress. Black and foreign-born Mexican American respondents had the highest stressor exposure yet displayed different patterns of coping and perceived stress patterns. Active coping may be particularly effective for African Americans but may not offset extreme stress disparities. For Mexican Americans, the lack of association between coping and stress underscores the need for more work focused on the culturally diverse coping experiences.

James S. Jackson and the program for research on Black Americans: Contributions to psychology and the social sciences

James S. Jackson (1944-2020) is remembered as a groundbreaking social psychologist whose career contributions in scholarship, research, and service were fundamental to the field of psychology. This article briefly outlines his career-long work and contributions. A strong believer in interdisciplinary work, his research spanned other related social science disciplines (e.g., sociology, political science), as well as health and social welfare professions (public health, social work, medicine). As the founding director of the Program for Research on Black Americans at the Institute for Social Research, James Jackson initiated and led a long-standing program with a dual focus on research and training and mentoring doctoral students, postdoctoral scholars, and early career scientists. Jackson's efforts in the development of several nationally representative surveys of the Black population in the United States (e.g., National Survey of Black Americans, National Survey of American Life) revolutionized research focusing on the lives of Black Americans. James Jackson's international influence and reputation included numerous prestigious positions within national science organizations and honors and awards for his scientific contributions. Among James S. Jackson's most enduring legacies is the vast network of current scientists, researchers, and academics who were trained under his direction and leadership. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Whose unemployment hurts more? Joblessness and subjective well-being in U.S. married couples

While heterosexually married women's labor force participation has increased, their careers may still take a back seat to their husbands' careers. This article examines the effects of unemployment on the subjective well-being of husbands and wives in the U.S., including effects of one spouse's unemployment on the other spouse's well-being. I use 21st century longitudinal data with well-validated measures of subjective well-being capturing negative affect (psychological distress) and cognitive well-being (life satisfaction). Consistent with theories of gender deviation, the results of this analysis indicate that men's unemployment negatively affects their wives' affective and cognitive well-being, but women's unemployment has no significant effects on their husbands' well-being. Additionally, own unemployment has a larger negative effect on men's than on women's subjective well-being. These findings indicate that the male breadwinner model and its associated conditionings continue to shape men's and women's subjective, internal responses to unemployment.

"Now I just need something sweet": Racism, emotional eating, and health among African Americans

BACKGROUND

The Environmental Affordances Model theorizes that systemic racism disproportionately exposes African Americans in the United States to chronic everyday stressors (e.g., individual racism) while simultaneously shaping the availability of coping resources (e.g., fast food outlets) and engagement in self-regulatory strategies (e.g., emotional eating). Greater engagement in self-regulatory strategies is theorized to preserve mental health while contributing to medical morbidities and mortality.

OBJECTIVE

However, few studies have tested the Environmental Affordances Model, limiting our understanding of how the proposed pathways operate in the lives of African Americans.

METHODS

In the present study, the associations between systemic racism (institutional racism, cultural racism, neighborhood disadvantage), chronic everyday stressors (exposure to individual racism), emotional eating, and mental (anxiety symptomatology) and physical (self-rated overall physical health) health are assessed in a sample of 751 African Americans aged 18 to 88.

RESULTS

The path analysis reveals that institutional and cultural racism are both positively associated with individual racism. Neighborhood disadvantage is inversely associated with individual racism. Individual racism is significantly associated with greater anxiety symptomatology but is unrelated to self-rated overall physical health. Institutional and cultural racism are associated with emotional eating although individual racism and neighborhood disadvantage are not. Moreover, engagement in emotional eating exacerbates, rather than mitigates, the impacts of individual racism on anxiety symptomatology.

CONCLUSIONS

We conclude that institutional and cultural racism contribute to individual racism experiences and emotional eating whereas emotional eating exacerbates associations among individual racism and anxiety symptomatology.

Chronic Stress, Coping, and Mental Health Among Older African Americans

OBJECTIVES

African Americans experience relatively low rates of mental disorder despite being disproportionately exposed to psychosocial stressors. Coping is an understudied area that may help explain the mental health resilience among this population.

METHODS

Using data from the National Survey of American Life, I use negative binomial logistic regression to investigate the relationships between stress exposure/appraisal, ten coping responses, and mental health among older African American adults.

RESULTS

Seven of 10 coping responses were predictive of psychological distress. I also found evidence of moderation for six responses. Active coping, instrumental social support, looking for something good in what has happened, and two measures of acceptance were protective against psychological distress associated with high levels of stress. Substance use generally exacerbated the association between stress and psychological distress.

DISCUSSION

Problem-focused coping and acceptance responses were effective coping strategies for older African Americans under high levels of stress exposure/appraisal.

Self-Regulatory Coping Behaviors and Stress Reactivity: Exploring the Environmental Affordance Model of Health Disparities

Objectives

To explore the relationship between self-regulatory coping behaviors (SRCB) and hypothalamic pituitary adrenal (HPA) stress reactivity.

Methods

Data came from the Richmond Stress and Sugar Study (n=125, median age: 57 years, 46% non-Hispanic White, 48% African American). The relationships between 11 SRCB (“health-harming” [e.g., smoking] and “health-promoting” [e.g., exercising]) with HPA stress reactivity, indicated by salivary cortisol response to the Trier Social Stress Test, was assessed using multi-level modeling.

Results

Health-harming and health-promoting SRCB were positively correlated (+0.33, p<0.001). Several individual behaviors were related to HPA stress reactivity, for example, smoking and meditation were associated with shallower increases in cortisol (smoking: −13.0%, 95%CI: −20.9% to −4.3%; meditation: −14.0%, 95%CI: −22.0% to −5.1%). However, SRCB summary measures were unrelated to stress reactivity.

Discussion

Health-harming and health-promoting SRCB are inter-related. Specific behaviors, rather than groupings as health-harming versus -promoting, are related to HPA stress reactivity.

Allostatic load, unhealthy behaviors, and depressive symptoms in the Hispanic Community Health Study/Study of Latinos

BACKGROUND

The Environmental Affordances Model (EAM) proposes that the effects of chronic stress on depression are moderated by unhealthy behaviors and race/ethnicity. The unique social structures and contexts of Hispanics/Latinos in the U.S. may influence such relationships. This study evaluated whether unhealthy behaviors weakened the relationship between allostatic load, a measure of chronic stress, and future elevated depressive symptoms among Hispanic Community Health Study/Study of Latinos participants.

METHODS

Longitudinal data (2008-2011 and 2014-2017) from 11,623 participants were analyzed. The exposure was allostatic load, an index of twelve established biomarkers categorized using clinically relevant cut points, at Visit 1. Elevated depressive symptoms were operationalized as a score of ≥10 (out of 30) on the CES-D 10 at Visit 2. An index of unhealthy behaviors, with one point each for cigarette smoking, excessive/binge drinking, sedentary behavior, and poor diet quality at Visit 1, was examined as an effect modifier. Multivariable logistic regression, in the overall sample and among Mexicans specifically and adjusted for demographic characteristics and elevated depressive symptoms at Visit 1, was used to model allostatic load, unhealthy behavior index (range: 0-4), and their interaction in relation to elevated depressive symptoms at Visit 2.

RESULTS

Overall, greater allostatic load was associated with higher odds of elevated depressive symptoms after at least 6 years (aOR = 1.06, 95% CI = 1.01, 1.10). Overall, individuals with greater allostatic load and an unhealthy behavior index = 1, compared to those with an unhealthy behavior index = 0, had lower odds of elevated depressive symptoms at follow-up (aβ = -0.065, 95% CI = -0.12, -0.007).

CONCLUSIONS

The relationship between chronic stress and depression was partially moderated among Hispanics/Latinos who engaged in unhealthy behavior, which may have reduced their risk of elevated depressive symptoms given more chronic stress.

Evaluating hypothesized explanations for the Black-white depression paradox: A critical review of the extant evidence

The Black-white Depression paradox, the lower prevalence of major depression among non-Hispanic Black (relative to non-Hispanic white) individuals despite their greater exposure to major life stressors, is a phenomenon that remains unexplained. Despite a decade plus of research, there is little clarity as to whether the paradoxical observations are an invalid finding, spuriously produced by selection bias, information bias, or confounding, or are a valid finding, representative of a true racial patterning of depression in the population. Though both artefactual and etiologic mechanisms have been tested, a lack of synthesis of the extant evidence has contributed towards an unclear picture of the validity of the paradox and produced challenges for researchers in determining which proposed mechanisms show promise, which have been debunked, and which require further study. The objective of this critical review is to assess the state of the literature regarding explanations for the Black-white depression paradox by examining some of the more prominent hypothesized explanatory mechanisms that have been proposed and assessing the state of the evidence in support of them. Included mechanisms were selected for their perceived dominance in the literature and the existence of at least one, direct empirical test using DSM major depression as the outcome. This review highlights the very limited evidence in support of any of the extant putative mechanisms, suggesting that investigators should redirect efforts towards identifying novel mechanisms, and/or empirically testing those which show promise but to date have been relatively understudied. We conclude with a discussion of the broader implications of the evidence for well-accepted social theories and raise questions regarding the use of DSM major depression to assess mental health burden in Black communities.

Exploratory Analysis of Racial/Ethnic and Educational Differences in a Randomized Controlled Trial of a Mindfulness-Based Weight Loss Intervention

OBJECTIVE

People of color and lower socioeconomic groups have higher obesity prevalence, lose less weight compared with Whites and higher socioeconomic groups, and are underrepresented in randomized controlled trials of mindfulness-based interventions. We examined whether mindfulness approaches reduce disparities in weight loss interventions.

METHODS

We analyzed data from a randomized controlled trial of 194 participants with obesity (41% participants of color, 36% without college degree) comparing a 5.5-month mindfulness-based weight loss intervention to an active-control with identical diet-exercise guidelines. We assessed attendance, 18-month attrition, and weight change at 6, 12, and 18 months by race/ethnicity and education level using linear mixed models, adjusting for baseline body mass index, age, and education or race/ethnicity, respectively.

RESULTS

Participants without versus with a college degree attended fewer sessions and had higher attrition across interventions. Participants of color attended fewer intervention sessions in the mindfulness compared with the control intervention. Overall, participants of color lost significantly less weight at 12 and 18 months compared with Whites. However, during the 6- to 18-month maintenance period, we found an interaction of intervention arm, race/ethnicity, and time (p = .035), indicating that participants of color compared with Whites regained more weight in the control (0.33 kg/mo; p = .005) but not mindfulness intervention (0.06 kg/mo; p = .62). Participants without a college degree had greater initial weight loss in the mindfulness compared to control intervention from 0 to 6 months (-0.46 kg/mo; p = .039).

CONCLUSIONS

Although disparities persist, mindfulness approaches may mitigate some racial/ethnic and socioeconomic differences in weight loss compared with conventional diet-exercise programs.Trial Registration: Clinicaltrials.gov registration: NCT00960414.

Examining Coping Skills as a Mediating Factor in Perceived Stress and Life Satisfaction: A Comparison Between Minority and Nonminority Older Adults

Although stress due to racial and ethnic differences can negatively impact life satisfaction, there is a lack of focus on the differences between minority and nonminority older adults in how stress and coping skills impact life satisfaction. The objectives of this study are to explore (a) the differences between minority and nonminority older adults in their levels of life satisfaction, stress, and coping skills; and (b) the mediating effects of coping skills on the relationship between perceived stress and life satisfaction among both groups. Cross-sectional data from the Well Elderly 2 study (N = 460) were utilized in bivariate and mediation analyses. Minority older adults reported higher levels of stress and prioritized different coping skills. Mediation was not supported for either group. These findings enable practitioners to focus on the coping skills more frequently identified by clients' racial/ethnic grouping, as well as to target the primary stressors identified.

Explaining the Black-white depression paradox: Interrogating the Environmental Affordances Model

The Environmental Affordances (EA) model posits that Black Americans' engagement with unhealthy behaviors (i.e. smoking, alcohol use, eating calorie-dense foods) to cope with stressor exposure may simultaneously account for their observed greater risk of chronic physical illness, and their observed equal or lesser prevalence of depression, relative to white Americans - the so-called "Black-white depression paradox." However, the specific mechanisms through which such effects might arise have been theorized and analyzed inconsistently across studies, raising concerns regarding the appropriateness of existing empirical tests of the model as well as the validity of the conclusions. We specify the two mechanisms most consistent with the EA model - 'Mediation-only' and 'Mediation and Modification' - and derive a priori predictions based on each. We systematically test these pathways using a subset of 559 participants of the Child Health and Development Study who were included in an adult follow-up study between 2010 and 2012 and self-identified as Black or white. Results failed to support either of the two mechanisms derived from the EA model, challenging the validity and utility of the model for explaining racial differences in depression; efforts to develop alternative hypotheses to explain the paradox are needed.

"What Doesn't Kill You, Makes You Stronger": Psychosocial Resources and the Mental Health of Black Older Adults

A robust body of research has shown that Black Americans are less likely than Whites to have psychiatric disorders despite the social and economic disadvantage and systemic racism that they face. This mental health paradox has been demonstrated across all ages of the life course, including older adulthood. One of the prevailing explanations for the lower prevalence of psychiatric disorders among Blacks pertains to the influence of psychosocial resources on mental health. Psychosocial resources can directly or indirectly support mental health through physiological and psychological pathways. They can also mitigate the adverse effects of social stressors of discrimination and other stressors on psychological distress and mental illness. Black older adults may particularly benefit from psychosocial resources because they have had a lifetime of experiencing and overcoming adversity. Although this cycle of stress adaptation can wear away at the physical body, it may facilitate mental health resilience. In this chapter, we review research on the relationship between psychosocial resources and mental health. The chapter begins with a brief review of the Black-White mental health paradox and the mechanisms through which psychosocial resources operate to influence mental health. We then review research on intrapersonal, interpersonal, and community-level psychosocial resources that are particularly salient for Black Americans. Throughout the chapter we highlight research specifically focused on Black older adults and discuss the cultural relevance of each resource to their mental health and psychological functioning.

Can Hostile Attitudes and Hostile Affections Lead to Depressive Symptoms Under Stress? A Study Based on Racial/Ethnic and Gender Differences

BACKGROUND

Stress has a significant influence on the development of depressive symptoms. An individual's coping style and resilience may moderate the symptoms of depression. This study is aimed to investigate the role of coping styles and resilience to depressive symptoms when individuals are facing stress in life based on racial/ethnic and gender differences.

METHODS

Enrolled individuals were assessed using the Unfairness Scale, City Stress Inventory, Cook-Medley Hostility Scale, Conner-Davidson Resilience Scale, and Beck Depression Inventory (BDI).

RESULTS

Three hundred ninety-six individuals completed the rating scales. There were significant interactions between race and unfairness, city stress (P = 0.006, P < 0.001), and between gender and city stress (P = 0.016). AAs and males suffer more stress than EAs and females. Hostile attitudes and affects act as mediators and significantly affect the relationship between stress and depressive symptoms (indirect effect: B = 0.812, P < 0.001; direct effect: B = 1.015, P < 0.001). Individuals with high resilience reported lower BDI scores. AAs with high stress and medium resilience had a buffer effect on depressive symptoms, while EAs did not.

CONCLUSION

The racial and gender effects of stress on depressive symptoms were significant. Individuals who have frequently experienced stress exhibited a more hostile attitude/affect compared to those who have experienced less stress. Furthermore, individuals who had a more hostile attitude/affect were more likely to be affected by depressive symptoms. Resilience has a protective factor for all participants, and medium resilience had a better buffer effect for AAs compared to EAs. There should be training for boosting resilience in schools and in vulnerable communities.

Mental Health and Weather Extremes in a Southeastern U.S. City: Exploring Group Differences by Race

The connection between mental health and weather extremes is a public health concern, but less studied to date than physical health. This exploratory study examines the mental health impacts of two kinds of weather extremes increasingly linked to climate change—summer heat waves and extreme winter weather—in a low- to middle-income population in the Southeastern U.S. The distribution of mental health impacts, and potential pathways to them, are examined with a focus on race. Data are from a random-sample survey of 426 participants and are analyzed with bivariate statistics and path analysis. Self-reported mental health impacts, in both seasons, were common in our study, with White participants tending to report worse impacts than participants who identified with other racial groups. Physical health had direct effects on mental health across several models, overall and by racial group. For summer heat waves, concern about climate change and social cohesion had direct and indirect effects, respectively, on mental health in White participants only. For extreme winter weather, preparedness had a direct negative effect on mental health in White, but not Black, participants. Results suggest that there may be racial differences in the influence of human and social capital factors on mental health related to weather extremes, warranting further study of this critical topic and with larger racial subgroup samples.

Racial differences in alcohol and tobacco use in adolescence and mid-adulthood in a community-based sample

PURPOSE

Smoking and alcohol use have been posited as possible contributors to racial health disparities, despite higher smoking and alcohol use among non-Hispanic White youth and young adults compared to Blacks. To further investigate this claim, we aim to assess variation in alcohol and cigarette use across two distinct points of the life course.

METHOD

Data are from a subset of 559 (279 male, 280 female) self-identified Black and White participants of the Child Health and Development study. Self-report alcohol and cigarette use were collected between age 15-17 and at mean age 50. Logistic regressions were estimated; supplementary analyses adjusted for maternal age, prenatal smoking, household income, childhood SES, and education.

RESULTS

White participants were more likely to drink regularly (Odds ratio (OR) 2.2; 95%CI 1.2, 4.0) and be intoxicated (OR 2.0; 95%CI  1.2, 3.2) in adolescence compared with Blacks. In mid-adulthood, Whites remained more likely to currently drink (OR  2.3; 95%CI 1.6, 3.4) but among drinkers, less likely to binge drink (OR 0.4; 95%CI  0.2, 0.8). White participants were less likely to smoke in mid-adulthood (OR  0.4; 95%CI  0.3, 0.6), but among smokers, were more likely to smoke ≥ ½ a pack per day (OR 3.4; 95%CI  1.5, 7.8).

CONCLUSIONS

Blacks were less likely to engage in drinking across the life course, but, among drinkers, more likely to binge drink in mid-adulthood. Blacks were more likely to smoke in mid-adulthood, but smoked infrequently compared with Whites. These patterns suggest that a reframing of disparities mechanisms to focus on broader structural and social factors may benefit progress in understanding and ameliorating inequities.

A Review of Mental Health and Mental Health Care Disparities Research: 2011-2014

Racial/ethnic minorities in the United States are more likely than Whites to have severe and persistent mental disorders and less likely to access mental health care. This comprehensive review evaluates studies of mental health and mental health care disparities funded by the National Institute of Mental Health (NIMH) to provide a benchmark for the 2015 NIMH revised strategic plan. A total of 615 articles were categorized into five pathways underlying mental health care and three pathways underlying mental health disparities. Identified studies demonstrate that socioeconomic mechanisms and demographic moderators of disparities in mental health status and treatment are well described, as are treatment options that support diverse patient needs. In contrast, there is a need for studies that focus on community- and policy-level predictors of mental health care disparities, link discrimination- and trauma-induced neurobiological pathways to disparities in mental illness, assess the cost effectiveness of disparities reduction programs, and scale up culturally adapted interventions.

Testing a somatization hypothesis to explain the Black-White depression paradox

PURPOSE

Epidemiologic studies document a lower prevalence of major depression in Blacks than Whites in the United States. This is paradoxical from the perspective of social stress theory. A long-standing claim in the (clinical) literature is that Blacks express depression more somatically than Whites. If true, the diagnostic algorithm may undercount depression in Blacks, since the screening symptoms privilege the psychological rather than somatic dimensions of depression. We test hypotheses that (1) Blacks express depression more somatically than Whites which (2) reduces their likelihood of endorsing screening symptoms, thereby undercounting Blacks' depression and explaining the Black-White depression paradox.

METHODS

We use cross-sectional data collected in 1991-92 from the National Longitudinal Alcohol Epidemiologic Survey (n = 42,862) among Blacks and Whites endorsing at least one past-12-month depression symptom. We compare groups on depression somatization and test whether greater somatization in Blacks leads to lower endorsement of psychological screening symptoms, and therefore under-diagnosis.

RESULTS

Blacks have higher mean depression somatization scores than Whites (0.28, SE 0.04 vs. 0.15, SE 0.02), t(122) = - 2.15, p = 0.03. This difference is small and driven by Blacks' higher endorsement of 1 somatic symptom (weight/appetite change) and Whites' greater propensity to endorse psychological symptoms. However, Blacks have the same odds as Whites of endorsing screening symptoms, before and after adjusting for somatization.

CONCLUSIONS

We find minimal evidence that Blacks express depression more somatically than Whites. Furthermore, this small difference does not appear to inhibit endorsement of diagnostic depression screening symptoms among Blacks, and therefore does not resolve the Black-White depression paradox.

Racial/ethnic disparities in depression: Investigating how sources of support and types of integration matter

Although social support and social integration are key predictors of depression and exhibit racial/ethnic patterns in the US, previous research has not examined how they shape racial/ethnic disparities in depression. Applying hybrid models to data from the Americans' Changing Lives study from 1986 to 2002, this study analyzes how sources of social support (spouse and friend/relative) and types of social integration (informal/formal) explain black-white and Hispanic-white disparities in depression. We find that strong social support and high social integration are negatively associated with depression and that the patterns of social support and integration vary by race/ethnicity. The results of hybrid models show that social support from one's spouse and friend/relative account for over 25 percent of the black-white disparity, whereas formal social integration including religious groups widens the black-white differential by roughly 10 percent. However, Hispanic-white disparities in depression are mostly a result of the difference in socioeconomic status. The change in spousal support is the most powerful predictor for the change in depression across race/ethnicity groups. Our findings suggest that the racial/ethnic differences in sources of social support and types of social integration play important roles in shaping racial/ethnic disparities in depression.

Allostatic Load, Unhealthy Behaviors, and Depressive Symptoms by Birthplace Among Older Adults in the Sacramento Area Latino Study on Aging (SALSA)

Objective: To assess whether unhealthy behaviors moderated the relationship between allostatic load (AL) and future significant depressive symptoms (SDSs) among 1,789 older Latinos. Method: Longitudinal data included baseline AL, three unhealthy behaviors (UBs), and 2-year follow-up SDS. Multivariable logistic regression analyses, stratified by birthplace (U.S. vs. foreign born), modeled the effects of AL, UB count (range = 0-3), and their interaction on follow-up SDS. Results: Compared with U.S.-born, foreign-born participants engaged in fewer UBs (0.52 vs. 0.60 behaviors, p = .01) and had higher baseline SDS (31% vs. 20%, p < .001). Among foreign-born participants, the effect of AL on future SDS (adjusted odds ratios [aORs]; 95% confidence interval [CI]) significantly increased across UB counts of 0 to 3: 1.06 [0.83, 1.35], 1.46 [1.14, 1.87], 2.00 [1.18, 3.41], and 2.75 [1.18, 6.44], respectively. Discussion: Among foreign-born Latinos, these results were most pronounced for women and adults above age 80, which may represent higher risk groups requiring more intensive screening for depression.

The Black-White Paradox Revisited: Understanding the Role of Counterbalancing Mechanisms during Adolescence

The tendency for blacks to report similar or better mental health than whites has served as an enduring paradox in the mental health literature for the past three decades. However, a debate persists about the mechanisms that underlie this paradox. Drawing on the stress process framework, we consider the counterbalancing roles of self-esteem and traumatic stress exposure in understanding the "black-white paradox" among U.S. adolescents. Using nationally representative data, we observe that blacks have higher levels of self-esteem than whites but also encounter higher levels of traumatic stress exposure. Adjusting for self-esteem reveals a net higher rate of mood disorders and distress among blacks relative to whites, and differences in traumatic stress exposure mediate this association. In the full model, we show that self-esteem and stress exposure offset each other, resulting in a null association between race and mood disorders and a reduced association between race and distress.

Sex, race, and the role of relationships in diabetes health: intersectionality matters

Previous research has seldom used an intersectionality framework to consider how sex and race affect diabetes health, nor has it examined the role of sex and race in the well-established link between romantic relationship quality and health. This study targeted 200 adults with type 2 diabetes (46% Black; 45% female) and examined whether sex, race, and the interaction between sex and race predicted behavioral and psychological health, or moderated the link between relationship quality and health outcomes. Black women reported poorer diabetes self-care and lower self-efficacy compared to other groups. Relationship quality was associated with better self-care, increased self-efficacy, and lower depressive symptoms. The association between relationship quality and medication adherence was stronger for Black women, and the association between relationship quality and self-efficacy was stronger for both Black women and White men. Results suggest that Black women with diabetes experience more health disadvantages than other groups, but some of these disadvantages might be attenuated by supportive romantic relationships.

The role of emotional eating in the links between racial discrimination and physical and mental health

The environmental affordances (EA) model posits that maladaptive self-regulatory strategies (e.g., emotional eating) directly and indirectly heighten African Americans' risk for downstream medical morbidities while also potentially mitigating the psychological impact of stressors. We empirically tested the full EA model. In doing so, we investigated the associations among racial discrimination, depressive symptomatology, and physical health proxies as well as the intervening role of emotional eating in these associations among 150 African Americans aged 18-27. The increased frequency of experiencing racial discrimination was significantly associated with poorer self-reported health, greater depressive symptomatology, and more emotional eating. There was no significant association between emotional eating and physical health and emotional eating did not mediate the relation between racial discrimination and physical health. Finally, racial discrimination was associated with depressive symptomatology, but only among African Americans with mean or high levels of emotional eating.

Is the Black-White Mental Health Paradox Consistent Across Gender and Psychiatric Disorders?

This study assessed whether the black-white mental health epidemiologic paradox (i.e., blacks' lower or similar rates of mental disorder relative to whites) extends across 12 lifetime and past-year psychiatric disorders and whether it varies with gender. We used data from the National Comorbidity Survey Replication and the National Survey of American Life, 2001-2003 (n = 4,584 black and 6,668 non-Hispanic white persons). Results showed overwhelming evidence of the paradox across lifetime and past-year disorders for women and men. In addition, blacks' mental health advantage over whites widened after adjusting for socioeconomic factors. There was one exception: Black women experienced higher risk of lifetime posttraumatic stress disorder compared with white women. These findings provide strong evidence for the "black-white mental health paradox"; however, additional research is needed to understand black women's heightened risk for posttraumatic stress disorder.

Is the Black-White Mental Health Paradox Consistent Across Gender and Psychiatric Disorders?

This study assessed whether the black-white mental health epidemiologic paradox (i.e., blacks' lower or similar rates of mental disorder relative to whites) extends across 12 lifetime and past-year psychiatric disorders and whether it varies with gender. We used data from the National Comorbidity Survey Replication and the National Survey of American Life, 2001-2003 (n = 4,584 black and 6,668 non-Hispanic white persons). Results showed overwhelming evidence of the paradox across lifetime and past-year disorders for women and men. In addition, blacks' mental health advantage over whites widened after adjusting for socioeconomic factors. There was one exception: Black women experienced higher risk of lifetime posttraumatic stress disorder compared with white women. These findings provide strong evidence for the "black-white mental health paradox"; however, additional research is needed to understand black women's heightened risk for posttraumatic stress disorder.

Stress and the Mental Health of Populations of Color: Advancing Our Understanding of Race-related Stressors

This article provides an overview of research on race-related stressors that can affect the mental health of socially disadvantaged racial and ethnic populations. It begins by reviewing the research on self-reported discrimination and mental health. Although discrimination is the most studied aspect of racism, racism can also affect mental health through structural/institutional mechanisms and racism that is deeply embedded in the larger culture. Key priorities for research include more systematic attention to stress proliferation processes due to institutional racism, the assessment of stressful experiences linked to natural or manmade environmental crises, documenting and understanding the health effects of hostility against immigrants and people of color, cataloguing and quantifying protective resources, and enhancing our understanding of the complex association between physical and mental health.

Relationships between allostatic load, unhealthy behaviors, and depressive disorder in U.S. adults, 2005-2012 NHANES

Unhealthy behaviors may modify relationships between chronic stress and depression among diverse older adults. We analyzed nationally representative cross-sectional data from participants aged 40-79 years of the 2005-2012 National Health and Nutrition Examination Survey. Unhealthy behaviors included current smoking, excessive/binge drinking, insufficient physical activity, and fair/poor diet. Allostatic load was defined by 10 biomarkers indicating the cumulative physiologic burden of stress. Depressive disorder was assessed using the Patient Health Questionnaire. Multivariable logistic regression examined whether current smoking, excessive/binge drinking, insufficient physical activitiy, and fair/poor diet modified relationships between allostatic load and depressive disorder. Mean age of 12,272 participants was 55.6 years (standard error = 0.19), 51.9% were women, and most had at least a high school education (81.8%). Latinos (11.3%) and African Americans (10.4%) were more likely than Whites (7.1%; p < 0.001) to meet depressive disorder criteria. Allostatic load was not associated independently with depressive disorder in any racial/ethnic group and this lack of a relationship did not differ by the extent of unhealthy behaviors. Although Latinos and African Americans report higher levels of depression than Whites, physiological markers of stress do not appear to explain these differences.

Quantitative care: Caring for the aggregate in US academic population health sciences

Academic quantitative population health scientists (AQPHS) in the US care for populations with an ostensibly apolitical set of quantitative methods. This quantitative care has three interconnected components: AQPHS care about populations, they care for their data sets and models, and they care with these models' outputs. In the process their ideals of objectivity compete with, and enable, a moral ideal of political advocacy. Slipping between knowledge and intervention, the "real" and the imagined, and individuals and populations, AQPHS produce knowledge that they hope will change public narratives about marginalized populations. In doing so they draw on ideal types, converting quantitative findings about populations into speculation about individual behavior. AQPHS' ideal types both precede and tautologically reemerge from their science.

Prevalence of Mental Disorder and Service Use by Immigrant Generation and Race/Ethnicity Among U.S. Adolescents

OBJECTIVE

To examine differences in lifetime prevalence of mental disorder and service use among U.S. adolescents by both immigrant generation and race/ethnicity.

METHOD

A total of 6,250 adolescents aged 13 to 18 years in the National Comorbidity Survey Replication Adolescent Supplement were assessed for lifetime prevalence of mood and/or anxiety disorders, behavior disorders, and mental health service use. Twelve groups defined by self-identified race/ethnicity (non-Hispanic white, Hispanic, non-Hispanic black, Asian) and immigrant generation (first, second, third, or more) were compared.

RESULTS

Differences in prevalence of lifetime mental disorder were most apparent when immigrant generation and race/ethnicity were considered jointly. Compared to third+generation non-Hispanic white adolescents, the odds of mood/anxiety disorder were increased among second-generation Asian (adjusted odds ratio [AOR] = 2.51; 95% CI = 1.22-5.17) and third+generation Hispanic (AOR = 1.28; 95% CI = 1.00-1.63) but reduced among first-generation Asian (AOR = 0.27; 95% CI = 0.10-0.71) and second-generation non-Hispanic white adolescents (AOR = 0.50; 95% CI = 0.30-0.81). The odds of behavior disorder were lower among first-generation Asian (AOR = 0.26; 95% CI = 0.09-0.71) and all generations of non-Hispanic black adolescents (AOR range 0.43-0.55). Adjusting for lifetime disorder, first-generation Hispanic and non-Hispanic white adolescents and all generations of non-Hispanic black adolescents were less likely to receive mental health services (AOR range 0.24-0.55).

CONCLUSIONS

Variation in risk of disorder by immigrant generation and race/ethnicity underscores the importance of considering social, economic, and cultural influences in etiologic and treatment studies of adolescent psychopathology. Lower rates of service use, particularly among first-generation immigrant adolescents, highlight the need to identify and address barriers to recognition and treatment of mental disorders among adolescents from immigrant and racial/ethnic minority backgrounds.

Beck Depression Inventory-II: Factor Analyses with Three Groups of Midlife Women of African Descent in the Midwest, the South, and the U.S. Virgin Islands

This research encompasses a factor analysis of the Beck Depression Inventory-II (BDI-II), which involves three groups of midlife women of African descent who reside in the Midwest, the South, and the U.S. Virgin Islands. The purpose of the study was to determine the factor structure of the BDI-II when administered to a sample of women aged 40-65 of African descent who reside in the three distinct geographical regions of the United States. A correlational, descriptive design was used, and 536 women of African descent were invited to participate in face-to-face interviews that transpired in community settings. Results of the factor analysis revealed a two-factor explanation. Factor one included symptoms such as punishment feelings and pessimism (cognitive), and the second factor included symptoms such as tiredness and loss of energy (somatic-affective). The application of the Beck Depression Inventory-II among the three groups of women generated specific information about each group and common findings across the groups. Knowledge gained from the research could help to guide specific intervention programs for the three groups of women, and explicate the common approaches that could be used for the three groups.

A Risk Typology for Depression in African Americans

Studies report that African Americans are likely to experience severe, chronic, and disabling depressive symptoms leading to poor depression outcomes. There are several psychosocial and sociocultural factors that individually contribute to depression in African Americans (i.e. chronic stress, negative life events, negative social interaction, social support, and religiosity). However, African Americans are a heterogeneous population and the identification of subpopulations with distinct constellations of multiple co-occurring risk and protective factors may offer greater explanatory potential into depression burden for African Americans. This study used data from the American's Changing Lives Survey to identify risk types for depression in a national sample of African American adults and older adults (n = 1174). Latent class analysis results revealed a risk typology that included 3 distinct risk patterns for African Americans. Individuals in the High Protective/Low Risk Type (41%) had high levels of religiosity and social support. Those in the Moderate Protection/Low Risk Type (44%) had moderate levels of religiosity and social support. The Low Protection/Low Risk Type (15%) had low organizational and non-organizational religiosity and relatively low social support. All three types were marked by relatively low risk factors (i.e. negative events, financial stress, and negative social interaction). Multinomial logistic regression results suggested associations between demographic characteristics (i.e. gender, age, education, marital status), depressive symptoms, and risk type. Study results have implications for the development of depression interventions that are targeted to a specific risk type and tailored to the demographic profile of individuals likely to experience poor depression outcomes.

Do racial patterns in psychological distress shed light on the Black-White depression paradox? A systematic review

PURPOSE

Major epidemiologic studies in the US reveal a consistent "paradox" by which psychiatric outcomes such as major depressive disorder (MDD) are less prevalent among Blacks relative to Whites, despite greater exposure to social and economic stressors and worse physical health outcomes. A second paradox, which has received less attention and has never been systematically documented, is the discrepancy between these patterns and Black-White comparisons in psychological distress, which reveal consistently higher levels among Blacks. By systematically documenting the latter paradox, this paper seeks to inform efforts to explain the first paradox.

METHODS

We conduct a systematic review of the literature estimating the prevalence of MDD and levels of psychological distress in Blacks and Whites in the US.

RESULTS

The literature review yielded 34 articles reporting 54 relevant outcomes overall. Blacks have a lower prevalence of MDD in 8 of the 9 comparisons observed. In contrast, Blacks have higher levels of psychological distress (in terms of "high distress" and mean scores) than Whites in 42 of the 45 comparisons observed. Tests of statistical significance, where available, confirm this discrepant pattern.

CONCLUSIONS

A systematic review of the epidemiologic evidence supports the existence of a "double paradox" by which Blacks' lower prevalence of MDD relative to Whites' is inconsistent with both the expectations of social stress theory and with the empirical evidence regarding psychological distress. Efforts to resolve the Black-White depression paradox should account for the discordant distress results, which seem to favor artifactual explanations.

Stress, self-regulation, and context: Evidence from the Health and Retirement Survey

Health-related behaviors, such as smoking, alcohol use, exercise, and diet, are major determinants of physical health and health disparities. However, a growing body of experimental research in humans and animals also suggests these behaviors can impact the ways our bodies respond to stress, such that they modulate (that is, serve as a means to self-regulate or cope with) the deleterious impact of stressful experiences on mental health. A handful of epidemiologic studies have investigated the intersection between stress and health behaviors on health disparities (both mental and physical), with mixed results. In this study we use a novel instrument designed to explicitly measure the self-regulatory motivations and perceived effectiveness of eight health-related self-regulatory behaviors (smoking, alcohol, drug use, overeating, prayer, exercise, social support, talking with a councilor) in a subset of the Health and Retirement Study (N=1,354, Mean age=67, 54% female). We find that these behaviors are commonly endorsed as self-regulatory stress-coping strategies, with prayer, social support, exercise, and overeating used most frequently. The likelihood of using particular behaviors as self-regulatory strategies varied significantly by sex, but not by race/ethnicity, education, or wealth. We also find that greater stress exposure is associated with higher likelihood of using these behaviors to self-regulate feelings of emotional distress, particularly health-harming behaviors like smoking, alcohol, and overeating. These findings provide an important link between sociological and psychological theoretical models on stress and empirical epidemiological research on social determinants of health and health disparities.

Coping With Chronic Stress by Unhealthy Behaviors: A Re-Evaluation Among Older Adults by Race/Ethnicity

OBJECTIVE

To assess the role of unhealthy behaviors in the relationship between chronic stress and significant depressive symptoms by race/ethnicity among older adults.

METHOD

Participant data from the 2006 to 2008 Health and Retirement Study were analyzed. Unhealthy behaviors included current smoking, excessive/binge drinking, and obesity. Chronic stress was defined by nine previously used factors. The eight-item Center for Epidemiologic Studies Depression (CES-D) Scale measured depressive symptoms, where ≥4 symptoms defined significant. Multivariable logistic regression assessed the effects of chronic stress and unhealthy behaviors in 2006 on depressive symptoms in 2008.

RESULTS

A higher chronic stress index score predicted depressive symptoms in 2008 among African Americans, Latinos, and Whites (adjusted odds ratio [aOR] = 1.78, 95% confidence interval [CI] = [1.48, 2.15]; aOR = 1.54, 95% CI = [1.15, 2.05]; and aOR = 1.40, 95% CI = [1.26, 1.56], respectively). Unhealthy behaviors moderated this relationship among Latinos (aOR = 1.54, 95% CI = [1.02, 2.33]).

DISCUSSION

Unhealthy behaviors were not effective coping mechanisms for chronic stress in terms of preventing significant depressive symptoms. Instead, they strengthened the relationship between chronic stress and significant depressive symptoms among Latinos.

The National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) Waves 1 and 2: review and summary of findings

PURPOSE

The NESARC, a "third-generation" psychiatric epidemiologic survey that integrated detailed measures of alcohol and drug use and problems has been the data source for over >850 publications. A comprehensive review of NESARC findings and their implications is lacking.

METHOD

NESARC was a survey of 43,093 participants that covered alcohol, drug and psychiatric disorders, risk factors, and consequences. Wave 1 of the NESARC was conducted in 2001-2002. Three years later, Wave 2 follow-up re-interviews were conducted with 34,653 of the original participants. Scopus and Pubmed were used to search for NESARC papers, which were sorted into topic areas and summarized.

RESULT

The most common disorders were alcohol and posttraumatic stress disorders, and major depression. Females had more internalizing disorders and males had more externalizing disorders, although the preponderance of males with alcohol disorders (the "gender gap") was less pronounced than it was in previous decades. A race/ethnic "paradox" (lower risk among disadvantaged minorities than whites) remains unexplained. Younger participants had higher risk for substance and personality disorders, but not unipolar depressive or anxiety disorders. Psychiatric comorbidity was extensive and often formed latent trans-diagnostic domains. Since 1991-1992, risk for marijuana and prescription drug disorders increased, while smoking decreased, although smoking decreases were less pronounced among those with comorbidity. A nexus of comorbidity, social support, and stress predicted transitions in diagnostic status between Waves 1 and 2. Childhood maltreatment predicted psychopathology. Alcohol and drug use disorders were seldom treated; attitudinal barriers (little perceived need, perceived alcoholism stigma, pessimism about efficacy) were more important in predicting non-treatment than financial barriers.

CONCLUSIONS

Understanding comorbidity and the effects of early stressors will require research incorporating biologic components, e.g., genetic variants and brain imaging. The lack of treatment for alcohol and drug disorders, predicted by attitudinal rather than financial variables, suggests an urgent need for public and professional education to reduce the stigma associated with these disorders and increase knowledge of treatment options.

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

This study examines the role of cumulative disadvantage mechanisms across the life course in the production of racial and ethnic disparities in depressive symptoms at midlife, including the early life exposure to health risk factors, the persistent exposure to health risk factors, and varying mental health returns to health risk factors across racial and ethnic groups. Using data from the over-40 health module of the National Longitudinal Study of Youth (NLSY) 1979 cohort, this study uses regression decomposition techniques to attend to differences in the composition of health risk factors across racial and ethnic groups, differences by race and ethnicity in the association between depressive symptoms and health risk factors, and how these differences combine within racial and ethnic groups to produce group-specific levels of--and disparities in--depressive symptoms at midlife. While the results vary depending on the groups being compared across race/ethnicity and gender, the study documents how racial and ethnic mental health disparities at midlife stem from life course processes of cumulative disadvantage through both unequal distribution and unequal associations across racial and ethnic groups.

The association between obesity and back pain in nine countries: a cross-sectional study

Background

The association between obesity and back pain has mainly been studied in high-income settings with inconclusive results, and data from older populations and developing countries are scarce. The aim of this study was to assess this association in nine countries in Asia, Africa, Europe, and Latin America among older adults using nationally-representative data.

Methods

Data on 42116 individuals ≥50 years who participated in the Collaborative Research on Ageing in Europe (COURAGE) study conducted in Finland, Poland, and Spain in 2011–2012, and the World Health Organization’s Study on Global Ageing and Adult Health (SAGE) conducted in China, Ghana, India, Mexico, Russia, and South Africa in 2007–2010 were analysed. Information on measured height and weight available in the two datasets was used to calculate Body Mass Index (BMI). Self-reported back pain occurring in the past 30 days was the outcome. Multivariable logistic regression analysis was used to assess the association between BMI and back pain.

Results

The prevalence of back pain ranged from 21.5% (China) to 57.5% (Poland). In the multivariable analysis, compared to BMI 18.5-24.9 kg/m², significantly higher odds for back pain were observed for BMI ≥35 kg/m² in Finland (OR 3.33), Russia (OR 2.20), Poland (OR 2.03), Spain (OR 1.56), and South Africa (OR 1.48); BMI 30.0-34.0 kg/m² in Russia (OR 2.76), South Africa (OR 1.51), and Poland (OR 1.47); and BMI 25.0-29.9 kg/m² in Russia (OR 1.51) and Poland (OR 1.40). No significant associations were found in the other countries.

Conclusions

The strength of the association between obesity and back pain may vary by country. Future studies are needed to determine the factors contributing to differences in the associations observed.

The White ceiling heuristic and the underestimation of Asian-American income

The belief that ethnic majorities dominate ethnic minorities informs research on intergroup processes. This belief can lead to the social heuristic that the ethnic majority sets an upper limit that minority groups cannot surpass, but this possibility has not received much attention. In three studies of perceived income, we examined how this heuristic, which we term the White ceiling heuristic leads people to inaccurately estimate the income of a minority group that surpasses the majority. We found that Asian Americans, whose median income has surpassed White median income for nearly three decades, are still perceived as making less than Whites, with the least accurate estimations being made by people who strongly believe that Whites are privileged. In contrast, income estimates for other minorities were fairly accurate. Thus, perceptions of minorities are shaped both by stereotype content and a heuristic.

Genetic and environmental risk for major depression in African-American and European-American women

It is unknown whether there are racial differences in the heritability of major depressive disorder (MDD) because most psychiatric genetic studies have been conducted in samples comprised largely of white non-Hispanics. To examine potential differences between African-American (AA) and European-American (EA) young adult women in (1) Diagnostic and Statistical Manual of Mental Disorders, 4th Edition (DSM-IV) MDD prevalence, symptomatology, and risk factors, and (2) genetic and/or environmental liability to MDD, we analyzed data from a large population-representative sample of twins ascertained from birth records (n = 550 AA and n = 3226 EA female twins) aged 18-28 years at the time of MDD assessment by semi-structured psychiatric interview. AA women were more likely to have MDD risk factors; however, there were no significant differences in lifetime MDD prevalence between AA and EA women after adjusting for covariates (odds ratio = 0.88, 95% confidence interval [CI]: 0.67-1.15). Most MDD risk factors identified among AA women were also associated with MDD at similar magnitudes among EA women. Although the MDD heritability point estimate was higher among AA women than EA women in a model with paths estimated separately by race (56%, 95% CI: 29-78% vs. 41%, 95% CI: 29-52%), the best fitting model was one in which additive genetic and non-shared environmental paths for AA and EA women were constrained to be equal (A = 43%, 33-53% and E = 57%, 47-67%). In spite of a marked elevation in the prevalence of environmental risk exposures related to MDD among AA women, there were no significant differences in lifetime prevalence or heritability of MDD between AA and EA young women.

Do stressful events account for the link between socioeconomic status and mental health?

BACKGROUND

The purpose of this study was to prospectively examine the relationships between socioeconomic status (SES), demographic variables and mental health and to determine whether number of life stressors mediated these relationships.

METHODS

Wave 1 (2001-02) and 2 (2004-05) data from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC; n = 34,459) were used in the current study. Controlling for wave 1 mental health, a mediation model was tested to determine the relative impact of socioeconomic and demographic variables (all measured at wave 1) on mental health 3 years later (wave 2). The number of life stressors experienced in the 12 months prior to wave 1, assessed at wave 1, was evaluated as the mediator.

RESULTS

Findings indicated that SES, age, race/ethnicity, gender and marital status independently predicted changes in mental health ratings at wave 2. In addition, the number of life stressors mediated the relation between socioeconomic and demographic variables and mental health. Exposure to life stressors helps to explain commonly reported socioeconomic and demographic disparities in mental health.

CONCLUSIONS

Findings may suggest that reducing exposure to stressors and/or improving coping with life stressors may both improve mental health and reduce health disparities.

Access to and utilization of health services as pathway to racial disparities in serious mental illness

Often considered to fare better than White Americans in terms of mental health, African-Americans are nevertheless more vulnerable to chronic, persistent conditions should they become mentally ill, the literature suggests. The present study used data from the 2009 National Health Interview Survey to examine race differences in the prevalence rates of serious mental illness and race's role in relationships among such illness and variables of (a) social status and (b) health services. Results showed that non-Hispanic Blacks' level of reported chronic mental illness (in the past 30 days) exceeded that of non-Hispanic Whites. The results indicate that variables describing respondents' mental health care, along with their age and alcohol consumption, affect serious mental illness differently among African-Americans compared to Whites. Implications concerning racial disparities in mental health are discussed.

Relationships of choice: can friendships or fictive kinships explain the race paradox in mental health?

African Americans typically exhibit similar or better mental health outcomes than whites, an unexpected pattern given their disproportionate exposure to psychosocial stressors. The "race paradox in mental health" has been attributed to presumed stronger social ties among blacks but there is scarce empirical research in this regard. Using data from the 2001-2003 National Survey of American Life (N=4086), I test whether more abundant and higher quality friendships and fictive kin relationships among African Americans (if they exist) account for the race paradox in mental health. I find few race differences in the quantity and quality of friendships and fictive kinships and these differences did not explain the race paradox in mental health. Future research should investigate other potential resilience mechanisms among African Americans to explain their relatively positive mental health outcomes.

Structural racism and myocardial infarction in the United States

There is a growing research literature suggesting that racism is an important risk factor undermining the health of Blacks in the United States. Racism can take many forms, ranging from interpersonal interactions to institutional/structural conditions and practices. Existing research, however, tends to focus on individual forms of racial discrimination using self-report measures. Far less attention has been paid to whether structural racism may disadvantage the health of Blacks in the United States. The current study addresses gaps in the existing research by using novel measures of structural racism and by explicitly testing the hypothesis that structural racism is a risk factor for myocardial infarction among Blacks in the United States. State-level indicators of structural racism included four domains: (1) political participation; (2) employment and job status; (3) educational attainment; and (4) judicial treatment. State-level racial disparities across these domains were proposed to represent the systematic exclusion of Blacks from resources and mobility in society. Data on past-year myocardial infarction were obtained from the National Epidemiologic Survey on Alcohol and Related Conditions (non-Hispanic Black: N = 8245; non-Hispanic White: N = 24,507), a nationally representative survey of the U.S. civilian, non-institutionalized population aged 18 and older. Models were adjusted for individual-level confounders (age, sex, education, household income, medical insurance) as well as for state-level disparities in poverty. Results indicated that Blacks living in states with high levels of structural racism were generally more likely to report past-year myocardial infarction than Blacks living in low-structural racism states. Conversely, Whites living in high structural racism states experienced null or lower odds of myocardial infarction compared to Whites living in low-structural racism states. These results raise the provocative possibility that structural racism may not only harm the targets of stigma but also benefit those who wield the power to enact stigma and discrimination.