Reconsidering the Role of Social Disadvantage in Physical and Mental Health:Stressful Life Events, Health Behaviors, Race, and Depression

摘要

Prevalence of depression is associated inversely with some indicators of socioeconomic position, and the stressnof social disadvantage is hypothesized to mediate this relation. Relative to whites, blacks have a higher burden ofnmost physical health conditions but, unexpectedly, a lower burden of depression. This study evaluated an etiologicnmodel that integrates mental and physical health to account for this counterintuitive patterning. The BaltimorenEpidemiologic Catchment Area Study (Maryland, 1993–2004) was used to evaluate the interaction between stressnand poor health behaviors (smoking, alcohol use, poor diet, and obesity) and risk of depression 12 years later forn341 blacks and 601 whites. At baseline, blacks engaged in more poor health behaviors and had a lower prevalencenof depression compared with whites (5.9% vs. 9.2%). The interaction between health behaviors and stress wasnnonsignificant for whites (odds ratio (OR ¼ 1.04, 95% confidence interval: 0.98, 1.11); for blacks, the interactionnterm was significant and negative (b: u00010.18, P < 0.014). For blacks, the association between median stress andndepression was stronger for those who engaged in zero (OR ¼ 1.34) relative to 1 (OR ¼ 1.12) and u00022 (OR ¼ 0.94)npoor health behaviors. Findings are consistent with the proposed model of mental and physical health disparities.