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Health Disparities and the Stress Hypothesis

Health Disparities and the Stress Hypothesis. R. Jay Turner, Ph.D Vanderbilt University. Presented at Montana State University February 10, 2012. Stress Process Model. Retrospective self-report, computer assisted personal interviews.

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Health Disparities and the Stress Hypothesis

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  1. Health Disparities and the Stress Hypothesis R. Jay Turner, Ph.D Vanderbilt University Presented at Montana State University February 10, 2012

  2. Stress Process Model

  3. Retrospective self-report, computer assisted personal interviews DSM-IV CIDI diagnoses: major depression, dysthymia, GAD, social phobia, panic disorder, alcohol abuse and dependence, drug abuse and dependence, PTSD, and antisocial personality disorder. PLUS attention deficit and hyperactive disorder and Childhood conduct disorder from the Diagnostic Interview schedule.

  4. TABLE 3. Depressive Symptomatology (CES-D) Regressed on Social Status and Stress Process Components: Toronto, 1990–1991 1 2 3 4 5 6 7 8 Intercept 24.744*** 23.766*** 44.327*** 59.348*** 14.286** 30.444*** 23.123*** 47.003*** (4.320) (4.199) (4.221) (4.226) (4.148) (4.488) (4.136) (4.584) Female 2.643*** 2.149*** 2.226*** 2.234*** 2.096** 2.196*** 3.105*** 1.556** (.623) (.568) (.546) (.595) (.612) (.580) (.599) (.482) Age –.739** –.701** –.597* –.598** –.592* –.728** –.619** –.447* (.237) (.227) (.228) (.210) (.228) (.233) (.230) (.189) Age2 .008* .008** .006† .006* .006* .008* .006* .004† (.003) (.003) (.003) (.003) (.003) (.003) (.003) (.003) Previously-married 3.342** 1.339 3.803*** 3.491*** 3.909*** 2.994** 1.324 1.733* (1.064) (1.004) (.978) (.866) (.994) (1.035) (.861) (.757) Never-married 1.198 1.176 1.872** .647 1.891* 1.038 –.083 1.114† (.808) (.727) (.688) (.693) (.799) (.778) (.723) (.629) SES –1.060** –.682* –.175 –.712** –.713* –1.417*** –.877** –.091 (.299) (.294) (.267) (.266) (.294) (.280) (.283) (.251) Stress 3.968*** 2.799*** (.289) (.287) Mastery –.767*** –.359*** (.060) (.050) Self Esteem –1.326*** –.683*** (.081) (.079) Emotional Reliance .543*** .302*** (.071) (.051) Assertion of Autonomy –.618*** –.250** (.105) (.076) Social Support –2.829*** –.931** (.247) (.264) R2 .104 .276 .258 .266 .143 .141 .182 .443 † p <.10 *p < .05 **p < .01 ***p < .001 Note: Unstandardized OLS regression coefficients; standard errors are in parentheses; data weighted to adjust for respondent selection bias; standard errors adjusted for clustered sampling design using Stata survey regression procedure. N = 1338.

  5. 1. To evaluate the stress hypothesis and assess the utility of an elaborated “stress process” model for explaining race and socioeconomic position (SES) differences in health and changes in health over time, where: • a) health status is estimated in multiple ways that address the problem of misclassification. • b) variations in stress exposure are estimated more comprehensively than in prior research. • c) the direct, mediating and moderation effects of an extended array of social and personal coping resources and of contextual and cultural factors are examined in the context of a) and b) above.

  6. 2. To confirm and extend epidemiological estimates of race and SEP differences in the prevalence of health problems, variously and collectively defined, while addressing the misclassification problem. • 3. To evaluate the interrelationships of differing dimensions of health, variously estimated, and their risk significance for one another, in cross section and over time. • 4. To describe the distribution of each risk factor identified across race, SEP, age and gender while examining antecedent factors that put individuals and groups at differential risk for acquiring such risk factors. • 5. To obtain and preserve samples to support subsequent studies (not here proposed) on gene-environment interactions relating to factors hypothesized to be of risk or protective significance.

  7. Table 1. Co-occurrence of Lifetime DSM-IV Psychiatric and Substance Dependence Disorders (No Temporal Ordering) Substance Dependence c N % OR e 95% CI Comorbid Depression (Across and/or Within Category) Pure Depression 185 130 47.2 18.5 6.8*** 1.8* 4.7 - 10.0 1.1 - 3.0 Comorbid PTSD (Across and/or Within Category) Pure PTSD 140 65 45.0 20.8 7.0*** 2.8** 4.6 - 10.7 1.4 - 5.5 Comorbid Anxiety Disorder a 75 41.5 5.0*** 2.9 - 8.5 Pure Anxiety Disorder 22 15.0 1.3 0.4 - 3.9 Comorbid Personality Disorder b 287 43.4 6.3*** 4.5 - 8.7 Pure Personality Disorder 179 16.4 1.5† 0.9 - 2.4

  8. Table 2. Temporally Ordered Associations between Lifetime DSM-IV Psychiatric and Substance Dependence Disorders Substance Dependence b N % OR d 95% CI Comorbid Depression 162 121 39.7 5.0*** 3.3 - 7.4 Pure Depression 12.6 1.1 0.6 - 2.0 Comorbid PTSD 76 44.0 6.7*** 3.9 - 11.3 Pure PTSD 43 20.0 3.0** 1.3 - 6.9 Comorbid Anxiety Disorder a 70 37.5 4.2*** 2.4 - 7.4 Pure Anxiety Disorder 20 10.5 0.6 0.1 - 2.9

  9. Table 4. Effects of Stress Exposure on Associations between Lifetime DSM-IV Psychiatric and Substance Dependence Disorders Substance Dependence b Not Ordered Ordered OR OR d 95% CI d 95% CI Comorbid Depression 2.4*** 1.5 - 3.8 1.5† 0.9 - 2.6 Pure Depression 1.2 0.6 - 2.2 0.7 0.3 - 1.4 Comorbid PTSD 1.7* 1.0 - 3.1 1.5 0.7 - 3.1 Pure PTSD 1.1 0.4 - 2.7 1.7 0.6 - 4.5 Comorbid Anxiety Disorder a 1.7 0.8 - 3.4 1.3 0.8 - 2.1 Pure Anxiety Disorder 1.3 0.4 - 4.1 0.8 0.1 - 3.6

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