Psychosocial Pathways to Racial/Ethnic Inequalities in Late-Life Memory Trajectories.
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ABSTRACT: Objectives
Blacks and Hispanics are at increased risk for dementia, even after socioeconomic and vascular factors are taken into account. This study tests a comprehensive model of psychosocial pathways leading to differences in longitudinal cognitive outcomes among older blacks and Hispanics, compared to non-Hispanic whites.Methods
Using data from 10,173 participants aged 65 and older in the Health and Retirement Study, structural equation models tested associations among race/ethnicity, perceived discrimination, depressive symptoms, external locus of control, and 6-year memory trajectories, controlling for age, sex, educational attainment, income, wealth, and chronic diseases.Results
Greater perceived discrimination among blacks was associated with lower initial memory level via depressive symptoms and external locus of control, and with faster memory decline directly. Greater depressive symptoms and external locus of control among Hispanics were each independently associated with lower initial memory, but there were no pathways from Hispanic ethnicity to memory decline.Discussion
Depression and external locus of control partially mediate racial/ethnic differences in memory trajectories. Perceived discrimination is a major driver of these psychosocial pathways for blacks, but not Hispanics. These results can inform the development of policies and interventions to reduce cognitive morbidity among racially/ethnically diverse older adults.
PROVIDER: S-EPMC6377058 | BioStudies |
REPOSITORIES: biostudies
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Project description:<h4>Background</h4>Evidence suggests that psychosocial factors are associated with cognitive health in older adults; however, associations of psychosocial factors with cognition remain largely unexamined in middle-aged and older Hispanics/Latinos.<h4>Objective</h4>To examine the cross-sectional associations of psychosocial factors with cognitive function among middle-aged and older Hispanics/Latinos living in the US.<h4>Methods</h4>Baseline (2008-2011) data from the Hispanic Community Health Study/Study of Latinos Sociocultural Ancillary Study (n = 2,818; ages 45-74) were used to examine the associations of each psychosocial factor with global cognition (GC), verbal learning, verbal memory, verbal fluency, and processing speed independent of age, sex, education, Hispanic/Latino background, income, language, and depressive symptoms. Psychosocial variables included: intrapersonal factors (ethnic identity, optimism, and purpose in life), interpersonal factors (family cohesion, familism, social network embeddedness, and social support), and social stressors (perceived ethnic discrimination, loneliness, and subjective social status).<h4>Results</h4>In fully-adjusted models, purpose in life and social support were each positively associated with all five cognitive variables. Loneliness was negatively associated with GC, verbal learning, memory, and processing speed. Ethnic identity was positively and familism negatively associated with GC, verbal fluency, and processing speed. Family cohesion was positively associated with verbal learning.<h4>Conclusion</h4>These findings extend previous evidence from older, largely non-Hispanic White cohorts to show that higher purpose in life and social support are also strongly associated with cognitive health among middle-aged and older Hispanics/Latinos. We also highlight that intrapersonal factors, interpersonal factors, and social stressors have differential relationships with individual cognitive tests.
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Project description:<h4>Purpose of the study</h4>This study examined whether the relation between perceived racial discrimination and psychiatric disorders varied by large geographic region among Black older adults in the United States.<h4>Design and methods</h4>Black adults aged 55 or older who had experienced racial/ethnic-specific discrimination were drawn from the National Survey of American Life (NSAL). Logistic regression analysis was used to examine main and interaction effects.<h4>Results</h4>Results show that there was a significant main effect of perceived racial discrimination, indicating that greater perceived discrimination was significantly associated with increased odds of having any past-year psychiatric disorder. The interaction of region by perceived racial discrimination was significant: The effect of perceived racial discrimination on any past-year psychiatric disorder was stronger among Blacks in the West than those in the South.<h4>Implications</h4>Findings suggest that whereas, in general, perceived racial discrimination is a risk factor for poor mental health among older Blacks, this association may differ by geographic region. Additional research examining reasons for this variation is needed.
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Project description:<h4>Objectives</h4>The main purpose of the study was to examine a bidirectional temporal relationship between perceived age discrimination and depressive symptoms. A secondary goal was to examine whether the negative effects of perceived age discrimination on one's depressive symptoms are stronger among respondents older than 70 years old, compared with respondents between the ages of 51 and 70.<h4>Methods</h4>The Health and Retirement Study is a U.S. nationally representative sample of individuals over the age of 50 and their spouse of any age. A cross-lagged model was estimated to examine the reciprocal associations of depressive symptoms and perceived age discrimination, controlling for age, gender, education, ethnicity, marital status, employment status, satisfaction with financial status, number of medical conditions, mobility, strength and fine motor skills, and memory functioning.<h4>Results</h4>The baseline model for the overall sample resulted in adequate fit indices: CFI = .945, TLI = .940, RMSEA = .024 (90% CI = .023, .025). The cross-lagged effect of perceived age discrimination on depressive symptoms was nonsignificant (B [SE] = -.01 [.04], p = .82), whereas the cross-lagged effect of depressive symptoms on perceived age discrimination was small, but significant (B [SE] = .04 [.02], p = .03). This implies that higher levels of depressive symptoms precede a greater likelihood of perceived age discrimination, net of sociodemographic and clinical variables. The cross-lagged effects did not vary according to age group (51-70 vs >70 years old).<h4>Discussion</h4>The subjective nature of perceived age discrimination is discussed.
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Project description:<h4>Objective</h4>Psychosocial factors likely contribute to racial and ethnic inequalities in cardiovascular diseases (CVDs). However, precise social, psychological, and physiological pathways linking race and ethnicity to the development of CVDs are not well understood. Systemic inflammation, commonly indexed by C-reactive protein (CRP), is a biomarker for CVD risk and progression. The objective of this study was to identify mediating pathways from race and ethnicity to CRP through social, psychological, and behavioral variables.<h4>Methods</h4>Using data from 12,382 participants aged 51 and older in the Health and Retirement Study, structural equation models tested for direct and indirect effects of race and ethnicity on CRP measured over four years through educational disadvantage, everyday discrimination, depressive symptoms, external locus of control, and smoking.<h4>Results</h4>Educational disadvantage mediated Black-White and Hispanic-White disparities in baseline CRP directly, as well as indirectly through elevated depressive symptoms, higher external locus of control, and smoking. Educational disadvantage also mediated Black-White and Hispanic-White disparities in CRP change directly, as well as indirectly through higher external locus of control and smoking. Independent of education, discrimination mediated Black-White differences in baseline CRP via elevated depressive symptoms, higher external locus of control, and smoking. Discrimination also mediated Black-White disparities in CRP change via external locus of control.<h4>Conclusions</h4>Results from this population-based, longitudinal study support the view that racially patterned social disadvantage is prospectively associated with longitudinal inflammatory processes, and some of these effects are independently mediated by psychological and behavioral factors. Biopsychosocial pathways to health disparities also differ between minority groups.
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Project description:<h4>Background and objectives</h4>Hopelessness-a state of despair characterized by a negative outlook towards the future and a belief in insurmountable challenges-is a risk factor for major depression, cardiovascular disease, and all-cause mortality among older adults. It is also an understudied consequence of discrimination. Older blacks disproportionately report experiencing discrimination and, as a result, may be at greater risk of feeling hopeless. However, social and religious resources may protect against the adverse effects of discrimination. The current study examines whether social support, social engagement, religious attendance, and religiosity buffer the effects of self-reported everyday discrimination on hopelessness among a nationally representative sample of blacks.<h4>Research design and methods</h4>Using data from the 2010/2012 psychosocial assessment of the Health and Retirement Study, we regressed hopelessness on everyday discrimination, stratifying by 2 age groups, ages 51-64, representing middle-age (<i>n</i> = 1,302), and age 65 and older, representing old age (<i>n</i> = 887). Interaction terms tested whether each resource moderated the discrimination-hopelessness relationship controlling for depressive symptoms, socioeconomic status, and demographic characteristics.<h4>Results</h4>Greater reports of everyday discrimination were associated with higher levels of hopelessness for middle-aged and older blacks. For middle-aged blacks, the resources did not moderate the discrimination-hopelessness relationship; rather, higher levels of support (<i>b</i> = -0.294, <i>p</i> < .01), religiosity (<i>b</i> = -0.297, <i>p</i> < .001), religious attendance (<i>b</i> = -0.218, <i>p</i> < .05) were independently and inversely associated with hopelessness. For older blacks, higher levels of religiosity moderated the discrimination-hopelessness relationship (<i>b</i> = -0.208, <i>p</i> < .05) and higher levels of support (<i>b</i> = -0.304, <i>p</i> < .05) and social engagement (<i>b</i> = -0.236, <i>p</i> < .05) were independently and inversely associated with hopelessness.<h4>Discussion and implications</h4>Findings suggest that self-reported everyday discrimination increases hopelessness among middle-aged and older blacks but social and religious resources may counterbalance its effects, in age-specific ways, to protect against hopelessness. Religiosity may be especially important for older blacks as a buffer against the negative consequences of discrimination on hopelessness.
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Project description:<h4>Background</h4>Very few studies have explored the utility of subjective cognitive complaints (SCCs) in primary care settings.<h4>Objective</h4>We aim to investigate associations between SCCs (item-level), objective cognitive function (across domains and global), and mood in a diverse primary care population, including subjects with mild cognitive impairment.<h4>Methods</h4>We studied 199 (75.9%females; 57.8%Hispanics; 42.2%African Americans) older adults (mean age 72.5 years) with memory concerns at a primary care clinic. A five-item SCC questionnaire, and objective cognitive assessments, including the Montreal Cognitive Assessment (MoCA) and the Geriatric Depression Scale, were administered.<h4>Results</h4>Logistic regression analyses showed associations between SCC score and depressive symptoms. A memory-specific ("memory worsening") SCC predicted scores on the MoCA (p = 0.005) in Hispanics.<h4>Conclusion</h4>SCCs are strongly linked to depressive symptoms in African Americans and Hispanics in a primary care setting; a specific type of SCC is related to global cognitive function in Hispanics.
| S-EPMC8190561 | BioStudies
Project description:Though Hispanics live long lives, whether a "Hispanic paradox" extends to older-age health remains unclear, as do the social processes underlying racial-ethnic and immigrant-native health disparities. Using data from the Health and Retirement Study (2004-2012; N = 6,581), we assess the health of U.S.- and foreign-born Hispanics relative to U.S.-born whites and blacks and examine the socioeconomic, stress, and behavioral pathways contributing to health disparities. Findings indicate higher disability, depressive, metabolic, and inflammatory risk for Hispanics relative to whites and similar health profiles among Hispanics and blacks. We find limited evidence of a healthy immigrant pattern among foreign-born Hispanics. While socioeconomic factors account for Hispanic-white gaps in inflammation, disparities in other outcomes persist after adjustment for socioeconomic status, due in part to group differences in stress exposure. Hispanics may live long lives, but their lives are characterized by more socioeconomic hardship, stress, and health risk than whites and similar health risks as blacks.
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Project description:Hopefulness is associated with better health and may be integral for stress adaptation and resilience. Limited research has prospectively examined whether hopefulness protects against physiological dysregulation or does so similarly for U.S. whites, blacks and Hispanics. We examined the association between baseline hopefulness and future allostatic load using data from the Health and Retirement Study (n = 8,486) and assessed differences in this association by race/ethnicity and experiences of discrimination. Four items measured hopefulness and allostatic load was a count of seven biomarkers for which a respondent's measured value was considered high-risk for disease. A dichotomous variable assessed whether respondents experienced at least one major act of discrimination in their lifetime. We used Poisson regression to examine the association between hopefulness and allostatic load and included a multiplicative interaction term to test racial/ethnic differences in this association. Subsequent analyses were stratified by race/ethnicity and tested the interaction between hopefulness and discrimination within each racial/ethnic group. Hopefulness was associated with lower allostatic load scores, but its effects varied significantly by race/ethnicity. Race-stratified analyses suggested that hopefulness was protective among whites and not associated with allostatic load among Hispanics irrespective of experiencing discrimination. Hopefulness was associated with lower allostatic load among blacks reporting discrimination but associated with higher allostatic load among those who did not. Findings suggest that hopefulness plays differing roles for older whites, blacks and Hispanics and, for blacks, its protective effects on physiological dysregulation are intricately tied to their experiences of discrimination.
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Project description:OBJECTIVE:Little is known about the relationship of perceived racism to ambulatory blood pressure (ABP) in Hispanics. We explored possible associations between ABP nocturnal dipping and perceived racism in a Hispanic cohort. METHODS:Participants included 180 community-dwelling Hispanics from the Northern Manhattan Study. Measures included perceived racism, socioeconomic status, social support, and ABP monitoring. Nocturnal ABP nondipping was defined as a less than 10% decline in the average asleep systolic blood pressure relative to the awake systolic blood pressure. RESULTS:Overall, 77.8% of participants reported some form of perceived racism (Perceived Ethnic Discrimination Questionnaire scores >1.0). Greater social support was associated with less perceived discrimination (Spearman r = -0.54, p < .001). Those with higher perceived discrimination scores reported more depressive symptoms (r = 0.25, p < .001). Those with higher Perceived Ethnic Discrimination Questionnaire scores were less likely to show nocturnal ABP nondipping in multivariate models (odds ratio = 0.40, confidence interval = 0.17-0.98, p = .045). Among those with low perceived racism, black Hispanic participants were more likely to have nocturnal ABP nondipping (82.6%) compared with white Hispanics (53.9%; p = .02). Among those with high perceived racism, no associations between race and the prevalence of ABP nondipping was found (black Hispanic = 61.5% versus white Hispanic = 51.4%, p = .39; p interaction = .89). CONCLUSIONS:Perceived racism is relatively common among US Hispanics and is associated with ABP. Nondipping of ABP, a potential cardiovascular risk factor, was more common in black Hispanic participants with low perceived racism. This finding may reflect different coping mechanisms between black versus white Hispanics and related blood pressure levels during daytime exposures to discrimination.
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Project description:<h4>Background and objectives</h4>Perceived discrimination is a risk factor for poor mental health. However, most studies measure discrimination at one time point, which does not account for heterogeneity in the cumulative patterning of exposure to discrimination. To address this gap, we examine the association between discrimination trajectories and depressive symptoms among black middle-aged and older adults.<h4>Research design and methods</h4>Data were analyzed from a subsample of black Health and Retirement Study respondents (2006-2018, <i>N</i> = 2926, older than 50 years). General discrimination and racial discrimination trajectories were constructed based on the Everyday Discrimination Scale using repeated measures latent profile analyses. We examined the extent to which the association between discrimination trajectories are differentially associated with depressive symptoms (8-item Center for Epidemiological Studies-Depression scale) using negative binomial regression models adjusted for potential confounders. Effect modification by age and gender was tested.<h4>Results</h4>Individuals in the persistently high (incident rate ratio [IRR]: 1.70; 95% confidence interval [CI]: 1.49-1.95) and moderate general discrimination trajectories (IRR: 1.19; 95% CI: 1.06-1.33) were more likely to have elevated depressive symptoms in comparison to those in the persistently low trajectory. This relationship was strongest among older adults aged older than 65 years. Respondents in the persistently high racial discrimination trajectory (IRR: 1.50; 95% CI: 1.29-1.73) had a higher risk of elevated depressive symptoms in comparison to respondents in the persistently low trajectory. Sensitivity analyses indicated that there was an independent association between persistently high racial discrimination trajectory class and elevated depressive symptoms, after adjusting for racial discrimination measured at a single time point.<h4>Discussion and implications</h4>Characterizing longitudinal patterns of perceived discrimination may facilitate the stratification of mental health risk and vulnerability among black middle-aged and older adults. Trajectories of racial discrimination may inform risk of worse depressive symptoms more accurately than a single assessment of discrimination.
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