Brown Lauren L, Abrams Leah R, Mitchell Uchechi A, Ailshire Jennifer A
Division of Health Management and Policy, San Diego State University School of Public Health, California.
Harvard Center for Population and Development Studies, Harvard T.H. Chan School of Public Health, Cambridge, Massachusetts.
Innov Aging. 2020 Sep 7;4(5):igaa040. doi: 10.1093/geroni/igaa040. eCollection 2020.
Prior research and theory suggest that exposure to objectively stressful events contributes to mental health disparities. Yet, blacks report higher cumulative stress exposure than whites but lower levels of common psychiatric disorders. In order to understand why blacks bear disproportionate stress exposure but similar or better mental health relative to whites, we need to consider race differences in not only stress exposure, but also stress appraisal-how upsetting stress exposures are perceived to be.
We examine whether race differences in the number of reported chronic stressors across 5 domains (health, financial, residential, relationship, and caregiving) and their appraised stressfulness explain black-white differences in anxiety and depressive symptoms. Data come from 6019 adults aged older than 52 from the 2006 Health and Retirement Study.
Older blacks in this sample experience greater exposure to chronic stressors but appraise stressors as less upsetting relative to whites. In fully adjusted models, stress exposure is related to higher levels of anxiety and depressive symptoms, and perceiving stress as upsetting is associated with higher symptomology for whites and blacks. We also find that blacks report greater anxiety symptoms but fewer depressive symptoms with more stress exposure relative to whites. Stress appraisal partially explains race differences in the association between stress exposure and anxiety symptoms and fully explains race differences in the association between exposure and depressive symptoms.
The relationship between race, chronic stress exposure, and mental health is mediated by stress appraisal. Stress appraisal provides insight on important pathways contributing to black-white mental health disparities in older adulthood.
先前的研究和理论表明，接触客观存在的压力事件会导致心理健康差异。然而，黑人报告的累积压力暴露比白人高，但常见精神疾病的水平却较低。为了理解为什么黑人承受着不成比例的压力暴露，但相对于白人而言，其心理健康状况却相似或更好，我们不仅需要考虑压力暴露方面的种族差异，还需要考虑压力评估方面的种族差异——即压力暴露被认为有多令人苦恼。
我们研究了在五个领域（健康、财务、居住、人际关系和照顾他人）报告的慢性压力源数量的种族差异及其评估的压力程度，是否能解释黑人和白人在焦虑和抑郁症状方面的差异。数据来自2006年健康与退休研究中6019名年龄超过52岁的成年人。
该样本中的老年黑人经历了更多的慢性压力源暴露，但相对于白人而言，他们认为压力源的苦恼程度较低。在完全调整后的模型中，压力暴露与更高水平的焦虑和抑郁症状相关，而将压力视为令人苦恼与白人和黑人的更高症状水平相关。我们还发现，相对于白人，黑人在压力暴露更多时报告的焦虑症状更多，但抑郁症状更少。压力评估部分解释了压力暴露与焦虑症状之间关联的种族差异，并完全解释了暴露与抑郁症状之间关联的种族差异。
种族、慢性压力暴露和心理健康之间的关系是由压力评估介导的。压力评估为导致老年期黑人和白人心理健康差异的重要途径提供了见解。
