Race and unhealthy behaviors: chronic stress, the HPA axis, and physical and mental health disparities over the life course

Abstract

Objectives: We sought to determine whether unhealthy behaviors play a stress-buffering role in observed racial disparities in physical and mental health.

Methods: We conducted logistic regressions by race on data from the first 2 waves of the Americans' Changing Lives Survey to determine whether unhealthy behaviors had buffering effects on the relationship between major stressors and chronic health conditions, and on the relationship between major stressors and meeting the criteria for major depression.

Results: Among Whites, unhealthy behaviors strengthened the relationship between stressors and meeting major-depression criteria. Among Blacks, however, the relationship between stressors and meeting major-depression criteria was stronger among those who had not engaged in unhealthy behaviors than among those who had. Among both race groups there was a positive association between stressors and chronic health conditions. Among Blacks there was an additional positive association between number of unhealthy behaviors and number of chronic conditions.

Conclusions: Those who live in chronically stressful environments often cope with stressors by engaging in unhealthy behaviors that may have protective mental-health effects. However, such unhealthy behaviors can combine with negative environmental conditions to eventually contribute to morbidity and mortality disparities among social groups.

FIGURE 1

Logistic regression model predicting DSM-III depression at different levels of unhealthy behaviors, by stressor, for (a) Blacks and (b) Whites: Americans' Changing Lives survey, 1986 and 1989.