Stress, coping, and depression: testing a new hypothesis in a prospectively studied general population sample of U.S.-born Whites and Blacks

Abstract

The scarcity of empirically supported explanations for the Black/White prevalence difference in depression in the U.S. is a conspicuous gap in the literature. Recent evidence suggests that the paradoxical observation of decreased risk of depression but elevated rates of physical illness among Blacks in the U.S. compared with Whites may be accounted for by the use of coping behaviors (e.g., alcohol and nicotine consumption, overeating) among Blacks exposed to high stress levels. Such coping behaviors may mitigate deleterious effects of stressful exposures on mental health while increasing the risk of physical ailments. The racial patterning in mental and physical health outcomes could therefore be explained by this mechanism if a) these behaviors were more prevalent among Blacks than Whites and/or b) the effect of these behavioral responses to stress was differential by race. The present study challenges this hypothesis using longitudinal, nationally-representative data with comprehensive DSM-IV diagnoses. Data are drawn from 34,653 individuals sampled in Waves 1 (2001-2002) and 2 (2004-2005) as part of the US National Epidemiologic Survey on Alcohol and Related Conditions. Results showed that a) Blacks were less likely to engage in alcohol or nicotine consumption at low, moderate, and high levels of stress compared to Whites, and b) there was a significant three-way interaction between race, stress, and coping behavior for BMI only (F = 2.11, df = 12, p = 0.03), but, contrary to the hypothesis, elevated BMI was protective against depression in Blacks at low, not high, levels of stress. Further, engagement in unhealthy behaviors, especially at pathological levels, did not protect against depression in Blacks or in Whites. In sum, the impact of stress and coping processes on depression does not appear to operate differently in Blacks versus Whites. Further research testing innovative hypotheses that would explain the difference in Black/White depression prevalence is warranted.

Figure 1

Prevalence of depression at Wave 2 by number of past year stressor among non-Hispanic U.S.-born Whites (N=19,216) and non-Hispanic U.S.-born Blacks (N=6,065) in the general population

Figure 2

Predicted probability of depression at Wave 2 based on unhealthy behaviors as defined by Jackson et al. (2009)* and past-year stressful life events at Wave 1, by race, among non-Hispanic U.S.-born Whites (Figure 2a, N=19,216) and non-Hispanic U.S.-born Blacks Figure 2b, N=6,065) in the general population * UHBs defined to be consistent with Jackson et al. (2009): any consumption of at least one alcoholic beverage in lifetime, any consumption of 100+ cigarettes in lifetime, and/or current BMI≥30.

Figure 3

Prevalence of depression at Wave 2 based on unhealthy behaviors and lifetime perceived discrimination exposure among non-Hispanic U.S.-born Blacks (N=6,065) in the general population