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Multicenter Study
. 2015 Apr;108(1):150-6.
doi: 10.1016/j.diabres.2015.01.025. Epub 2015 Jan 21.

Race/ethnicity moderates the relationship between chronic life stress and quality of life in type 2 diabetes

Amanda J Shallcross  1 , Mary-Jane Ojie  1 , William Chaplin  1 , Natalie Levy  1 , Taiye Odedosu  1 , Gbenga Ogedegbe  1 , Tanya M Spruill  2
Affiliations
Multicenter Study

Race/ethnicity moderates the relationship between chronic life stress and quality of life in type 2 diabetes

Amanda J Shallcross et al. Diabetes Res Clin Pract. 2015 Apr.

Abstract

Aims: To determine whether chronic life stress is differentially associated with quality of life (QoL) for Blacks vs. Hispanics with type 2 diabetes.

Methods: We assessed self-reported chronic stress and QoL in 125 patients with type 2 diabetes who self-identified as either non-Hispanic Black or Hispanic. Separate cross-sectional two-way interaction models (stress × race/ethnicity) with physical and mental health as outcomes were examined.

Results: The two-way interaction predicted mental (b=3.12, P=.04) but not physical health. Simple slopes analyses indicated that under conditions of high stress, Blacks (b=-4.4, P<.001), but not Hispanics, experienced significantly lower levels of mental health. In exploratory analyses, we examined a three-way interaction (stress × race/ethnicity × social support) with physical and mental health as outcomes. Results indicated the three-way interaction predicted mental (b=.62, P=.01) but not physical health. Simple slopes analyses indicated that under conditions of high stress, high levels of social support improved mental health for Hispanics (b=1.2, P<.001), but not for Blacks.

Conclusions: Black patients with type 2 diabetes may be particularly vulnerable to the deleterious effects of high chronic stress. Social support buffers effects of stress on mental health in Hispanics but not Blacks, which suggests differences in the use and/or quality of social support between Hispanics and Blacks. Longitudinal investigations that examine race/ethnicity, stress, social support, and QoL should help clarify the processes that underlie these observed relations.

Keywords: Diabetes; Race/ethnicity; Social support; Stress.

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Conflict of interest statement

Competing Interest Statement

The authors have no competing interests to report.

Figures

Figure 1
Figure 1
Test for a non-zero slope of the two-way interaction effect of ethnicity and stress on mental health scores. Values depict estimates at ±1 SD for stress. Error bars represent standard error of the mean. *Slope is significantly different from zero (P < .05).
Figure 2
Figure 2
Test for a non-zero slope of the three-way interaction effect of race/ethnicity × stress × social support on mental health scores. Results are shown separately for participants who experienced (a) low and (b) high life stress. Values depict estimates at ±1 SD for stress and social support. Error bars represent standard error of the mean. *Slope is significantly different from zero (P < .001)
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