Perceived Built Environment and Physical Limitations: Race Contrasts in Historically Lower-Income African American Neighborhoods.

This study uses primary data from a community-based random sample of adults in historically lower-income African American (or Black) neighborhoods in Atlanta, Georgia (N = 352). The aim was to investigate whether there are race differences in perceived neighborhood conditions/amenities, and the potential conditional effect of race on the relationship between the perceived built environment and physical limitations. Findings indicate significant race differences in the perceived built environment and that the relationship between the perceived built environment and physical limitations is conditioned by race, whereby Whites experience greater physical health benefits from more neighborhood conditions/amenities than African Americans.

SES and race-ethnic differences in the stress-buffering effects of coping resources among young adults.

OBJECTIVES: This study assesses socioeconomic status (SES) and race-ethnic differences in the extent to which coping resources (social support and self-esteem) buffer the negative impact of chronic stress on depressive symptoms. DESIGN: We analyze data from a large community-based sample of young adults (ages 18-23) living in Miami-Dade County, Florida, USA (N = 1411). RESULTS: Study findings indicate that the stress-buffering effects of social support or self-esteem do not vary by SES. However, independent of SES and other study controls, non-Hispanic whites experience greater stress-buffering effects from social support than African-Americans and African-Americans experience greater stress-buffering effects from self-esteem than Cubans and Nicaraguans. CONCLUSION: In light of these results, we conclude that a greater understanding of racial and ethnic differences in mental health requires close attention to cultural transmissions of coping strategies within groups, which may be partly responsible for these differences in buffering effects.

Physical Limitations, Health Rumination/Worry, and Depressive Symptoms: Gender Differences among African Americans.

Although studies have documented the relationships between physical health, health rumination/worry, and mental health, few investigations have assessed these linkages within African American communities. Using a community-based sample of residents in historically lower-income, African American communities (N = 306), this study assesses the mediating role of health rumination/worry in the physical limitation-depressive symptom relationship, and the moderating effect of gender on the relationship between health rumination/worry-depressive symptoms. Findings demonstrate that health rumination/worry explains half of the physical limitation-depressive symptom relationship, and the relationship between health rumination/worry and depressive symptoms is stronger for African American men than women. The findings underscore the importance of intersectional research for policy efforts aimed at reducing mental health morbidities within African American communities.

The long-term impact of childhood abuse on internalizing disorders among older adults: the moderating role of self-esteem.

OBJECTIVES: First, to determine if childhood experiences of abuse have an impact on internalizing disorders (e.g., anxiety and depressive disorders) among older adults. Second, we wish to determine if self-esteem plays a role in explaining the relationship between abuse and internalizing disorders. METHOD: First, we conducted an analysis on a population sample of participants aged 50 years or older (mean age = 67 years; SD = 10.3) assessed at two time points, three years apart (Wave 1, N = 1460; Wave 2, N = 1090). We examined the relationship between reports of childhood abuse (physical, emotional, and sexual) and internalizing disorders. Second, we determined the role self-esteem played in explaining the relationship. RESULTS: We found that childhood experiences of abuse assessed at Wave 1 predicted the number of DSM-IV internalizing disorders occurring three years later. Demonstrating the specificity of self-esteem; we found self-esteem, but not emotional reliance, to moderate the relationship between abuse and internalizing disorders such that childhood abuse had more negative effects on those with low self-esteem compared to those with higher self-esteem. Contrary to prediction, self-esteem did not mediate the relationship between abuse and internalizing disorders. CONCLUSION: The negative effects of childhood abuse persist for many years, even into older adulthood. However, contrary to the findings in younger adults, self-esteem was not correlated with childhood abuse in older adults. Moreover, childhood abuse only had a negative effect on those who had low self-esteem. It may be through the process of lifespan development that some abused individuals come to separate out the effects of abuse from their self-concept.

Physical limitations and depressive symptoms: exploring the nature of the association.

OBJECTIVES: Although evidence suggests that physical disability and depression may be reciprocally related, questions of causality versus spuriousness and the direction of causality remain to be confidently answered. This study considered the hypothesis of reciprocal influence; the possibility of spuriousness in relation to pain, stress, and lifetime major depression; and the possible mediating effects of pain and social stress. METHODS: We analyzed data from a two-wave panel study of Miami-Dade County residents (n = 1,455) that included a substantial oversampling of individuals reporting a physical disability. RESULTS: Results indicated that, although prior levels of physical limitations predicted changes in depressive symptoms, there was no evidence of the reverse association. Results also indicated that part of the association between prior physical limitations and changes in depressive symptoms was explained by intervening level of pain and, to a lesser extent, by the day-to-day experience of discrimination. DISCUSSION: Much of whatever causation may be involved in the linkage between physical limitations and depressive symptomatology flows from limitations to depression rather than in the reverse direction. Results also make clear that this linkage is not an artifact of shared associations with pain, social stress, or lifetime major depression.

Risk and Protective Factors for Depressive Symptoms Among African American Men: An Application of the Stress Process Model.

Objectives: This study employs the stress process model (SPM) to identify risk/protective factors for mental health among adult African American men. Method: Using a community-based sample of Miami, FL residents linked to neighborhood Census data, this study identifies risk/protective factors for depressive symptomatology using a sample of 248 adult African American men. Results: The stress process variables independently associated with depressive symptoms were family support, mastery, self-esteem, chronic stressors, and daily discrimination. While mastery and self-esteem mediated the relationship between neighborhood income and depressive symptoms, perceived family support served as a buffer for stress exposure. Collectively, the SPM explains nearly half of the variability in depressive symptoms among African American men. Discussion: The SPM is a useful conceptual framework for identifying psychosocial risk/protective factors and directing health initiatives and policies aimed at improving the psychological health of African American men.

Time-clustered Deaths and Substance Use Disorder among Young Adults.

This study assesses whether experiencing multiple deaths of loved ones clustered in time increases risk for substance use problems. Using survey data from a community sample of young adults in Miami, Florida (N = 1747), time-clustered deaths were categorized based on the age of the respondent at the time of each death, with less time between deaths representing greater time-clustering. Results indicate that young adults experiencing multiple deaths that are highly time clustered are at increased risk for substance use disorder and alcohol use. This study provides an alternative way of thinking about how young people may be affected by major life events. It suggests that the increased risk for substance use disorder associated with multiple deaths may be more likely to materialize when the deaths are highly clustered in time.

Reciprocity between depressive symptoms and physical limitations pre- and postretirement: exploring racial differences.

OBJECTIVE: This study assesses (a) the reciprocity between mental and physical health pre- and postretirement, and (b) the extent to which these associations vary by race. METHOD: Data are from the 1994 to 2008 waves of the Health and Retirement Study. RESULTS: Analyses based on structural equation modeling reveal that depression and physical health exert reciprocal effects for Whites pre- and postretirement. For Blacks preretirement, physical limitations predict changes in depression but there is no evidence of the reverse association. Further, the association between physical limitations and changes in depressive symptoms among Blacks is no longer significant after retirement. DISCUSSION: The transition into retirement alleviates the translation of physical limitations into depressive symptoms for Blacks only. The findings underscore the relevance of retirement for reciprocity between mental and physical health and suggest that the health implications associated with this life course transition vary by race.

Depressive symptoms and bodily pain: The role of physical disability and social stress.

This study evaluates the bi-directional association between depressive symptoms and bodily pain, and examines the role of physical disability and perceived social stress in the depression-pain relationship. Data are employed from a two-wave panel study of Miami-Dade county residents (n = 1,459) that includes a substantial over-sampling of individuals who identify as physically-disabled. Findings indicate that the bi-directional relationship between depression and pain is similar for those with and without a physical disability. Results also demonstrate that stress exposure, specifically recent life events and daily discrimination, partially mediated the relationship between prior levels of depression and changes in pain. Directions for future research and the need for a more comprehensive model of health incorporating physical, psychological, and social factors are discussed.

Help-seeking behaviors in a community sample of young adults with substance use disorders.

Despite the high prevalence of substance use disorders (SUDs) in the U.S., many with a SUD go untreated and/or report lengthy delays to help-seeking initiation. From a public health standpoint, because SUDs often emerge in early adulthood, information on help-seeking behaviors among young adults is important. Using data from young adults ages 18-23 years with a history of a SUD (n = 672) in Miami-Dade County, Florida, this study estimates the prevalence of lifetime help-seeking initiation and examines factors related to help seeking and delays to help-seeking initiation. The majority (68%) of young adults with a history of a SUD reported never having sought help, and those who reported help seeking experienced relatively lengthy delays (1-7 years) to help-seeking initiation. These findings underscore the need for both timely substance abuse treatment and for accelerated research on successful outreach strategies for young adults with SUDs.

The History and Timing of Depression Onset as Predictors of Young-Adult Self-Esteem.

Depression often emerges early in the lifecourse and is consistently shown to be associated with poor self-esteem. The three main objectives of the current study are to (1) evaluate the association between a history major depression and self-esteem in young adulthood; (2) assess the relationship between timing of depression onset and young adult self-esteem; and (3) help rule out the alternative interpretation that the relationship between major depression and self-esteem is due to state dependence bias stemming from recent depressive symptoms and stressful life events. To address these objectives we use data from a two-wave panel study based on a community sample of young adults in Miami-Dade County, Florida (n = 1,197). Results indicated a history of major depression during sensitive periods of social development is associated with negative changes in self-esteem over a two-year period during the transition to young adulthood. Among those with a history of depression, earlier onset was more problematic than later onset for young adult self-esteem, although the difference disappeared once the level of self-esteem two years prior was controlled. The linkages between the history and timing of depression onset with self-esteem were observed net of recent depressive symptoms and stressful life events, and thus robust to an alternative interpretation of state dependence. The findings support the argument that major depression, especially if it develops earlier during child-adolescent development, has negative consequences for one's self-esteem.

The mental health and psychosocial adjustment of Cuban immigrants in south Florida.

Given documented variation in pre-migration and migration-related experiences, Cuban immigrants in the U.S. who arrived during or subsequent to 1980 may be disadvantaged in mental health and psychosocial adjustment relative to earlier arrivals. Using wave 1 of the Physical Challenge and Health study, we compare earlier and later arriving immigrants in levels of depression, anxiety, and self-esteem and test whether adversity and social support, acculturation-related factors, or pre-migration conditions account for any differences observed among a sample of adults living in South Florida (N = 191). Bivariate analyses reveal that later arrivals are relatively disadvantaged in anxiety and self-esteem and marginally so in depression. While later arrivals do not report more adversity in the U.S., they have lower levels of family support to cope with any adversity experienced. Later arrivals are also less likely to interview in English or to have a strong American identity, and they were more likely to have arrived as adults. Relative disadvantages in anxiety and self-esteem are best explained by indicators of acculturation and family support. Policies and programs that address acculturation difficulties and increase family support could improve the health and adjustment of these and similar immigrants.

Trends in state prison admission of offenders with serious mental illness.

OBJECTIVE: This study examined whether the proportion as well as the number of prisoners with behavioral health disorders have increased in recent years. METHODS: Among 41,440 persons admitted to Washington State prisons from 1998 through 2006, this study estimated numbers and proportions of behavioral health disorders diagnosed while persons were in the community or in prison. RESULTS: There was a 44% increase in persons admitted with a diagnosed co-occurring substance use disorder between 1998 (N=477) and 2005 (N=686); this increase dropped to 27% by 2006 (N=604). Ratewise, increases in the annual proportion of persons admitted with co-occurring disorders were much smaller, ranging from approximately .2% to 2.6%. CONCLUSIONS: The growth in the numbers of prisoners with serious mental illness and co-occurring substance use disorders was not due primarily to increases in admission base rates. Nevertheless, more treatment resources will be needed in prisons to meet growing mental health care needs, and more community-based resources will be needed to ensure continuity of treatment and successful community reentry.