Presented at Montana State University February 10, 2012 Health Disparities and the Stress Hypothesis R. Jay Turner, Ph.D Vanderbilt University

Stress Process Model

Retrospective self-report, computer assisted personal interviews DSM-IV CIDI diagnoses: major depression, dysthymia, GAD, social phobia, panic disorder, alcohol abuse and dependence, drug abuse and dependence, PTSD, and antisocial personality disorder. PLUS attention deficit and hyperactive disorder and Childhood conduct disorder from the Diagnostic Interview schedule.

TABLE 3. Depressive Symptomatology (CES-D) Regressed on Social Status and Stress Process Components: Toronto, 1990– Intercept24.744***23.766***44.327***59.348***14.286**30.444***23.123***47.003*** (4.320)(4.199)(4.221)(4.226)(4.148)(4.488)(4.136)(4.584) Female2.643***2.149***2.226***2.234***2.096**2.196***3.105***1.556** (.623)(.568)(.546)(.595)(.612)(.580)(.599)(.482) Age–.739**–.701**–.597*–.598**–.592*–.728**–.619**–.447* (.237)(.227)(.228)(.210)(.228)(.233)(.230)(.189) Age 2.008*.008**.006†.006*.006*.008*.006*.004† (.003)(.003)(.003)(.003)(.003)(.003)(.003)(.003) Previously-married3.342** ***3.491***3.909***2.994** * (1.064)(1.004)(.978)(.866)(.994)(1.035)(.861)(.757) Never-married ** *1.038– † (.808)(.727)(.688)(.693)(.799)(.778)(.723)(.629) SES–1.060**–.682*–.175–.712**–.713*–1.417***–.877**–.091 (.299)(.294)(.267)(.266)(.294)(.280)(.283)(.251) Stress3.968***2.799*** (.289)(.287) Mastery–.767***–.359*** (.060)(.050) Self Esteem–1.326***–.683*** (.081)(.079) Emotional Reliance.543***.302*** (.071)(.051) Assertion of Autonomy–.618***–.250** (.105)(.076) Social Support–2.829***–.931** (.247)(.264) R † p <.10 *p <.05 **p <.01 ***p <.001 Note: Unstandardized OLS regression coefficients; standard errors are in parentheses; data weighted to adjust for respondent selection bias; standard errors adjusted for clustered sampling design using Stata survey regression procedure. N = 1338.

1. To evaluate the stress hypothesis and assess the utility of an elaborated “stress process” model for explaining race and socioeconomic position (SES) differences in health and changes in health over time, where: a) health status is estimated in multiple ways that address the problem of misclassification. b) variations in stress exposure are estimated more comprehensively than in prior research. c) the direct, mediating and moderation effects of an extended array of social and personal coping resources and of contextual and cultural factors are examined in the context of a) and b) above.

2. To confirm and extend epidemiological estimates of race and SEP differences in the prevalence of health problems, variously and collectively defined, while addressing the misclassification problem. 3. To evaluate the interrelationships of differing dimensions of health, variously estimated, and their risk significance for one another, in cross section and over time. 4. To describe the distribution of each risk factor identified across race, SEP, age and gender while examining antecedent factors that put individuals and groups at differential risk for acquiring such risk factors. 5. To obtain and preserve samples to support subsequent studies (not here proposed) on gene- environment interactions relating to factors hypothesized to be of risk or protective significance.

Table 2. Temporally Ordered Associations between Lifetime DSM-IV Psychiatric and Substance Dependence Disorders Substance Dependence b N%OR d 95% CI Comorbid Depression *** Pure Depression Comorbid PTSD *** Pure PTSD ** Comorbid Anxiety Disorder a *** Pure Anxiety Disorder

Table 4. Effects of Stress Exposure on Associations between Lifetime DSM-IV Psychiatric and Substance Dependence Disorders Substance Dependence b Not OrderedOrdered OR Comorbid Depression 2.4*** † Pure Depression Comorbid PTSD 1.7* Pure PTSD Comorbid Anxiety Disorder a Pure Anxiety Disorder OR d 95% CId