Abstract P373: Psychosocial Risk and Resilience Profile in Rural Alabama: A Preliminary Analysis of Risk Underlying Rural Areas Longitudinal (RURAL) Study

Abstract

Background: Given the disproportionate burden of cardiovascular disease risk and outcomes, there is an urgent need to understand the psychosocial drivers of these inequities. We characterized the psychosocial risk and resilience profiles of a cohort of rural-dwelling adults in the southeast U.S. Methods: This preliminary analysis includes 765 participants with complete covariate data (mean age 47.9 (SD=10.9), 70.7% self-reporting as women, 77.9% Black individuals, 41.4% with annual household income below $15,000; 43.7% possessing a high school diploma/GED or lower) residing in two rural counties in Alabama, part of the larger RURAL study. We evaluated participants across six crucial psychosocial domains: financial strain (continuous), financial adjustments (categorized as 0, 1-3, 4+), housing stability (tertiles), childhood adversity (including general, physical, and emotional trauma experienced before 18 years, categorized into tertiles), depression (measured using CES-D 16; yes/no), and resilience (measured using CD-RISC, categorized into tertiles). We examined the distribution of study outcomes and conducted race and sex-based comparisons. Results: Resilience was high overall and did not vary significantly by race or sex. Significant racial disparities were observed, with Black participants experiencing higher financial strain (mean: 2.84 Black vs. 2.34 White), housing instability (30.1% Black vs. 11.9% White), and elevated depressive symptoms (35.2% Black vs. 25.3% White). Conversely, White participants reported greater general trauma and depression (highest tertile: 17.8% Black, 23.8 % White for general trauma; 64.3% Black vs. 73.8% White for depression). Sex-based differences were statistically insignificant across most psychosocial factors, except for financial adjustments (highest tertile: 27.7% men vs. 36.0% women) and physical trauma (38.0% men vs. 22.0% women). When considering the intersection of race and sex, Black men had the highest prevalence of housing instability (highest tertile: 35.2% Black men, 27.8% Black women, 6.8% White men, 15.8% White women), and elevated depressive symptoms (35.8% Black men, 35% Black women, 15.3 % White men, 31.6% White women). White men had the highest prevalence of physical trauma (highest tertile: 35.8% Black men, 21.3% Black women, 44.1% White men, 25.3% White women), and White women had the highest prevalence of financial adjustments (highest tertile: 30.3% Black men, 33.9% Black women, 20.3% White men, 46.3% White women). Conclusion: Our preliminary analysis of the RURAL study underscores substantial psychosocial adversity in these Southern rural communities. Future investigations should explore the relationship between these psychosocial factors and CVD risk to help identify potential intervention targets to improve cardiovascular health in rural communities.