Abstract
The prevalence and severity of depression differ in women and men and across racial groups. Psychosocial factors such as chronic stress have been proposed as contributors, but causes of this variation are not fully understood. Allostatic load, a measure of the physiological burden of chronic stress, is known to be associated with depression. Using data from the National Health and Nutrition Examination Survey 2005–2010, we examined the associations of nine allostatic load biomarkers with depression among US black and white adults aged 18–64 years (n = 6431). Depressive symptoms were assessed using the Patient Health Questionaire-9; logistic models estimated adjusted odds of depression based on allostatic load biomarkers. High-risk levels of c-reactive protein were significantly associated with increased odds of depression among white women (adjusted odds ratio (aOR) = 1.7, 95% CI: 1.1–2.5) and men (aOR = 1.8, 95% CI: 1.1–2.8) but not black women (aOR = 0.8, 95% CI: 0.6–1.1) or men (aOR = 0.9, 95% CI: 0.5–1.5). Among black men, hypertension (aOR = 1.7, 95% CI: 1.1–2.7) and adverse serum albumin levels (aOR = 1.7, 95% CI: 1.0–2.9) predicted depression, while high total cholesterol was associated with depression among black women (aOR = 1.6, 95% CI: 1.0–2.7). The associations between allostatic load biomarkers and depression varies with gendered race, suggesting that, despite consistent symptomatology, underlying disease mechanisms may differ between these groups.
Highlights
A large proportion of the United States chronic disease burden is attributed to depressive disorders [1]
Sociodemographics, depression, and high-risk levels of each of the nine included biomarkers are reported in Table 1 by gendered race
Another study examined how allostatic load differentially predicts depressive symptoms in black and white women and men, finding an association only among black men and white women [45]. In accordance with these findings, our results indicate different underlying disease relationships among black and white women and men, divergence in the predictors of depressive symptoms potentially steered by unmeasured psychosocial exposures that are unique to each gendered race
Summary
A large proportion of the United States chronic disease burden is attributed to depressive disorders [1]. Major depressive disorder (MDD), the most common form of depression, is the leading cause of disability among those aged 15 years and older [2]. Of central public health concern are racial and gender disparities in who develops depression; differences in the prevalence and incidence of MDD diagnosis and depressive symptomatology between black and white women and men have been well documented [3,4,5,6]. Rates of MDD diagnosis are higher among white persons. Black women and men report a higher prevalence of depressive symptoms. There is evidence that somatic symptoms are more common among black persons, while affective symptoms of depression are more frequently reported among whites [7]
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