Is stress exposure enough? Race/ethnic differences in the exposure and appraisal of chronic stressors among older adults

2018-08-06The current project examines the experience of chronic stressors, specifically the exposure and appraisal of chronic stress, as separate but principal mechanisms contributing to mental health disparities in older adulthood. The differential exposure and vulnerability hypotheses have been the dominant frameworks in examining stress to better understand race/ethnic differences in health. These theories suggest that minorities, and blacks in particular, are more exposed to stressors and are more vulnerable to the effects of stress on health due to their disadvantaged social status. Research has shown that stress exposure is linked to worse physical and mental health. However, most of the stress and health literature at the population level fails to consider how race/ethnicity uniquely shapes chronic stress exposure and subsequent stress appraisal on mental health outcomes in a nationally representative sample of diverse older adults. Further, demographic health disparities research has been unable to establish whether stress exposure and stress appraisal are differentially linked to race and ethnic differences in mental health in mid- and late-life. ❧ This project aims to advance the science of health disparities by using a racially diverse nationally representative sample of older adults from the Health and Retirement Study (N=6,878) to: 1) examine racial/ethnic differences in the number of reported chronic stressors across five domains (health, financial, residential, relationship and caregiving), and their appraised stressfulness; 2) determine whether chronic stress exposure and appraisal are differentially related to mental health outcomes and 3) examine age variation in race/ethnic differences in the number of reported chronic stress exposures across the five key domains. ❧ Results show older blacks and Hispanics report the highest levels of chronic stress exposure and are twice as likely as whites to experience financial strain and housing related stress. Despite experiencing a greater number of stressors, blacks and Hispanics are less likely to be upset by exposure to stressors than whites. Hispanics were less upset by relationship strain while blacks were less upset across every domain (health, financial, residential, relationship and caregiving) of chronic stress. Results also show that greater chronic stress exposure and appraisal are significantly associated with more anxiety and depressive symptoms Yet, race and stress appraisal interactions show that when blacks rate their stress as not upsetting they report fewer depressive symptoms than whites. Comparatively, when blacks consider their stress exposure as either somewhat or very upsetting they report significantly more depressive symptoms relative to whites. Finally, in considering age differences in stress exposure, results show fewer chronic stressors are reported by adults 70+, compared to adults 54-69 years. Yet, analysis of age interactions show that the decline in total stress burden found with age is only true among white older adults. Domain specific results show whites report less exposure to every stress domain except for health problems after age 70. Blacks report similar amounts of stress before and after age 70 with the exception that they report less employment strain than younger blacks. Hispanic groups report similar stress burdens before and after age 70 as whites after adjusting for SES. ❧ This distinction between exposure and appraisal based measures of stress shed light on important pathways that may differentially contribute to mental health disparities among these groups. Further, race/ethnic disparities in stress exposure may reflect differential experiences of age-related declines in chronic stress exposure. The results inform long-standing debates over whether stress exposure alone is enough to incite race and ethnic differences in health or whether appraising a stressor as stressful is equally necessary in the manufacturing of health disparities. Additionally, this research identifies the unique social, economic, and psychological challenges minority populations face in maintaining mental and physical wellbeing in old age by acknowledging aspects of the stress process that may vary due, in part, to the higher stress burdens they face