Background:
Emerging evidence suggests that psychosocial factors are related to morbidity and mortality due to cardiovascular disease (CVD). African American women experience a unique multitude of psychosocial stressors, including racism, discrimination, poverty, neighborhood stress, anxiety, and depression. The impact of these stressors on CVD risk in African American women during early adulthood (age 19-24 years) is limited.
Objective:
In this systematic review, we synthesized and evaluated the existing evidence on the relationship between psychosocial stress and CVD risk in young adult African American women.
Methods:
We conducted a comprehensive search of the literature in PubMed, APA PsycINFO, and CINAHL for studies published between January 1975 and May 2020 that examined psychosocial stress and CVD risk factors in young adult African American women. Eligible studies measured at least one psychosocial stress exposure, a CVD risk factor, or subclinical CVD outcome (e.g., body mass index, blood pressure, carotid intima-media thickness), and included African American women age 19-24 years or reported sex-stratified analyses. We excluded reviews, editorials, case studies, and gray literature. Two reviewers independently screened studies for eligibility and appraised the quality of the included studies using the Newcastle-Ottawa Scale.
Results:
The literature search yielded 1,100 potentially relevant articles for review. Of these, we identified nine studies that met our inclusion criteria: six cross-sectional and three prospective cohort studies. The mean age of participants ranged from 19 to 22 years. Of the nine studies, eight found that stress (i.e., perceived stress, racial discrimination, internalized racism, depression) was related to higher body mass index and blood pressure. In one longitudinal study, a greater frequency of everyday discrimination was associated with a nearly 2-fold higher odds of excessive weight gain (>40 pounds) during pregnancy. Overall, the majority of studies (n=6) were rated
as
excellent
; the remainder were
good
and
fair.
The lowest risk of bias was the selection and outcome measurement.
Conclusion:
This systematic review found sufficient evidence to support a relationship between psychosocial stress and CVD risk factors in young adult African American women. However, future studies that follow women from childhood to early adulthood are needed to gain a better understanding of the impact of psychosocial stress on the progression of CVD risk. Further investigation on specific stressors relevant to early adulthood, including self-identity and social role stress, are needed to understand the full extent to which psychosocial stress impacts CVD risk in young African American women.
Wisconsin Twin Project Overview: Temperament and Affective Neuroscience