The Association between Multiple Chronic Conditions and Depressive Symptoms: Intersectional Distinctions by Race, Nativity, and Gender

2021 ◽  
pp. 002214652110401
Author(s):  
Christy L. Erving ◽  
Cleothia Frazier
Keyword(s):  
Depressive Symptoms ◽  
Black Women ◽  
Chronic Conditions ◽  
Hispanic Women ◽  
Multiple Chronic Conditions ◽  
Growth Curve Analysis ◽  
Foreign Born ◽  
And Gender ◽  
Gender Groups ◽  
Retirement Study

Using random coefficient growth curve analysis, this study utilizes 12 waves of data from the Health and Retirement Study (1994–2016; person-waves = 145,177) to examine the association between multiple chronic conditions (MCC) and depressive symptoms among older adults. Applying cumulative disadvantage and intersectionality theories, we also test whether the association between MCC and depressive symptoms differs by race, nativity, and gender. Findings reveal that MCC prevalence is highest among U.S.-born black women, whereas depressive symptoms are highest among foreign-born Hispanic women. Compared to men, MCC has a stronger effect on women’s depressive symptoms. Furthermore, the MCC–depressive symptoms association is strongest for foreign-born Hispanic women. Despite an increase in MCC in the transition from midlife to late life, all race–nativity–gender groups experience a decline in depressive symptoms as they age. The decline in depressive symptoms is steepest for U.S.-born black and foreign-born Hispanic women. Study implications are discussed.

scholarly journals Individual-Level and Couple-Level Discordant Chronic Conditions: Longitudinal Links to Functional Disability

2019 ◽  
Vol 54 (7) ◽  
pp. 455-469
Author(s):  
Courtney A Polenick ◽  
Kira S Birditt ◽  
Angela Turkelson ◽  
Helen C Kales
Keyword(s):  
Depressive Symptoms ◽  
Chronic Conditions ◽  
Functional Disability ◽  
Well Being ◽  
Multiple Chronic Conditions ◽  
Individual Level ◽  
Growth Curve Models ◽  
Rate Of Increase ◽  
The Individual ◽  
Retirement Study

Abstract Background Multiple chronic conditions may erode physical functioning, particularly in the context of complex self-management demands and depressive symptoms. Yet, little is known about how discordant conditions (i.e., those with management requirements that are not directly related and increase care complexity) among couples are linked to functional disability. Purpose We evaluated own and partner individual-level discordant conditions (i.e., discordant conditions within individuals) and couple-level discordant conditions (i.e., discordant conditions between spouses), and their links to levels of and change in functional disability. Methods The U.S. sample included 3,991 couples drawn from nine waves (1998–2014) of the Health and Retirement Study. Dyadic growth curve models determined how individual-level and couple-level discordant conditions were linked to functional disability over time, and whether depressive symptoms moderated these links. Models controlled for age, minority status, education, each partner’s baseline depressive symptoms, and each partner’s number of chronic conditions across waves. Results Wives and husbands had higher initial disability when they had their own discordant conditions and when there were couple-level discordant conditions. Husbands also reported higher initial disability when wives had discordant conditions. Wives had a slower rate of increase in disability when there were couple-level discordant conditions. Depressive symptoms moderated links between disability and discordant conditions at the individual and couple levels. Conclusions Discordant chronic conditions within couples have enduring links to disability that partly vary by gender and depressive symptoms. These findings generate valuable information for interventions to maintain the well-being of couples managing complex health challenges.

scholarly journals Racial/ethnic/gender-based Disparities in Health Trajectories among American Older Adults

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 894-894
Author(s):  
Dexia Kong ◽  
Peiyi Lu ◽  
Joan Davitt ◽  
Mack Shelley
Keyword(s):  
Older Adults ◽  
Depressive Symptoms ◽  
Black Women ◽  
Physical Function ◽  
Hispanic Women ◽  
White Men ◽  
Gender Based ◽  
And Gender ◽  
Ethnicity And Gender ◽  
Racial Ethnic

Abstract Numerous studies have examined racial/ethnic- or gender-based disparities in health. However, few examined health outcomes based on a combination of individuals’ race, ethnicity, and gender. Guided by an intersectionality framework, this study explores racial/ethnic/gender-based differences in older adults’ health trajectories over a ten-year period. Longitudinal data from the Health and Retirement Study (2004-2014) were used (n=16,654). Older adults (65+) were stratified into six groups based on their race, ethnicity, and gender, including (1) Non-Hispanic (NH) White Men; (2) NH White Women; (3) NH Black Men; (4) NH Black Women; (5) Hispanic Men; and (6) Hispanic Women. Growth curve models were used to examine the trajectories of three health indicators over time, including cognitive function, physical function (i.e. the sum of activities of daily living and instrumental activities of daily living), and depressive symptoms. The results indicated that NH White men and women outperformed racial/ethnic minority groups in cognition and physical function trajectories. Females in all racial/ethnic groups had more depressive symptoms but better cognition than their male counterparts. Hispanic women reported the most depressive symptoms. Hispanic women and NH Black women had the poorest physical function. NH Black men/women had the lowest cognition. Study findings highlighted the utility of an intersectionality framework in understanding health disparities in later life. Multiple social identities intersect with each other and generate protective and/or risk effects on cognitive, mental, and physical health status. Multilevel intervention strategies are warranted to close the health equity gap among various marginalized population groups.

scholarly journals Onset of Multiple Chronic Conditions and Depressive Symptoms: A Life Events Perspective

2017 ◽  
Vol 1 (2) ◽  
Author(s):  
Maureen Wilson-Genderson ◽  
Allison R Heid ◽  
Rachel Pruchno
Keyword(s):  
Heart Disease ◽  
Depressive Symptoms ◽  
Pulmonary Disease ◽  
Chronic Conditions ◽  
Clinical Care ◽  
Psychological Impact ◽  
Multiple Chronic Conditions ◽  
Care Providers ◽  
The Subject ◽  
Independent Effects

Abstract Background While the association between depressive symptoms and chronic illness has been the subject of many studies, little is known about whether depressive symptoms differ as a function of the illnesses people have as they transition to living with multiple chronic conditions. Methods Self-reports of five diagnosed chronic conditions (arthritis, diabetes, heart disease, hypertension, and pulmonary disease) and depressive symptoms were provided by 3,396 people participating in three waves of the ORANJ BOWLSM research panel. Longitudinal multilevel modeling was used to examine the effects that transitioning to having a diagnosis of multiple chronic conditions has on depressive symptoms. Results Between 2006 and 2014, controlling for age, gender, income, race, and a lifetime diagnosis of depression, people who transitioned to having a diagnosis of multiple chronic conditions had significantly higher levels of depressive symptoms than people who did not make this transition. The diagnosis of arthritis, diabetes, heart disease, and pulmonary disease, but not hypertension had independent effects, increasing depressive symptoms. Conclusions Having a diagnosis of multiple chronic conditions leads to increases in depressive symptoms, but not all illnesses have the same effect. Findings highlight the need for clinicians to be aware of mental health risks in patients diagnosed with multiple chronic conditions, particularly those with a diagnosis of arthritis, diabetes, heart disease, and pulmonary disease. Clinical care providers should take account of these findings, encouraging psychosocial supports for older adults who develop multiple chronic conditions to minimize the negative psychological impact of illness diagnosis.

scholarly journals Patterns of Multimorbidity in Adults: An Association Rules Analysis Using the Korea Health Panel

2020 ◽  
Vol 17 (8) ◽  
pp. 2618 ◽  
Author(s):  
Yoonju Lee ◽  
Heejin Kim ◽  
Hyesun Jeong ◽  
Yunhwan Noh
Keyword(s):  
Network Analysis ◽  
Chronic Conditions ◽  
Integrated Approach ◽  
Classification Of Diseases ◽  
Standard Classification ◽  
And Gender ◽  
Gender Groups ◽  
Association Rules Analysis ◽  
Different Characteristics ◽  
Public Health Practitioners

This study aimed to identify the prevalence and patterns of multimorbidity among Korean adults. A descriptive study design was used. Of 11,232 adults aged 18 and older extracted from the 2014 Korean Health Panel Survey, 7118 had one or more chronic conditions. The chronic conditions code uses the Korean Standard Classification of Diseases. Association rule analysis and network analysis were conducted to identify patterns of multimorbidity among 4922 participants with multimorbidity. The prevalence of multimorbidity in the overall population was 34.8%, with a higher prevalence among women (40.8%) than men (28.6%). Hypertension had the highest prevalence in both men and women. In men, diabetes mellitus and hypertension yielded the highest probability of comorbidity (10.04%). In women, polyarthrosis and hypertension yielded the highest probability of comorbidity (12.51%). The results of the network analysis in four groups divided according to gender and age showed different characteristics for each group. Public health practitioners should adopt an integrated approach to manage multimorbidity rather than an individual disease-specific approach, along with different strategies according to age and gender groups.

scholarly journals Deaths, Disparities, and Cumulative (Dis)Advantage: How Social Inequities Produce an Impairment Paradox in Later Life

2021 ◽  
Author(s):  
Heide Jackson ◽  
Michal Engelman
Keyword(s):  
Black Women ◽  
Multinomial Logistic Regression ◽  
Functional Limitations ◽  
Later Life ◽  
Functional Health ◽  
Race And Gender ◽  
Nationally Representative ◽  
And Gender ◽  
Gender Groups ◽  
The Impact

Abstract Background Research on health across the life course consistently documents widening racial and socioeconomic disparities from childhood through adulthood, followed by stabilization or convergence in later life. This pattern appears to contradict expectations set by cumulative (dis)advantage (CAD) theory. Informed by the punctuated equilibrium perspective, we examine the relationship between midlife health and subsequent health change and mortality and consider the impact of earlier socioeconomic exposures on observed disparities. Methods Using the Health and Retirement Study, we characterize the functional impairment histories of a nationally-representative sample of 8,464 older adults between 1994-2016. We employ non-parametric and discrete outcome multinomial logistic regression to examine the competing risks of mortality, health change, and attrition. Results Exposures to disadvantages are associated with poorer functional health in midlife and mortality. However, a higher number of functional limitations in midlife is negatively associated with the accumulation of subsequent limitations for white men and women and for Black women. The impact of educational attainment, occupation, wealth, and marriage on later life health differs across race and gender groups. Conclusions Observed stability or convergence in later-life functional health disparities is not a departure from the dynamics posited by CAD, but rather a result of the differential impact of racial and socioeconomic inequities on mortality and health at older ages. Higher exposure to disadvantages and a lower protective impact of advantageous exposures lead to higher mortality among Black Americans, a pattern which masks persistent health inequities later in life.

scholarly journals Child’s Developmental Disabilities and Parental Health in Later Life: Do Parental Race and Gender Matter?

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 312-313
Author(s):  
Juha Lee ◽  
Manjing Gao ◽  
Chioun Lee
Keyword(s):  
Black Women ◽  
Developmental Disabilities ◽  
Adverse Effects ◽  
Early Life ◽  
The United States ◽  
Parental Health ◽  
Race And Gender ◽  
And Gender ◽  
Gender Groups ◽  
The Impact

Abstract Parents, particularly mothers, who experienced early life adversities (ELAs) are more likely to have a child with developmental disabilities (DD). We have little knowledge about how parental health varies across race-gender groups among those with a DD child and the role of ELAs in the associations. Using Black and White adults (n = 8,778; 25% Blacks) from the Midlife in the United States (MIDUS) study, we examine racial disparities in the impact of having a child with DD (vs. having healthy children) on parental health outcomes. This study questions (1) the extent to which parents’ ELAs (e.g., poverty and abuse) are associated with having a child with DD and (2) how considering early-life factors reveals racial and gender disparities in the impact of having a child with DD. We found that as the number of ELAs increases, the probability of having a healthy child decreases for all race-gender groups, but most dramatically for Black women. Having a DD has adverse effects on chronic illnesses and functional limitations more for mothers than fathers. Black women are most adversely affected, with no effect on Black men. There is no gender difference in the impact of having a DD child on depressive symptoms, yet White parents are more vulnerable than Black parents. After controlling for ELAs, the adverse effects of having a DD child on both physical and mental health remain significant. Future research should identify life-course circumstances that reveal why the impact of having a DD child varies by race and gender.

scholarly journals CHRONIC CONDITIONS, FUNCTIONAL LIMITATIONS, AND DEPRESSION IN OLDER ADULTS: ANALYSIS OF A LONGITUDINAL STUDY

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S572-S572
Author(s):  
Jyotsana Parajuli ◽  
Diane Berish ◽  
Ying-Ling Jao
Keyword(s):  
Older Adults ◽  
Depressive Symptoms ◽  
Direct Effect ◽  
Chronic Conditions ◽  
Functional Limitations ◽  
Mediation Effect ◽  
High Risk Population ◽  
Longitudinal Impact ◽  
The Relationship ◽  
Retirement Study

Abstract Background: Chronic conditions, functional limitations, and depression are highly prevalent in older adults. Evidence suggests the links between chronic conditions, functional limitations, and depressive symptoms separately. However, few studies have considered these three conditions together longitudinally. This study examined the longitudinal relationship between chronic conditions and depressive symptoms and evaluated the mediation effect of functional limitations on the relationship between chronic conditions and depressive symptoms in older adults. Methods: This study analyzed longitudinal data from the Health and Retirement Study collected in 2012 and 2014. Mediation analysis was used to examine the direct and indirect effects of chronic conditions and functional limitations measured at the year 2012 on depressive symptoms measured at the year 2014 controlling for demographics. Results: Results revealed that chronic conditions predicted depressive symptoms. Specifically, one additional chronic condition in 2012 corresponded to an increase of 0.35 in depressive symptoms in 2014 (p<.001). After adding functional limitations as a mediator, the direct effect was reduced to 0.26 and the indirect effect was .088 (p<.001). In other words, functional limitations explained approximately 25% of the direct effect of chronic diseases on depression. Discussion: Findings reveal the longitudinal impact of chronic conditions and functional limitations on depressive symptoms in older adults. Findings help identify the high-risk population of depressive symptoms and intervene early.

scholarly journals DISCORDANT CHRONIC CONDITIONS AND DEPRESSIVE SYMPTOMS AMONG MIDDLE-AGED AND OLDER COUPLES

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S58-S58
Author(s):  
Courtney A Polenick ◽  
Kira S Birditt ◽  
Angela Turkelson ◽  
Benjamin Bugajski ◽  
Helen C Kales
Keyword(s):  
Depressive Symptoms ◽  
Marital Quality ◽  
Chronic Conditions ◽  
Later Life ◽  
Well Being ◽  
Minority Status ◽  
Middle Aged ◽  
Older Couples ◽  
Individual Level ◽  
Retirement Study

Abstract Discordant chronic conditions (i.e., those with competing management requirements) have adverse consequences for well-being, yet little is known about their implications among couples. We evaluated how depressive symptoms are linked to discordant conditions within individuals and between spouses across an 8-year period. The U.S. sample included 1,116 middle-aged and older couples from five waves (2006 – 2014) of the Health and Retirement Study. Longitudinal actor-partner interdependence models controlled for age, minority status, education, depressive symptoms in the previous wave, and each partner’s report of baseline marital quality and number of chronic conditions in each wave. Wives and husbands with their own discordant conditions reported higher depressive symptoms, and this association intensified over time. Over and above this link, husbands had higher depressive symptoms when there were discordant conditions between spouses. Both individual-level and couple-level discordant chronic conditions appear to have enduring implications for depressive symptoms in middle and later life.

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