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Does psychological distress contribute to racial and socioeconomic disparities in mortality?

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  • Fiscella, Kevin
  • Franks, Peter

Abstract

Being black or poor are powerful predictors of mortality. Although psychological distress has been proposed as mediating the effects of race and socioeconomic status on mortality, this hypothesis has not been previously directly tested. We used data from the National Health and Nutrition Examination I (NHANES I), a nationally representative sample from the U.S, and the NHANES I Epidemiological Follow-up Survey (NHEFS) of subsequent mortality to test this hypothesis. Both black race and lower family income were associated with significantly higher psychological distress as measured at the time of the initial survey by reports of hopelessness, depression, and life dissatisfaction. Black race and low income in addition to each of the measures of psychological distress were associated with higher mortality at follow-up. In a series of Cox proportional hazards models that controlled for the effects of age and gender, additional adjustment for hopelessness, depression, or life dissatisfaction had little effect on the relationship between either African American race or family income and subsequent all-cause mortality. We conclude that the effects of both race and income on mortality are largely independent of psychological distress. These findings do not support the hypothesis that psychological distress is a significant mediator of the effects of race or class on health.

Suggested Citation

  • Fiscella, Kevin & Franks, Peter, 1997. "Does psychological distress contribute to racial and socioeconomic disparities in mortality?," Social Science & Medicine, Elsevier, vol. 45(12), pages 1805-1809, December.
    • Handle: RePEc:eee:socmed:v:45:y:1997:i:12:p:1805-1809
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    Cited by:

    1. Muennig, Peter & Franks, Peter & Jia, Haomiao & Lubetkin, Erica & Gold, Marthe R, 2005. "The income-associated burden of disease in the United States," Social Science & Medicine, Elsevier, vol. 61(9), pages 2018-2026, November.
    2. Bjørnskov, Christian, 2008. "Healthy and happy in Europe? On the association between happiness and life expectancy over time," Social Science & Medicine, Elsevier, vol. 66(8), pages 1750-1759, April.
    3. Zajacova, Anna & Huzurbazar, Snehalata & Todd, Megan, 2017. "Gender and the structure of self-rated health across the adult life span," Social Science & Medicine, Elsevier, vol. 187(C), pages 58-66.
    4. Jin, Lei & Wen, Ming & Fan, Jessie X. & Wang, Guixin, 2012. "Trans-local ties, local ties and psychological well-being among rural-to-urban migrants in Shanghai," Social Science & Medicine, Elsevier, vol. 75(2), pages 288-296.
    5. Samir KC & Harold Lentzner, 2010. "The effect of education on adult mortality and disability: a global perspective," Vienna Yearbook of Population Research, Vienna Institute of Demography (VID) of the Austrian Academy of Sciences in Vienna, vol. 8(1), pages 201-235.
    6. Hong Zou & Qianqian Xiong & Hongwei Xu, 2020. "Does Subjective Social Status Predict Self-Rated Health in Chinese Adults and Why?," Social Indicators Research: An International and Interdisciplinary Journal for Quality-of-Life Measurement, Springer, vol. 152(2), pages 443-471, November.
    7. Kate Levin & Lorenza Dallago & Candace Currie, 2012. "The Association Between Adolescent Life Satisfaction, Family Structure, Family Affluence and Gender Differences in Parent–Child Communication," Social Indicators Research: An International and Interdisciplinary Journal for Quality-of-Life Measurement, Springer, vol. 106(2), pages 287-305, April.
    8. K. Levin & C. Currie, 2014. "Reliability and Validity of an Adapted Version of the Cantril Ladder for Use with Adolescent Samples," Social Indicators Research: An International and Interdisciplinary Journal for Quality-of-Life Measurement, Springer, vol. 119(2), pages 1047-1063, November.

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