Donald A. Lloyd

The epidemiology of social stress.

We examine the social distribution of exposure to stress to test the hypothesis that differences in stress exposure are one factor in sociodemographic variations in mental health. We make a more comprehensive effort to estimate stress exposure than has been typical, and present data that challenge the prevailing view that differences in exposure to stress are of only minimal significance for understanding variations in mental health. We report several findings, principal among which are: Differences in exposure to stress account for substantially more variability in depressive symptoms and major depressive disorder than previous reports have suggested; the distributions of stress exposure across sex, age, marital status, and occupational status precisely correspond to the distributions of depressive symptoms and major depressive disorder across the same factors; and differences in exposure to stress alone account for between 23 and 50 percent of observed differences in mental health by sex, marital status, and occupation. These findings contrast with the prevailing view that differences in vulnerability to stress across social statuses account for social status variations in mental health.

Race/ethnicity and depressive symptoms in community-dwelling young adults: a differential item functioning analysis

To examine variations in the manifestation of depressive symptomatology across racial/ethnic groups, analyses of differential item functioning (DIF) on the Center for Epidemiologic Studies Depression Scale (CES-D) were separately conducted for representative samples of young adults in the following groups: African-Americans (n = 434), Hispanics born in the US (n = 493), and Hispanics born outside the US (n = 395). Non-Hispanic whites (n = 463) were employed as the reference group in all analyses. The effects of gender and age were controlled. DIF analyses indicated that: (1) about half of the CES-D items functioned differently among non-Hispanic whites compared to each of the other racial/ethnic groups; (2) the manifestation of symptoms seemed to be similar for both Hispanic groups, except for low positive affect; (3) African-Americans tended to favor somatic symptoms over affective (depressive) symptoms; (4) Immigrant Hispanics appeared to inhibit the expression of positive affect, and thus more high scorers on the total CES-D were observed within this subgroup. In contrast, no differences were observed when only negative items were considered. The use of positive affect items might artifactually induce spurious differences among people who were born outside the United States or North America.

Personal Resources and the Social Distribution of Depression

This paper addresses the hypothesis that gender, age, marital status, and SES matter for depression partly because of associated differences in the availability and/or impact of the personal resources of mastery and self-esteem. It is argued that findings indicating that the social distributions of these resources complement those for depression would provide preliminary support for this hypothesis. Based on a large urban community sample (n = 1,390), our findings fail to support the availability hypothesis in relation to marital status, provide only modest support in reference to age and gender, but yield compelling support in relation to socioeconomic status (SES). Indeed, variations in the availability of these resources, especially mastery, provide a largely, if not entirely, adequate explanation for the SES–depressive symptoms relationship and accounts for nearly half of the SES–Major Depressive Disorder relationship. Although the significance of mastery was more pronounced among women and unmarried persons, such differences did not contribute to understanding observed gender or marital status variations in depression.

Cumulative Adversity and Posttraumatic Stress Disorder: Evidence From a Diverse Community Sample of Young Adults

The authors hypothesized that a history of adversities, whether they were objectively traumatic or not, predicts risk for 1st onset of PTSD. Survival analysis in a community sample of 1,803 young adults revealed that risk is associated with retrospectively reported adverse experiences that occurred in years prior to the focal traumatic event. Analyses control for clustering of events proximal to onset. Implications for etiology and preventive intervention are noted.

Physical disability and mental health: An epidemiology of psychiatric and substance disorders.

Objective: To estimate the lifetime and 1-year prevalence of psychiatric and substance disorders as they vary by the presence of physical disability and across gender, race– ethnicity, and age. Study Design: Community screening provided a sampling frame from which stratified random samples were drawn. Participants: Half were men, half were screened as having activity limitation, and African Americans, non-Hispanic Whites, persons of Cuban heritage, and other Hispanics each composed 25% of the sample. Interviews were completed with 1,986 individuals using the Composite International Diagnostic Interview. Outcome Measures: The authors provide the lifetime and past-year occurrence of both psychiatric and substance disorders. Results: A compelling relationship is observed between physical disability and risk for the lifetime occurrence of both psychiatric and substance disorders and for the past-year occurrence of psychiatric disorders. Elevations in risk are greater for men than for women, for the young than for the old, and for persons of Hispanic heritage compared with African Americans and nonHispanic Whites. Conclusions: Physical disability appears to represent a dimension of stress that increases risk for the occurrence of psychiatric or substance disorders.

The long-term impact of childhood abuse on internalizing disorders among older adults: The moderating role of self-esteem

Objectives: First, to determine if childhood experiences of abuse have an impact on internalizing disorders (e.g., anxiety and depressive disorders) among older adults. Second, we wish to determine if self-esteem plays a role in explaining the relationship between abuse and internalizing disorders. Method: First, we conducted an analysis on a population sample of participants aged 50 years or older (mean age = 67 years; SD = 10.3) assessed at two time points, three years apart (Wave 1, N = 1460; Wave 2, N = 1090). We examined the relationship between reports of childhood abuse (physical, emotional, and sexual) and internalizing disorders. Second, we determined the role self-esteem played in explaining the relationship. Results: We found that childhood experiences of abuse assessed at Wave 1 predicted the number of DSM-IV internalizing disorders occurring three years later. Demonstrating the specificity of self-esteem; we found self-esteem, but not emotional reliance, to moderate the relationship between abuse and internalizing disorders such that childhood abuse had more negative effects on those with low self-esteem compared to those with higher self-esteem. Contrary to prediction, self-esteem did not mediate the relationship between abuse and internalizing disorders. Conclusion: The negative effects of childhood abuse persist for many years, even into older adulthood. However, contrary to the findings in younger adults, self-esteem was not correlated with childhood abuse in older adults. Moreover, childhood abuse only had a negative effect on those who had low self-esteem. It may be through the process of lifespan development that some abused individuals come to separate out the effects of abuse from their self-concept.

Lifetime cumulative adversity, mental health and the risk of becoming a smoker:

We analyze the effect of stress exposure on the transition to heavy smoking, in a community sample of 1747 young adults in Miami, Florida. The effects of distal life stress are assessed in the context of recent stress exposure. Distal stress exposure predicts smoking independently of recent stress. Intervening stressful events do not appreciably mediate the influence of distal stress. We investigate the extent to which stress effects may be mediated by psychiatric and substance dependence disorders. We conclude that the effect of social stress on the risk for smoking is additive over time. The significant independent effect of early stress exposure implies that youths who are at greater risk for eventual heavy smoking may be identified at ages considerably younger than peak initiation age.

Self-Derogation, Peer Factors, and Drug Dependence Among a Multiethnic Sample of Young Adults

ABSTRACT Previous research suggests that self-derogation/rejection and peer factors are strongly related to adolescent substance use. However, much less in known about the role and significance of these risk factors in the escalation of drug use over time. In the current study, we examined whether early reports of self-derogation and peer approval prospectively predicted drug dependence. Data from three waves of a nine-year prospective study were employed to examine these relationships among a multiethnic sample of young adult males (N = 872). Analysis confirmed that self-derogation and peer approval of substance use independently predicted drug dependence even when early substance use was controlled. These findings underscore the utility of these factors in identifying high-risk individuals for prevention and early intervention efforts.

Racial and Ethnic Disparities in Dementia Risk among Individuals with Low Education

INTRODUCTION As higher dementia prevalence in ethnic minority groups could be attributed to low education, we studied individuals with low education and explored potential factors driving dementia disparities. METHODS We examined differences in dementia risk between low-educated non-Hispanic whites, Hispanics, and African Americans, and the impact of lifetime risk factors using data from the nationally representative Aging, Demographics, and Memory Study (N = 819). RESULTS As indicated by Cox regression modeling, dementia risk of low-educated individuals was not significantly different between ethnic groups but was related to having an APOE e4 allele (hazard ratio [HR] 1.89), depression (HR 1.67), stroke (HR 1.60), and smoking (HR 1.32). Further, even in people with low education, every additional year of education decreased dementia risk (HR 0.95). DISCUSSION Our findings imply that higher dementia prevalence in ethnic minorities may be attributable to low education, especially among Hispanics, in addition to other risk factors.