Profiles of Psychological Distress Among Middle-Aged and Older Adults: Findings From the National Survey of American Life

Background and Purpose: In 2007, an estimated 24.3 million adults (10.9%), had symptoms of serious psychological distress (SPD). Adults with SPD have a higher prevalence of heart disease, diabetes, arthritis, and stroke than persons without SPD. They are also more likely to need help with activities of daily living and instrumental activities of daily living, and to use more medical care services. Few studies examine the risk factors for SPD using representative national or community samples of Black Americans. Consequently, little is known about whether identified risk factors function in the same way and to the same extent among African Americans compared with other groups. The purpose of this study is to identify risk profiles of SPD among a nationally representative sample of middle-aged and older African American, Caribbean Black and non-Hispanic white adults. Methods: Data from the National Survey of American Life (N = 6,082) were used to identify risk profiles of SPD. Serious psychological distress was measured using the K6. Demographic factors included as covariates were age (45+ years), gender, education, and poverty status). Body mass index was measured using standard categories (e.g., not overweight; BMI<25, overweight; BMI=25-29, and obese; BMI=30+). Latent class analysis was used to identify SPD profiles (e.g., classes) of individuals in the sample. Multivariable logistic regression was used to identify significant covariates that predict class assignment. Geo mapping was used to demonstrate the geographic distribution of adults with SPD based on class assignment. Results: Two latent profile classes were identified; a “high distressed” class (16.3% of the sample) and a “low distressed” class (83.7%). Non-Hispanic whites were more likely to be assigned to the “high distressed” class compared to African Americans, but 44% of whites were assigned to the “low distress” class. Similar proportions of men and women were assigned to each class, and results from regression analysis indicated no significant gender differences in likelihood of class assignment. Poverty and less than high school diploma were associated with SPD. However, higher levels of education had little or no protective effect. BMI had a curvilinear relationship with SPD; those who were “not overweight” and “obese” had the highest risk of SPD. Geo mapping revealed that those classified as distressed were dispersed across the U.S., but there are clear regional patterns with respect to the distribution of distressed adults. Conclusions and Implications: This study highlights the importance of considering heterogeneity within and between racial/ethnic groups and the importance of identifying “risk profiles.” Results demonstrate the utility of a latent profile approach to risk characterization while also providing substantively meaningful information regarding the constellation of factors that combine to increase risk for SPD. One particular innovation worth noting is the use of geo mapping to locate individuals assigned to the distressed class. This information has important public health, clinical and policy implications, as it can be used to identify available and needed resources in neighborhoods, as well as social environment factors that increase risk for SPD in the adult population.