Chronic Diseases and Psychological Outcomes Among the Older African Americans : The Roles of Interpersonal Support and Religiosity/Spirituality

Purposes: The empirical relationship between chronic illness and mental health status has been consistently supported by numerous studies. It is estimated that up to one-third of individuals with a serious medical condition experience symptoms of depression and then certain amount of despair and helplessness. Despite lower socioeconomic status and higher rates of morbidity and mortality for African Americans overall, older African Americans have been found to have higher positive psychological well-being than most groups when faced with stressful life situations. As a source of resilience in the wake of life stresses, religion and spirituality remain important social and psychological factors in the lives of older adults. This study is to examine the complex relationships among chronic diseases and learned helplessness depression development and the mediating role of social support and religiosity and spirituality in older African Americans in the Jackson Heart Study.

Methods: The parent study is a large, community, population-based cohort study designed to investigate risk factors for cardiovascular disease (CVD) in African American men and women. Major components of this study include medical history, physical examination, stress, coping, spirituality, racism and discrimination and socioeconomic position. For this paper, the secondary analysis included a total of 1303 participants over 55 year older out of total 5,301 participants. The rationale of variable selection for the hierarchical regression analysis is conceptual in nature, addressing the hypothesized effects of daily spiritual experience and religious coping and interpersonal support on helplessness and depressive symptoms including selected socioeconomic variables and chronic health condition.

Results Majority of older participants have multiple chronic health conditions (M=1.73, SD=1.13) such as Diabetes (25.5%), CVD (10.8%), Hypertension (78.6%), Kidney (17.8%), Asthma (12.2%), Lung (12.3%), Cancer (8.8%), and Stroke (7.1%). Descriptive statistics revealed the relatively higher symptoms of depression (M = 10.20, SD = 6.84) measured by the CES-D. With cut-off score of 16, 14.6% of respondents might be classified as “depressed”. The correlational analyses revealed that lower socio-economic factors, poorer chronic health conditions are all significantly associated with helplessness. Multiple regression analysis identified several significant predictors to the depressive symptoms (20.2% variance explained): The negative associations with education (t = -2.94) & Interpersonal support (t = -7.600) and positive relations with self-rated health (t = 5.499). Further, there is a significant relationship (t= -2.155) between the Daily Spiritual Experience Scale (DSES) and the depression (CES-D). Additionally, selected variables such education (t=-6.258), DSES (t=-2.891), religious coping (t= =4.147), and interpersonal support (t=-13.297) are significantly related with helplessness(R˛ =.246)

Implications It is found that majority of older African Americans are experiencing multiple chronic disease and a higher level of depression and despair in which immediate diagnosis and treatment is needed. Our findings are consistent with previous studies in that the study confirmed to find the empirical evidence the relations between religiosity/spirituality and mental health. Further, it is supported the significant mediating role of interpersonal support rather than social network to improved mental health condition. This study highlighted the enduring importance of supportive social relationships to psychological well-being among older African Americans.