Race, Income, and Aging Mental Health: Implications for Social Work Research

Background: Social determinants, such as race/ethnicity, nativity, and income, play important roles in elders’ mental health functioning.  The prevalence of psychiatric limitations decreases social functioning, increases the risk of morbidity, decreases lifespan, and reduces overall quality of life.  With an aging and diversifying U.S. population, we need to identify the prevailing factors that affect mental health functioning in later life. LaVeist’s Conceptual Model of Race offers a framework that will be used to begin the examination of social determinants and their relationship with mental health, physical health, and caregiving.  This study aims to empirically test how social determinants affect the mental health of older adults and how the relationship between social determinants and mental health is mediated by physical health and caregiving.

Method: Data from the 2009 California Health Interview Survey (CHIS) were used to test distress among Latino, non-Hispanic Whites, African American, and Asian adults aged 65 and over in California (n= 14,933).  Mental health functioning was measured using Kessler’s classification of psychological distress.  The following social determinants were examined: race/ethnicity, economic income, and nativity.  Limited information modeling techniques were used to test for direct and indirect effects of social determinants. 

Results: Racial/ethnic minorities comprised 19% of the sample. Compared to non-Hispanic Whites, Asian Americans reported being in poor health more frequently.  In addition, fewer Asian Americans identified themselves as caregivers as compared to non-Hispanic Whites.  Similarly, foreign-born individuals are also less likely than US born individuals to provide care and are more likely to be in poor physical health and mental health functioning.  As expected, individuals in poorer physical health were more likely to report higher levels of psychiatric distress.  Hispanic elders endorsed mental health limitations more frequently than any other group.  Caregivers endorsed higher levels of psychiatric distress. 

Ordinal logistic regression results indicate that economic income, caregiving status, and physical health had direct effects on mental health functioning.  Further, physical health was a partial mediator of the effects of race/ethnicity and nativity on psychological distress.  Notably, income moderated the relationship between race/ethnicity and health and mental health outcomes.  Compared to non-Hispanic Whites, increases in income protected African Americans from poor health (OR= 0.93) and higher levels of psychological distress (OR= 0.84).

Conclusions/Implications: Social determinants impact older adults’ physical and emotional well-being through numerous pathways. The specifications of culturally competent mental health models are needed for theoretically based interventions that promote health and mental health outcomes, while considering health, social, and economic risks. Evidence-based interventions would be important as a future aim to address the mental and physical healthcare challenges facing minority elders.