Baseline Neighborhood Factors and Trajectories of Depressive Symptoms Among Older African Americans: The Difference By Gender

Background and Purpose: Older African Americans are more likely to live in under-resourced and stress-inducing neighborhoods due to historical segregation and redlining, and thus can experience neighborhood-associated negative mental health outcomes. Focusing on older African Americans, this study aims to 1) identify the 9-year trajectories of depressive symptoms, 2) examine the relationship between neighborhood characteristics (i.e. social cohesion and physical disadvantage) and trajectories of depressive symptoms, and 3) examine whether gender moderates the relationship between neighborhood characteristics and the trajectories of depressive symptoms. We hypothesize that positive aspects of the neighborhood (i.e. social cohesion) will be protective against depressive symptoms. On the contrary, negative aspects of neighborhood (i.e. physical disadvantage) will be a risk factor of depressive symptoms.

Methods: Data came from Round 1 (2011) to Round 9 (2019) of the National Health and Aging Trend Study (NHATS), which is conducted among a nationally representative sample of Medicare beneficiaries aged 65 and older in the United States. The present study sample consisted of 1,662 older African Americans selected at baseline and followed up for 8 years. Trajectories of depressive symptoms were estimated using group-based trajectory modeling accounting for non-random attrition. The best fit model was selected based on Bayesian information criteria and average posterior probability. After identifying the trajectories, multinomial logistic regression models were conducted to test the study aims. Analytic sampling weights were adjusted to generate population estimates.

Results: Three trajectories of depressive symptoms were identified among older African Americans: persistently low, moderate and increasing, and high and decreasing. Results from the multinomial logistic regression show that high levels of perceived neighborhood social cohesion were associated with a lower relative risk of being on the “moderate and increasing” trajectory versus the “persistently low” trajectory (RRR=0.64, p<0.01). Neighborhood physical disadvantaged was not associated with depressive symptoms trajectories. However, gender moderated the relationship between neighborhood factors and depressive symptoms trajectories. Specifically, compared to older African American women, men who live in neighborhoods with higher levels of physical disadvantage had higher relative risk of being in the “moderate and increasing” (RRR=0.43, p=0.010) and “high and decreasing” (RRR=0.29, p =0.041) trajectories versus the “persistently low” trajectory.

Conclusions and Implications: Stronger neighborhood social cohesion may protect against depressive symptoms in older African Americans. Additionally, compared to women, older African American men may be more vulnerable to negative mental health effects of neighborhood physical disadvantage. The findings highlight the importance of neighborhood-level interventions to facilitate successful aging in place among older African Americans. Further, mental health services may recognize how neighborhoods differentially influence the trajectory of depressive symptoms by gender and provide tailored services for men and women. Future research may consider identifying additional neighborhood factors (e.g. street connectivity and walkability) that influence older African Americans’ mental health.