DOES PSYCHOLOGICAL DISTRESS CONTRIBUTE TO RACIAL AND SOCIOECONOMIC DISPARITIES IN MORTALITY

Being black or poor are powerful predictors of mortality. Although psy chological distress has been proposed as mediating the effects of race and socioeconomic status on mortality, this hypothesis has not been p reviously directly tested. We used data from the National Health and N utrition Examination I (NHANES I), a nationally representative sample from the U.S, and the NHANES I Epidemiological Follow-up Survey (NHEFS ) of subsequent mortality to test this hypothesis. Both black race and lower family income were associated with significantly higher psychol ogical distress as measured at the time of the initial survey by repor ts of hopelessness, depression, and life dissatisfaction. Black race a nd low income in addition to each of the measures of psychological dis tress were associated with higher mortality at follow-up. In a series of Cox proportional hazards models that controlled for the effects of age and gender, additional adjustment for hopelessness, depression, or life dissatisfaction had little effect on the relationship between ei ther African American race or family income and subsequent all-cause m ortality. We conclude that the effects of both race and income on mort ality are largely independent of psychological distress. These finding s do not support the hypothesis that psychological distress is a signi ficant mediator of the effects of race or class on health. (C) 1997 El sevier Science Ltd. All rights reserved.