The syndemogenesis of depression

Syndemics, or the deleterious interaction of diseases and structural factors, is an essential and increasingly utilized theory with which to address health inequities and how they interact with disease. However, less research has been conducted on syndemogenesis, a process by which a specific disease or structural factor is more likely to exacerbate syndemic interactions. With the increasing incidence and prevalence of depressive symptomology in Westernized nations, and with depression coexisting syndemically with other illnesses, I use depression as a case study to highlight syndemogenic processes in action. Doing so will hopefully aid preventive efforts in these areas

Social support and strain and emotional distress among Latinos in the northeastern United States

BACKGROUND: US Latinos report high levels of emotional distress. Having positive familial and friend social support buffers emotional distress among US Latinos, but thus far no research has been done on social support and ataque de nervios in that population, or on social strain and emotional distress. METHODS: This paper assesses social support and strain across three relationship types (partner, family, and friends) with three measures of emotional distress (depression, anxiety, and ataque de nervios). The sample for partner, family, and friend support included 508 Latino adults 21 and older. Multivariate logistic regression models were used to assess the association of social support and strain with each outcome. RESULTS: As all social support types increased, the odds of emotional distress symptoms decreased. Conversely, as each unit of partner and family strain increased, the odds of emotional distress symptoms increased. Increased friend strain was associated with greater odds of depressive and anxiety symptoms only. CONCLUSION: Social support in all three network types (partner, family, and friend) was associated with a decrease in the odds of emotional distress, assessed as symptoms of depression, anxiety, and ataque de nervios

“Un Pueblo Tan Dulce”: Diabetes, Depression, and Obesity Syndemics in Puerto Rico

Diabetes, depression, and obesity are global health crises that disproportionately affect people with low socioeconomic status and other marginalized identities. These diseases have high incidence and prevalence rates in Puerto Rico due to high poverty and unemployment rates, changing dietary patterns, and Puerto Rico’s political status as a U.S. commonwealth. The myriad problems on the island contribute to the flight of Puerto Ricans to the mainland in search of better education and employment; there are currently more Puerto Ricans living on the mainland than there are in Puerto Rico. Puerto Rico’s political status is of particular importance, as it simultaneously contributes to and poses unique challenges to addressing the complex and myriad health crises on the island. As such, I take syndemic and critical medical anthropology approaches to maintain that depression, diabetes, and obesity are politicized in Puerto Rico. I draw on nearly a year of mixed-methods fieldwork to argue that depression, obesity and diabetes form a syndemic with the violence and political instability that are part and parcel of living in Puerto Rico. I named this syndemic the OVIDD (Obesity, Violence, political Instability, Diabetes, and Depression) Syndemic. One of my key findings is that Puerto Rico’s political status exacerbates the incidence and prevalence rates of diabetes, depression, and obesity on the island. These diseases are politically charged, and their incidence and prevalence rates are unlikely to diminish without also improving the political and economic crises in Puerto Rico. The diseases in question interact deleteriously and syndemically, contributing to the OVIDD Syndemic in Puerto Rico. Moreover, the question of Puerto Rico’s political status has remained in flux since the United States acquired the island from Spain following the Spanish-American War of 1898. Puerto Ricans report preferring either full statehood or full independence and do no want to maintain the current status quo. However, despite Puerto Ricans’ pleas to the U.S. Government to change the island’s status, the government has thus far not made any effort to heed their wishes. This leaves the island in a state of political liminality in which Puerto Rico is neither an independent nation with the power to make its own decisions, nor a full state that receives full economic and political benefits from the United States. These results highlight not only the necessity of syndemics as a theoretical framework for collecting and analyzing the data in this dissertation, but also the need for macro-level changes to the relationship between the United States and Puerto Rico

Neighborhood characteristics and ataque de nervios: the role of neighborhood violence

Ataque de nervios is a Latina/o idiom of distress that may occur as a culturally sanctioned response to acute stressful experiences, particularly relating to grief, threat, family conflict, and a breakdown in social networks. The contextual factors associated with ataque de nervios have received little attention in research. This study examined the association between neighborhood factors and the experience of ataque de nervios among a sample of Latinas/os participating in the Latino Health and Well-Being Project in the northeastern United States. We examined the association between neighborhood cohesion, safety, trust, and violence and ataque de nervios. In multivariate logistic regression models, neighborhood violence was associated with ataque de nervios (p = .02), with each unit increase in the neighborhood violence scale being associated with 1.36 times greater odds of experiencing ataque de nervios. None of the other neighborhood variables were significantly associated with ataque de nervios. The positive association between neighborhood violence and the experience of ataque de nervios makes a further case for policy efforts and other investments to reduce neighborhood violence

Adapting an In-Home Randomized Intervention Trial Protocol for COVID-19 Precautions

Background: The COVID-19 pandemic has significantly impacted the status of clinical trials in the United States, requiring researchers to reconsider their approach to research studies. In light of this, we discuss the changes we made to the protocol of the Home Air Filtration for Traffic-Related Air Pollution (HAFTRAP) study, a randomized crossover trial of air filtration in homes next to a major highway. The senior authors designed the trial prior to the pandemic and included in-person data collection in participants’ homes. Because of the pandemic, we delayed the start of our trial in order to revise our study protocol to ensure the health and well-being of participants and staff during home visits. To our knowledge, there have been few reports of attempts to continue in-home research during the pandemic. Methods: When pandemic-related protective measures were imposed in March 2020, we were close to launching our trial. Instead, we postponed recruitment, set a new goal of starting in September 2020, and spent the summer of 2020 revising our protocol by developing increased safety precautions. We reviewed alternative approaches to installing portable air filtration units in study participants’ homes, in order to reduce or eliminate entry into homes. We also developed a COVID-19 safety plan that covered precautionary measures taken to protect both field team staff and study participants. Results: Our primary approach was to minimize contact with participants when collecting the following measures in their homes: (1) placing portable air filtration units; (2) conducting indoor air quality monitoring; (3) obtaining blood samples and blood pressure measurements; and (4) administering screening, consent, and follow-up questionnaires that coincided with collection of biological measures. Adapting our public health trial resulted in delays, but also helped ensure ethical and safe research practices. Perceived risk of COVID-19 infection appeared to have been the primary factor for an individual in deciding whether or not to participate in our trial, particularly at the beginning of the pandemic, when less was known about COVID-19. Conclusions: We needed to be flexible, creative, and calm when collaborating with community members, the IRB, and the universities, while repeatedly adjusting to changing guidelines as we determined what worked and what did not for in-home data collection. We learned that high-quality air monitoring data could be collected with minimal in-person contact and without compromising the integrity of the trial. Furthermore, we were able to collect blood pressure and phlebotomy data with minimal risk to the participant

Communities catalyzing change with data to mitigate an invisible menace, traffic-related air pollution

Abstract Objectives To identify strategies and tactics communities use to translate research into environmental health action. Methods We employed a qualitative case study design to explore public health action conducted by residents, organizers, and public health planners in two Massachusetts communities as part of a community based participatory (CBPR) research study. Data sources included key informant interviews (n = 24), reports and direct observation of research and community meetings (n = 10) and project meeting minutes from 2016–2021. Data were coded deductively drawing on the community organizing and implementation frameworks. Results In Boston Chinatown, partners drew broad participation from community-based organizations, residents, and municipal leaders, which resulted in air pollution mitigation efforts being embedded in the master planning process. In Somerville, partners focused on change at multiple levels, developer behavior, and separate from the funded research, local legislative efforts, and litigation. Conclusions CBPR affords communities the ability to environmental health efforts in a way that is locally meaningful, leveraging their respective strengths. External facilitation can support the continuity and sustainment of community led CBPR efforts

Religiosity prevalence and its association with depression and anxiety symptoms among Hispanic/Latino adults.

OBJECTIVES:Religion plays an important role in the lives of people in the United States. We examined the prevalence of religiosity among Hispanic/Latinos in four regions of the United States and looked at its correlation to depression and anxiety symptoms. DESIGN:The population-based Hispanic Community Health Study/ Study of Latinos enrolled a cohort of Hispanic/Latino adults (N = 16,415) ages 18-74 in four US cities from June 2008 to June 2011. Participants with complete data on religiosity (i.e., religious affiliation, frequency of attending religious activities and importance of religion), depression (assessed with the CESD-10), and trait anxiety (assessed with the STAI-10) were included in the present study. Distribution of religiosity is described by sociodemographic characteristics. Associations between religiosity with depression and anxiety were examined with logistic regression models controlling for sex, age group, education, Hispanic/Latino background, clinical center, and nativity. RESULTS:The majority of the population (89.5%) reported having a religious affiliation. Weekly attendance at religious activities was reported by 41.6% of participants, while 20.6% did not attend any religious activities. Religion was very important to 63.9% and not at all important to 6.7% of the population. The CES-D scores and trait anxiety scores were not significantly related in the overall group to frequency of attending religious activity or perceived importance of religion. However, in age-stratified analyses, among older individuals (65+ years old) reporting "never" participating in religious activities compared to more than once per week was associated with an 80% higher likelihood of having high depressive symptomatology. Similarly, in the older age group, no religious affiliation or reporting that religion is "not at all important" was associated with greater anxiety symptomatology. CONCLUSION:Religiosity varied by Hispanic/Latino background. Lack of religiosity was associated with elevated depressive or anxiety symptomology in older adults but not in young or middle-aged adults

Age-and-sex adjusted distribution of frequency of participation in religious activities and importance of religion by socio-demographic characteristics, HCHS/SOL 2008–2010.

<p>Age-and-sex adjusted distribution of frequency of participation in religious activities and importance of religion by socio-demographic characteristics, HCHS/SOL 2008–2010.</p

Association between high trait anxiety symptomatology and measures of religiosity by age group in Hispanic/Latino adults, HCHS/SOL 2008–2011.

<p>Association between high trait anxiety symptomatology and measures of religiosity by age group in Hispanic/Latino adults, HCHS/SOL 2008–2011.</p