Community stress, demoralization, and body mass index: Evidence for social signal transduction

Columbia University, New York, New York, United States
Social Science & Medicine (Impact Factor: 2.89). 07/2003; 56(12):2467-78. DOI: 10.1016/S0277-9536(02)00282-4
Source: PubMed


Quantification of the relationship between community-level chronic stress from neighborhood conditions and individual morale has rarely been reported. In this work, pregnant women were recruited at the prenatal clinics of Harlem Hospital and Columbia Presbyterian Medical Center in the USA, and given an initial questionnaire that included all 27 questions of the Dohrenwend demoralization instrument, as well as questions about household economics and health. An index of chronic community stress (ICCS) was compiled for each of the health areas of the study zone by standardizing and weighting each stressor significantly associated with low birthweight rate and summing the standardized, weighted values. Health areas were divided into ICCS quintiles. The graph of the quintile weighted averages of the index vs. the quintile averages of the demoralization score was an asymmetric inverted 'U' shape that fitted well to a stochastic resonance signal transduction model (adjusted R2=0.73). On average, the women in the worst three quintiles were much heavier than those of the two best quintiles. Women reporting household economic deprivations were significantly more demoralized than the others. Median health area rents were strongly negatively associated with the ICCS. The worst average demoralization score occurred in the middle quintile, a state of coping with both poor community conditions and an economically strained household. Rents bridge community conditions and household economics.

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    • "The instrument has been applied to US ethnically diverse samples containing not only white participants, but also participants of African and Latin American descent (Vernon & Roberts, 1981; Page & Cole, 1992; Reyes et al. 2011; Wallace et al. 2003) and has also been used in Poland (Perera et al. 2013), Israel (Feldman et al. 1995; Ritsner et al. 1996), and Germany (Fichter et al. 1993; Fichter & Quadflieg, 2001). It has never been validated in non-Western populations. "
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    ABSTRACT: Background: Demoralization has been described as a psychological state characterized by helplessness, hopelessness, a sense of failure and the inability to cope. Methods: We conducted a systematic review with qualitative data analysis following PRISMA criteria with the following aims: to review validated assessment instruments of the demoralization syndrome, report main findings regarding demoralization as measured by validated instruments that emerge in the literature, compare and report evidence for the clinical utility of the identified instruments. Utilizing the key word ‘demoralization’ in PubMed and PsycINFO databases, an electronic search was performed, supplemented by Web of Science and manual searches. Study selection criteria included the assessment of medical patients and use of instruments validated to assess demoralization. Seventy-four studies were selected. Results: Four instruments emerged in the literature. Main findings concern prevalence rates of demoralization, evidence of discriminant validity from major depression, factors associated with demoralization and evidence of clinical utility. The instruments vary in their definition, the populations they aim to assess, prevalence rates they estimate and their ability to discriminate between different conditions. Nonetheless, demoralization appears to be a distinctive psychological state characterized by helplessness, hopelessness, giving up and subjective incompetence. It is not limited to life-threatening diseases such as cancer, but may occur in any type of clinical situation. It is associated with stress and adverse health outcomes. Conclusions: Studies addressing the incremental value of demoralization in psychiatry and psychology are needed. However, demoralization appears to entail specific clinical features and may be a distinct condition from major depression.
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    • "Recent literature does not support the nature of exchange theory. Many individuals, particularly women, consistently provide more support to others than they themselves receive or expect to receive (Hughes and Waite 2002, Wallace et al 2003, Wallsten 2000). The motivation for this social functioning is not well understood, but it is comprehensible that social relationships are not based on strict barter. "
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    ABSTRACT: Thesis (Ph. D.)--University of Notre Dame, 2004. Thesis directed by Felicia B. LeClere for the Department of Sociology. "April 2004." Includes bibliographical references (leaves 151-177). Electronic reproduction.
    Preview · Article · May 2004
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    ABSTRACT: We extend a cognitive paradigm for gene expression to the epigenetic epidemiology of mental disorders, recognizing the fundamental role that culture plays in human biology as another heritage mechanism parallel to, and interacting with, the more familiar genetic and epigenetic systems. In the mathematical model, culture acts as another tunable epigenetic catalyst that both directs developmental trajectories and becomes convoluted with individual ontology via a mutually interacting crosstalk mediated by a social interaction that is itself culturally driven. We call for the incorporation of embedding culture as an essential component of the epigenetic regulation of human mental development and its dysfunctions, bringing what is perhaps the central reality of human biology into the center of biological psychiatry. The cultural and epigenetic systems of heritage may well provide the 'missing' heritability of complex diseases now under so much intense discussion.
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