Abstract
Although studies have documented the relationships between physical health, health rumination/worry, and mental health, few investigations have assessed these linkages within African American communities. Using a community-based sample of residents in historically lower-income, African American communities (N = 306), this study assesses the mediating role of health rumination/worry in the physical limitation–depressive symptom relationship, and the moderating effect of gender on the relationship between health rumination/worry–depressive symptoms. Findings demonstrate that health rumination/worry explains half of the physical limitation–depressive symptom relationship, and the relationship between health rumination/worry and depressive symptoms is stronger for African American men than women. The findings underscore the importance of intersectional research for policy efforts aimed at reducing mental health morbidities within African American communities.
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References
Aneshensel CS, Frerichs RR, Huba GJ. Depression and physical illness: a multiwave, nonrecursive causal model. J Health Soc Behav. 1984;25(4):350–71.
Gayman MD, Jay Turner R, Cui M. Physical limitations and depressive symptoms: exploring the nature of the association. J Gerontol Soc Sci. 2008;63(4):S219–28.
Geerlings SW, Aartjan TF, Beekman DJH, Deeg JWR, Twisk, and W. Van Tilburg. The longitudinal effect of depression on functional limitations and disability in older adults: an eight-wave prospective community-based study. Psychol Med. 2001;31(8):1361–71.
Meeks S, Murrell SA, Mehl RC. Longitudinal relationships between depressive symptoms and health in normal older and middle-aged adults. Psychol Aging. 2000;15(1):100–9.
Ormel J, Rijsdijk FV, Sullivan MD, van Sonderen E, Kempen GIJM. Temporal and reciprocal relationship between IADL/ADL disability and depressive symptoms in late life. J Gerontol Psychol Sci. 2002;57B(4):P338–47.
Brown SL, Hughes M, Campbell S, Gemma Cherry M. Could worry and rumination mediate relationships between self-compassion and psychological distress in breast cancer survivors? Clin Psychol Psychother. 2020;27(1):1–10.
Hong RY. Worry and rumination: differential associations with anxious and depressive symptoms and coping behaviour. Behav Res Ther. 2007;45(2):277–90.
Brosschot JF, Gerin W, Thayer JF. The perseverative cognition hypothesis: a review of worry, prolonged stress-related physiological activation, and health. J Psychosom Res. 2006;60(2):113–24.
Marcus DK, Hughes KT, Arnau RC. Health anxiety, rumination, and negative affect: a mediational analysis. J Psychosom Res. 2008;64(5):495–501.
Nolen-Hoeksema S. Responses to depression and their effects on the duration of depressive episodes. J Abnorm Psychol. 1991;100(4):569–82.
Nolen-Hoeksema S. Ruminative coping with depression. In: Heckhausen J, Dweck CS, editors. Motivation and Self-Regulation Across the Life Span. New York: Cambridge University Press; 1998. p. 237–56.
Nolen-Hoeksema S. The role of rumination in depressive disorders and mixed anxiety/depressive symptoms. J Abnorm Psychol. 2000;109(3):504–11.
Nolen-Hoeksema S, Morrow J, Fredrickson BL. Response styles and the duration of episodes of depressed mood. J Abnorm Psychol. 1993;102(1):20–8.
Verkuil B, Brosschot JF, Gebhardt WA, Thayer JF. When worries make you sick: a review of perseverative cognition, the default stress response and somatic health. J Exp Psychopathol. 2010;1(1):87–118.
Verkuil B, Brosschot JF, Gebhardt WA, Thayer JF. Perseverative cognition, psychopathology, and somatic health. In: Nykliček I, Vingerhoets A, Zeelenberg M, editors. Emotion Regulation and Well-Being. New York: Springer; 2011. p. 85–100.
Watkins ER. constructive and unconstructive repetitive thought. Psychol Bull. 2008;134(2):163–206.
Watkins ER, Roberts H. Reflecting on rumination: consequences, causes, mechanisms and treatment of rumination. Behav Res Ther. 2020;127:1–28.
Appel JE, Vrijsen JN, Marchetti I, Becker ES, Collard RM, van Eijndhoven PF, Schene AH, Tendolkar I. The role of perseverative cognition for both mental and somatic disorders in a naturalistic psychiatric patient sample. Psychosom Med. 2021;83(9):1058–66.
Nuru-Jeter AM, Thorpe Jr RJ, Fuller-Thomson E. Black-White differences in self-reported disability outcomes in the U.S.: early childhood to older adulthood. Public Health Rep. 2011;126(6):834–43.
Cole ER. Intersectionality in research in psychology. Am Psychol. 2009;64(3):170–80.
Collins PH. Black Feminist Thought. New York, New York: Routledge; 2000.
Crenshaw KW. Demarginalizing the intersection of race and sex: a Black feminist critique of antidiscrimination doctrine, feminist theory and antiracist politics. Univ Chic Leg Forum. 1989;1989(8):139–67.
Crenshaw KW. Mapping the margins: intersectionality, identity politics, and violence against women of color. In: Fineman MA, Mykitiuk R, editors. The Public Nature of Private Violence. New York: Routledge; 1994. p. 93–118.
Davis AY. Women, race & class. New York: Random House Inc; 1981.
McLeod JD. The meanings of stress: expanding the stress process model. Soc Ment Health. 2012;2(3):172–86.
Mullings L. The Sojourner syndrome: race, class, and gender in health and illness. Voices. 2002;6(1):32–6.
Settles IH. Use of an intersectional framework to understand Black women’s racial and gender identities. Sex Roles. 2006;54(9/10):589–601.
Wallace M. Black macho and the myth of the superwoman. New York: Verso; 1990.
Pearlin LI. The stress process revisited: reflections on concepts and their relationships. In: Aneshensel CS, Phelan JC, editors. Handbook of the Sociology of Mental Health. New York: Plenum Publishers; 1999. p. 395–415.
Sansone RA, Sansone LA. Rumination: relationships with physical health. Innov Clin Neurosci. 2012;9(2):29–34.
Hughes ME, Alloy LB, Cogswell A. Repetitive thought in psychopathology: the relation of rumination and worry to depression and anxiety symptoms. J Cogn Psychother. 2008;22(3):271–88.
Papageorgiou C, Wells A. Process and meta-cognitive dimensions of depressive and anxious thoughts and relationships with emotional intensity. Clin Psychol Psychother. 1999;6(2):156–62.
Segerstrom SC, Tsao JCI, Alden LE, Craske MG. Worry and rumination: repetitive thought as a concomitant and predictor of negative mood. Cogn Ther Res. 2000;24(6):671–88.
Watkins ER, Moulds ML, Mackintosh B. Comparisons between rumination and worry in a non-clinical population. Behav Res Ther. 2005;43(12):1577–85.
Borkovec TD, Robinson EL, Pruzinsky T, DePree JA. Preliminary exploration of worry: some characteristics and processes. Behav Res Ther. 1983;21(1):9–16.
Preston DB, Bucher JA. The effects of community differences on health status, health stress, and helping networks in a sample of 900 elderly. Public Health Nurs. 1996;13(1):72–9.
Lazarus RS, Folkman S. Stress, appraisal, and coping. New York: Springer Publishing Company; 1984.
McEwen BS, Seeman T. Protective and damaging effects of mediators of stress: elaborating and testing the concepts of allostasis and allostatic load. In: Pp. 30-47 in Annals of the New York Academy of Sciences. Vol. 896, Socioeconomic Status and Health in Industrial Nations: Social, Psychological, and Biological Pathways, edited by N. E. Adler, M. Marmot, B. S. McEwen, and J. Stewart. New York: New York Academy of Sciences; 1999.
Seeman TE, Singer BH, Rowe JW, Horwitz RI, McEwen BS. Price of adaptation—allostatic load and its health consequences. Arch Intern Med. 1997;157(19):2259–68.
Thoits PA. Stress and health: major findings and policy implications. J Health Soc Behav. 2010;51(S):S41–53.
Turner RJ. The pursuit of socially modifiable contingencies in mental health. J Health Soc Behav. 2003;44(1):1–17.
Turner RJ. Understanding health disparities: the promise of the stress process model. In: Avison W, Aneshensel C, Schieman S, Wheaton B, editors. Advances in the Conceptualization of the Stress Process. New York: Springer; 2010. p. 3–21.
Lyubomirsky S, Nolen-Hoeksema S. Effects of self-focused rumination on negative thinking and interpersonal problem solving. J Pers Soc Psychol. 1995;69(1):176–90.
Lyubomirsky S, Tucker KL, Caldwell ND, Berg K. Why ruminators are poor problem solvers: clues from the phenomenology of dysphoric rumination. J Pers Soc Psychol. 1999;77(5):1041–60.
Nolen-Hoeksema S, Larson J, Grayson C. Explaining the gender difference in depressive symptoms. J Pers Soc Psychol. 1999;77(5):1061–72.
Pyszczynski T, Holt K, Greenberg J. Depression, self-focused attention, and expectations for positive and negative future life events for self and others. J Pers Soc Psychol. 1987;52(5):994–1001.
Nierop A, Bratsikas A, Zimmermann R, Ehlert U. Are stress-induced cortisol changes during pregnancy associated with postpartum depressive symptoms? Psychosom Med. 2006;68(6):931–7.
Robles TF, Glaser R, Kiecolt-Glaser JK. Out of balance: a new look at chronic stress, depression, and immunity. Curr Dir Psychol Sci. 2005;14(2):111–5.
Brosschot J, Pieper FS, Thayer JF. Expanding stress theory: prolonged activation and perseverative cognition. Psychoneuroendocrinology. 2005;30(10):1043–9.
Butler LD, Nolen-Hoeksema S. Gender differences in responses to depressed mood in a college sample. Sex Roles. 1994;30(5/6):331–46.
Just N, Alloy LB. The response styles theory of depression: tests and an extension of the theory. J Abnorm Psychol. 1997;106(2):221–9.
Nolen-Hoeksema S, Morrow J. A prospective study of depression and posttraumatic stress symptoms after a natural disaster: the 1989 Loma Prieta earthquake. J Pers Soc Psychol. 1991;61(1):115–21.
Philip S, van Hermert AM, Penninx BW. Repetitive negative thinking as a mediator in prospective cross-disorder associations between anxiety and depression disorders and their symptoms. J Behav Ther Exp Psychiatry. 2019;63:6–11.
McCracken LM, Barker E, Chilcot J. Decentering, rumination, cognitive defusion, and psychological flexibility in people with chronic pain. J Behav Med. 2014;37(6):1215–25.
Ottaviani C. Brain-heart interaction in perseverative cognition. Psychophysiology. 2018;55(7):e13082.
Cristina O, Thayer J, Verkuil B, Lonigro A, Medea B, Couyoumdjian A, Brosschot JF. Physiological concomitants of perseverative cognition: a systematic review and meta-analysis. Psychol Bull. 2016;142(3):231–59.
Bart V, Brosschot JF, Meerman EE, Thayer JF. Effects of momentary assessed stressful events and worry episodes on somatic health complaints. Psychol Health. 2012;27(2):141–58.
Slavish DC, Graham-Engeland JE. Rumination mediates the relationships between depressed mood and both sleep quality and self-reported health in young adults. J Behav Med. 2015;38(2):204–13.
Rogers AH, Bakhshaie J, Ditre JW, Manning K, Mayorga NA, Viana AG, Zvolensky MJ. Worry and rumination: explanatory roles in the relation between pain and anxiety and depressive symptoms among college students with pain. J Am Coll Heal. 2019;67(3):275–82.
Nolen-Hoeksema S, Parker LE, Larson J. Ruminative coping with depressed mood following loss. J Pers Soc Psychol. 1994;67(1):92–104.
Cheung MS-P, Gilbert P, Irons C. An exploration of shame, social rank and rumination in relation to depression. Personal Individ Differ. 2004;36(5):1143–53.
Lyubomirsky S, Nolen-Hoeksema S. Self-perpetuating properties of dysphoric rumination. J Pers Soc Psychol. 1993;65(2):339–49.
Lyubomirsky S, Caldwell ND, Nolen-Hoeksema S. Effects of ruminative and distracting responses to depressed mood on retrieval of autobiographical memories. J Pers Soc Psychol. 1998;75(1):166–77.
MacSwain KLH, Sherrya SB, Stewart SH, Watt MC, Hadjistavropoulos HD, Graham AR. Gender differences in health anxiety: an investigation of the interpersonal model of health anxiety. Personal Individ Differ. 2009;47(8):938–43.
Mezulis AH, Abramson LY, Hyde JS. Domain specificity of gender differences in rumination. J Cogn Psychother. 2002;16(4):421–34.
Wupperman P, Neumann CS. Depressive symptoms as a function of sex-role, rumination, and neuroticism. Personal Individ Differ. 2006;40(2):189–201.
Agata A’, Giromini L, Ales F, Zennaro A. A multimethod assessment to study the relationship between rumination and gender differences. Scand J Psychol. 2020;61(6):740–50.
Johnson DP, Whisman MA. Gender differences in rumination: a meta-analysis. Personal Individ Differ. 2013;55(4):367–74.
Tamres LK, Janicki D, Helgeson VS. Sex differences in coping behavior: a meta-analytic review and an examination of relative coping. Personal Soc Psychol Rev. 2002;6(1):2–30.
Shors TJ, Millon EM, Chang HYM, Olson RL, Alderman BL. Do sex differences in rumination explain sex differences in depression? J Neurosci Res. 2017;95(1-2):711–8.
Nolen-Hoeksema S. Sex differences in unipolar depression: evidence and theory. Psychol Bull. 1987;101(2):259–82.
Susan N-H. Sex differences in depression. Stanford‚ CA: Stanford University Press; 1990.
Nolan SA, Roberts JE, Gotlib IH. Neuroticism and ruminative response style as predictors of change in depressive symptomatology. Cogn Ther Res. 1998;22(5):445–55.
Calmes CA, Roberts JE. Repetitive thought and emotional distress: rumination and worry as prospective predictors of depressive and anxious symptomatology. Cogn Ther Res. 2007;31(3):343–56.
Jose PE, Brown I. When does the gender difference in rumination begin? Gender and age differences in the use of rumination by adolescents. J Youth Adolesc. 2008;37(2):180–92.
Brown LL, Abrams LR, Mitchell UA, Ailshire JA. Measuring more than exposure: does stress appraisal matter for black–white differences in anxiety and depressive symptoms among older adults? Innov Aging. 2020;4(5):1–15.
Collins PH. Black sexual politics: African Americans, gender, and the new racism. New York, New York: Routledge; 2004.
Gillespie MA. The myth of the strong black woman. In: Jaggar AM, Rothenberg PS, editors. Feminist Frameworks: Alternative Theoretical Accounts of the Relations Between Women and Men. New York: McGraw-Hill; 1984. p. 32–5.
Hooks B. Sisters of the yam: Black women and self-recovery. Boston: South End; 1993.
Angelou M. Phenomenal woman. In: Angelou M, editor. And Still I Rise. New York, NY: Random House; 1978. p. 8–10.
Woods-Giscombé CL. Superwoman schema: African American women’s views on stress, strength, and health. Qual Health Res. 2010;20(5):668–83.
Griffith D, M., Katrina R. Ellis, and Julie Ober Allen. An Intersectional approach to social determinants of stress for African American men: men’s and women’s perspectives. Am J Mens Health. 2013;7(4):19S–30S.
Miller B, Taylor J. Racial and socioeconomic status differences in depressive symptoms among Black and White youth: an examination of the mediating effects of family structure, stress and support. J Youth Adolesc. 2012;41(4):426–37.
Walton QL, Payne JS. Missing the mark: cultural expressions of depressive symptoms among African-American women and men. Soc Work Ment Health. 2016;14(6):637–57.
Assari S. High sense of mastery reduces psychological distress for African American women but not African American men. Arch Gen Intern Med. 2019;3(1):5–9.
Donovan RA, West LM. Stress and mental health: moderating role of the strong Black woman stereotype. J Black Psychol. 2015;41(4):384–96.
Romero RE. The icon of the strong Black woman: the paradox of strength. In: Jackson LC, Greene B, editors. Psychotherapy with African American women: innovations in psychodynamic perspectives and practice. New York: Guilford Press; 2000. p. 225–38.
Erving CL. Gender and physical health: a study of African American and Caribbean Black Adults. J Health Soc Behav. 2011;52(3):383–99.
Hammond WP, Mohottige D, Chantala K, Hastings JF, Neighbors HW, Snowden L. Determinants of usual source of care disparities among African American and Caribbean Black men: findings from the national survey of American life. J Health Care Poor Underserved. 2011;22(1):157–75.
Gilbert KL, Ray R, Siddiqi A, Shetty S, Baker EA, Elder K, Griffith DM. Visible and invisible trends in Black men’s health: pitfalls and promises for addressing racial, ethnic, and gender inequities in health. Annu Rev Public Health. 2016;37:295–311.
Tucker-Seeley RD, Mitchell JA, Shires DA, Modlin Jr CS. Financial hardship, unmet medical need, and health self-efficacy among African American men. Health Educ Behav. 2015;42(3):285–92.
Tigges LM, Browne I, Green GP. Social isolation of the urban poor: race, class, and neighborhood effects on social resources. Sociol Q. 1998;39(1):53–77.
Ellis KR, Griffith DM, Allen JO, Thorpe Jr RJ, Bruce MA. “If you do nothing about stress, the next thing you know, you’re shattered”: perspectives on African American men’s stress, coping and health from African American men and key women in their lives. Soc Sci Med. 2015;139:107–14.
Gayman MD, Kail BL, Spring A, Greenidge G. Risk and protective factors for depressive symptoms among African American men: an application of the stress process model. J Gerontol Psychol Sci. 2018;73(2):219–29.
Hammond WP. Taking it like a man: masculine role norms as moderators of the racial discrimination–depressive symptoms association among African American men. Am J Public Health. 2012;102(S2):S232–41.
Gayman MD, Wilkin H, Stover S, Vidmar C, Edwards T, Gallashaw C. Perceived built environment and physical limitations: race-contrasts in historically lower-income, African American communities. Fam Community Health. 2021;44(1):21–31.
United States Census Bureau. 2010 Census. U.S. Census Bureau. 2010. Web. 1 Feb 2019 http://www.census.gov/2010census/data/.
Radloff LS. The CES-D scale: a self-report depression scale for research in the general population. Appl Psychol Meas. 1977;1(3):385–401.
Lorig K, Stewart A, Ritter P, González V, Laurent D, Lynch J. Outcome measures for health education and other health care interventions. Thousand Oaks: Sage Publications, Inc.; 1996.
Stewart AL, Hays RD, Ware JE Jr. Health perceptions, energy/fatigue, and health distress measures. In: Stewart AL, Ware JE, editors. Measuring Functioning and Well-Being: The Medical Outcomes Study Approach. Durham, NC: Duke University Press; 1992. p. 143–72.
Fries JF, Patricia Spitz R, Kraines G, Holman HR. Measurement of patient outcome in arthritis. Arthritis Rheum. 1980;23(2):137–45.
Jette AM, Lynn Deniston O. Inter-observer reliability of a functional status assessment instrument. J Chronic Dis. 1978;31(9/10):573–80.
Katz S, Downs TD, Cash HR, Grotz RC. Progress in development of the index of ADL. Gerontologist. 1970;10(1):20–30.
Katz S, Ford AB, Moskowitz RW, Jackson BA, Jaffee MW. Studies of illness in the aged. The index of ADL: a standardized measure of biological and psychosocial function. J Am Med Assoc. 1963;185(12):914–9.
Centers for Disease Control and Prevention. 2016. “Defining adult overweight and obesity.” Retrieved Nov 8, 2017 (https://www.cdc.gov/obesity/adult/defining.html).
National Institutes of Health (NIH) National Heart, Lung, and Blood Institute’s (NHLBI) North American Association for the Study of Obesity (NAASO). “The practical guide: identification, evaluation, and treatment of overweight and obesity in adults.” Report 00-4084. Rockville, MD: National Institutes of Health; 2000.
Godin G, Shephard RJ. A simple method to assess exercise behavior in the community. Can J Appl Sport Sci. 1985;10(3):141–6.
U.S. Department of Health and Human Services. Physical Activity Guidelines for Americans. 2nd ed. Washington, DC: U.S. Department of Health and Human Services; 2018. Retrieved Feb 1, 2019 (https://health.gov/paguidelines/secondedition/pdf/Physical_Activity_Guidelines_2nd_edition.pdf)
Baron RM, Kenny DA. The moderator–mediator variable distinction in social psychological research: conceptual, strategic, and statistical considerations. J Pers Soc Psychol. 1986;51(6):1173–82.
Bollen KA, Stine R. Direct and indirect effects: classical and bootstrap estimates of variability. Sociol Methodol. 1990;20:115–40.
Braveman PA, Arkin E, Proctor D, Kauh T, Holm N. Systemic and structural racism: definitions, examples, health damages, and approaches to dismantling. Health Aff. 2022;41(2):171–8.
Phelan JC, Link BG, Tehranifar P. Social conditions as fundamental causes of health inequalities: theory, evidence, and policy implications. J Health Soc Behav. 2010;51:S28–40.
Pearlin LI. The sociological study of stress. J Health Soc Behav. 1989;30:241–56.
Benkert R, Peters RM, Clark R, Keves-Foster K. Effects of perceived racism, cultural mistrust and trust in providers on satisfaction with care. J Natl Med Assoc. 2006;98(9):1532–40.
King WD. Examining African Americans’ mistrust of the health care system: expanding the research question. Public Health Rep. 2003;118:366–7.
Craner J, Douglas KV, Dierkhising R, Hathaway J, Goel K, Thomas RJ. Associations of baseline depressed mood and happiness with subsequent well-being in cardiac patients. Soc Sci Med. 2017;174:209–12.
Krause ED, Vélez CE, Woo R, Hoffmann B, Freres DR, Abenavoli RM, Gillham JE. Rumination, depression, and gender in early adolescence: a longitudinal study of a bidirectional model. J Early Adolesc. 2018;38(7):923–46.
Zalta AK, Chambless DL. Exploring sex differences in worry with a cognitive vulnerability model. Psychol Women Q. 2008;32(4):469–82.
Gorski J, Young MA. Sociotropy/autonomy, self-construal, response style, and gender in adolescents. Personal Individ Differ. 2002;32(3):463–78.
Conway M, Alfonsi G, Pushkar D, Giannopoulos C. Rumination on sadness and dimensions of communality and agency: comparing white and visible minority individuals in a canadian context. Sex Roles. 2008;58(9/10):738–49.
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This work was supported by FY2015 GSU/CDC Collaborative Seed Grant from Georgia State University and the Centers for Disease Control and Prevention. We would also like to thank Chandra Gallashaw, community and research team member, for her work and dedication to the larger project.
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This work was supported by FY2015 GSU/CDC Collaborative Seed Grant from Georgia State University and the Centers for Disease Control and Prevention.
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Study conception and design was performed by Mathew Gayman. Material preparation, data collection, and/or analysis were performed by Mathew Gayman, Shanae Stover, Kara Tsukerman, Karen Nielsen, and Holley Wilkin. The first draft of the manuscript was written by Mathew Gayman, and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.
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Gayman, M.D., Stover, S., Tsukerman, K. et al. Physical Limitations, Health Rumination/Worry, and Depressive Symptoms: Gender Differences among African Americans. J. Racial and Ethnic Health Disparities (2023). https://doi.org/10.1007/s40615-023-01721-3
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DOI: https://doi.org/10.1007/s40615-023-01721-3