Stress and Coping Among Community-Dwelling Black Older Adults with Depression

Introduction

In the U.S., there are disparities between the well-being of Black and white older adults. Black older adults are more likely to develop chronic illnesses such as hypertension, heart disease, and diabetes, which can diminish their quality of life. The prevalence of chronic illness is compounded by the stressors common in aging, such as decreased income, changes in physical function, and the loss of spouses and friends. Psychological well-being contributes to an individual's overall health, along with their environment and quality of life. Despite Black older adults' burden of stressors and increased vulnerability to stress, only a few qualitative studies focus on the well-being or coping of community-dwelling Black older adults in the U.S. This mixed methods study aims to assess stressors older Black adults experience and how they cope.

Methods

We used data obtained as part of the Peer Enhanced Depression Care (PEERS) study, a randomized clinical trial testing the effectiveness of a community-based peer support intervention that provided depression care to low-income white older adults and older adults of color in an urban setting. Among 149 participants enrolled in the study, we focused on Black older adults (N=27) who completed the intervention and underwent an hour-long semi-structured interview to assess their experience of the study. We reviewed baseline survey data to describe stressors related to their medical comorbidities, social determinants of health, and the most common coping strategies they endorsed. In addition to baseline surveys, we analyzed their transcripts of semi-structured interviews, using thematic analysis as a framework to guide coding and theme generation. NVivo software was used for the organization of the data.

Results

Participants ranged in age from 54 to 90, with a mean age of 70 (SD= 8.0) years, and 89% were women. Participants had a mean income between 16,000 and 19,999 per year. 67% lived alone, and 33% were widowed. Social determinants of health needs were common; 56% experienced housing, transportation or food insecurity. The mean number of total chronic conditions was 5 (SD=1.7). Black participants in our sample, on average, were highly engaged with religion (M=7.1, SD= 1.28), planning (M= 6.2, SD= 1.6) and acceptance (M= 6.5, SD= 1.25) as coping mechanisms. In our analysis of transcripts, older adults described various stressors in their lives including limited resources, social isolation, family conflicts and grief. We found that many participants described self-reliance and emotional repression as ways in which they manage the stress in their lives.

Conclusions

Participants experienced many stressors in multiple aspects of their lives, ranging from resources to familial relationships, which was captured in the qualitative data. These stressors were compounded by high co-morbidity, resource insecurity, and widowhood. Although quantitative data showed the use of adaptive coping strategies, such as religion, acceptance, and planning, qualitative data showed less adaptive behaviors, such as self-reliance and emotional repression. A mixed methods approach provided a holistic view of coping since qualitative interviews allowed older adults to express experiences constrained by expert-derived survey questions. Additionally, future research should focus on developing interventions to support positive coping mechanisms for Black older adults while also addressing resource insecurities and managing chronic conditions.