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Stressed Out

A Black man plays a game of chess at Chicago's lakeshore chess pavilion.

SPH researchers are exploring stress exposure and higher rates of dementia among Black people and how social connectiveness can mitigate risks and loneliness.

In the U.S., Black and Latinx populations ages 65 and older have two to three times higher rates of Alzheimer’s disease and related dementias as compared with white populations. Most research on cognitive health problems focuses on older populations, but SPH’s Uchechi Mitchell, PhD, associate professor of community health sciences, believes the causes of these disparities may be occurring much earlier in the life course.

Mitchell is currently leading a National Institutes of Health grant entitled, “The Role of Mid-life Psychosocial Stressors, Social Resources and Physiological Dysregulation in Understanding Race Differences in Cognitive Decline.” Her research focuses on Black and white Americans in mid-life, specifically ages 50-64, who may be exposed to what she calls a “constellation of stressors,” – work-related stressors, family responsibilities on both ends of the aging spectrum and everyday chronic stressors like discrimination and financial strain – that contribute to cognitive decline.

“By age 65, that’s a point where a lot of the damage has already been done,” Mitchell said. “Experiences over the life course are what lead to these late life health outcomes, and shifting to an earlier timeframe is beneficial for getting a sense of what these early exposures are doing.”

Mitchell is using national data from the Health and Retirement Study, which has data dating back as far as 1992. The data includes measures of social, economic and behavioral health factors along with measures of cognitive functioning and multiple stressors.

She is focused on comparing the experience of mid-life Black and white people because of their disproportionate exposure to certain stressors: caring for adult children while simultaneously caring for parents, financial strain, experiences of discrimination and the demands of work life. Mitchell theorizes that this period of life may be a time of high exposure to these stressors. While stressors alone are not a cause of Alzheimer’s disease and related dementias, Mitchell says stressors impact cognitive performance across all stages of the life course. The result is that a person exposed to a high volume of stressors earlier in life would start at a lower threshold of cognitive functioning in old age and may experience an earlier onset of dementia or more severe dementia symptoms.

The initial data analysis from the project finds Black people are experiencing cognitive decline earlier than other populations and are starting that decline with lower levels of cognitive functioning because of these mid-life stressful exposures. Over time, the rates of decline are faster for middle-age white populations, likely because they are beginning the decline stage with higher levels of cognitive functioning and are essentially “catching up” in the decline process.

“Our memories slowly decline, which occurs naturally to some extent, but to reach the point of dementia and experience it early in life is what we’re trying to understand,” Mitchell said. “This change in cognition is hard to notice because they seem like ‘normal’ age- related changes in memory, and changes characteristic of dementia or mild cognitive impairment are difficult to detect without a clinical examination.”

Mitchell’s study is also examining areas for intervention and the role of social resources in mitigating the effects of stressors. She says social engagement may be key to maintaining a “cognitive reserve” despite stressful exposures. For example, if a middle-aged adult is experiencing financial strain, relying on a person in their social network for instrumental and emotional support can potentially mitigate the effect of these stressors. Mitchell cautions that protective pathways are often thought of as ways an individual or their networks can engage in self-care. She says institutions should be designing ways to support people both socially and cognitively to protect from stress exposures. Beyond financial support, organizations should intentionally implement mitigation practices such as protecting against experiences of discrimination through zero tolerance policies and providing supportive resources during major life events like bereavement.

Once interventions are in place, they can be specifically tailored to meet the needs of Black or other minoritized populations that may face more exposure to and more severe versions of stressful experiences.

Mitchell says future research should delve earlier into the life course, recognizing that mid-life in one’s 30’s and 40’s, and the stressors and protective resources characteristic of these ages, are quite different than in ages 50-64.

Understanding health impacts of social isolation Heading link

Uchechi Mitchell and Melissa Gutierrez-Kapheim pose for a photo.

There is a major barrier to building the cognitive protective factors needed for mid-life Black adults: America’s ongoing epidemic of loneliness. Even before the onset of the COVID-19 pandemic, half of U.S. adults reported experiencing measurable experiences of loneliness. The health effects of this sense of social isolation are stark: lacking connection can increase the risk for premature death to levels comparable to smoking daily, according to a study cited by the U.S. Surgeon General.

Dissertation research conducted by Melissa Gutierrez- Kapheim, PhD ‘22 with a concentration in community health sciences, found surveyed non-Latinx Black Chicagoans are experiencing perceived loneliness at rates 60 percent greater than non-Latinx white respondents, while Latinx participants tallied 30 percent higher than white respondents. Her dissertation research revealed that differences in neighborhood social cohesion and social infrastructure may explain these racial gaps. Currently serving as the director of health equity and assessment research at Sinai Chicago: Sinai Urban Health Institute, she is aiming to publish her findings and, in collaboration with the community, develop strategies to increase social connectedness in disinvested Black and Brown communities as a method to decrease and prevent loneliness.

“[As a society] we are spending a lot of time thinking about the concept of loneliness, but our methods to reduce loneliness have largely failed,” Gutierrez-Kapheim said. “We generally think about loneliness as an individualistic problem, but it may have to do with the communities in which we live and how we engage with our neighbors. The discrepancy in access to neighborhood social infrastructure is a byproduct of historical structural racism.”

Gutierrez-Kapheim describes loneliness as a disconnect between quantity and quality of a person’s relationships. She notes some people are content with a life partner, while others may have a life partner, children and an extended family network yet still experience deep loneliness. Her work builds on Eric Klinenberg’s concept of social infrastructure and Ray Oldenburg’s concept of third places, which underscore the importance of having place in which community members can gather and connect with one another and thus increase the strength of relationships among neighbors.

Her dissertation utilized data from the Sinai Community Health Survey 2.0 across ten Chicago neighborhoods, which explored residents’ views on neighborhood social cohesion, the degree to which one finds their neighborhood to be a trusting place with shared values, and self-reported feelings of loneliness. Gutierrez-Kapheim then used city license data to note every restaurant, library, park, community center, senior center, sites for musical events, art centers and other places of amusement in each census tract from the community health survey to create a measure of social infrastructure.

One of her key findings is that as social cohesion increases, loneliness decreases among Black and Latinx adults in her sample. Additionally, she found that her measure of social infrastructure was associated with a decrease in loneliness for Black participants, while for Latinx participants, neighborhood social cohesion explained the relationship between social infrastructure and loneliness. There was no statistically significant connection for white participants. Due to the study’s cross-sectional data, causation can not be determined.

Gutierrez-Kapheim’s research aligns with a May 2023 report from the U.S. Surgeon General, “Our Epidemic of Loneliness and Isolation,” highlighting the importance of social connectedness as a means of decreasing loneliness and improving health.

“Loneliness doesn’t happen in a bubble, it is influenced by societal structures,” Gutierrez-Kapheim said. “The more potentially segregated and disinvested communities
are, the less opportunities they have for this positive social engagement in community spaces.”