Physical morbidity and mortality disparities consistently favor non-Hispanic whites over black Americans.Epidemiological studies reveal that black Americans suffer the same or lower rates of mental disorders aswhites. In highly stressful environments individuals often engage in negative health behaviors, e.g. smoking,alcohol use and abuse, drug use, and over-eating, to cope with the stressors of daily life. These behaviors,perhaps through mechanisms associated with the HPA axis, alleviate the stressful reactions to theseenvironmental exposures; the same chronic stress exposures and poor health behaviors that are silentlyaffecting biological pathways to eventual negative physical health morbidity and mortality. Thus, lower ratesof mental disorders among the African American population are at the expense of higher physical healthmorbidities and mortality in comparison to the non-Hispanic white population. We hypothesize and present acomplex framework involving environmental factors, chronic stressors, and the stress response through theHPA-Axis, that account for the interrelationship among mental disorders and cardiovascular healthoutcomes. The observed epidemiological and clinical physical health/mental disorder paradox will beaddressed using: 1) analyses of existing large epidemiological datasets; 2) analyses of survey and clinicaldatasets containing epidemiological, risk factor, and biological indicators; and, 3) a longitudinal cohort,clinical study examining in detail the relationship among biological and social risk factors, biomarkers forcardiovascular health and mood disorders, among black and white women. There are three interrelated,multi-disciplinary, specific aims, at increasing levels of specificity: 1) analyses ofobservational/epidemiological data on physical and mental disorders, 2) analyses of potential biologicalpathways of physical morbidity and mental disorder interrelationships in observational/epidemiologicalstudies, and 3) a clinic based 112 month longitudinal study of potential interventions that affect cardiovascularrisk behaviors and risk and resilience biomarkers, and risks for mood disorders and biomarkers for stressand HPA functioning, among African American as compared to non-Hispanic white women.
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