Mediation and Moderation of Urban Distress and Coronary Artery Disease

Abstract

This study examines stress and cardiovascular disease among young normotensive adults and CHD inpatients. It was based on archival data from the Friedberg, Suchday, and Srinivas (2009) study, as well as the Friedberg, Suchday, and Shelov (2007) study and included 94 cardiac patients (n = 94; Mean Age = 57 years; 59 Males; 34 White/Caucasian, 19 Black/African American, 36 Hispanic/Latino) and 103 normotensive controls (n = 103 Mean Age = 35 years; 17 Males; 65 White/Caucasian, 8 Black/African American, 10 Hispanic/Latino). Cardiac patients were recruited from the Albert Einstein College of Medicine in the north Bronx, while normotensive control participants were recruited through students and staff from the Albert Einstein College of Medicine. Participants completed objective measures about urban stress, perceived stress, social support, and for cardiac patients physiological measures were taken from chart reviews. Results demonstrated that there were significant differences between cardiac patients and controls in neighborhood disorder, with cardiac patients indicating stronger endorsement of neighborhood disorder than controls ( M = 13.17 versus M = 9.07 respectively, p < .001). There was no significant difference between groups for exposure to violence. Additionally, cardiac patients may have increased stress perception compared to controls, while the result was not significant, there was a trend (M = 18.65 versus M = 16.86 respectively, p = .057). Hierarchical regression analysis for prediction of cardiovascular risk factors indicated that exposure to violence yielded a trend (beta = .313, p = .063) in predicting risk factors, while neighborhood disorder (beta = -.150, p = .364), perceived stress (beta = .078, p = .475) and social support (beta = -.075, p = .473), did not predict cardiovascular risk factors. There were no significant correlations found among the PSS, ISEL-12, and CSI measures to the composite cardiovascular risk score, but it was found that exposure to violence correlated with hypertension. Perceived stress and neighborhood disorder were found to correlate positively ( r = .287, p = < .001), while appraisal support correlated negatively with both scales (r = -.257, p = < .05 and r = -.232, p = < .05, respectively), which may represent a buffering effect with appraisal support. Racial differences were found between White/Caucasians and Black/African Americans with White/Caucasians experiencing both lower stress, urban and perceived, as well as higher social support across all indices of support. Compared to males, females reported higher levels of perceived stress, neighborhood disorder, and social support, but no gender differences were found for appraisal support and exposure to violence. Limitations and implications for psychologists and other health professionals are discussed.