Depressive symptoms and C-reactive protein in a Brazilian urban community.

Psychological depression is an independent risk factor for coronary artery disease. C-reactive protein has been implicated as a mediator of the effect of psychological depression. Several studies have found that individuals, especially men, who report higher levels of psychological depression also have higher levels of C-reactive protein. The current study was undertaken to replicate these results in a Brazilian population, in which there is a much wider range of variation in both background characteristics (such as socioeconomic status) and coronary artery disease risk factors. A sample of 271 individuals was interviewed using the Center for Epidemiological Studies Depression Scale. Fasting blood samples were obtained and evaluated for C-reactive protein (assessed by a turbidimetric immunoassay using a Dade Behring kit) analysis in a subsample (N = 258) of individuals. The mean +/- SD C-reactive protein for the entire sample was 0.43 +/- 0.44, with 0.42 +/- 0.48 for men and 0.43 +/- 0.42 mg/L for women. Data were analyzed using multiple regression analysis, controlling for age, sex, body mass index, socioeconomic status, tobacco use, and both total cholesterol and low-density lipoprotein cholesterol. Higher reported depressive symptoms were correlated with higher C-reactive protein for men (partial r = 0.298, P = 0.004) and with lower C-reactive protein for women (partial r = -0.154, P = 0.059). The differences in the associations for men and women could be a result of differential effects of sex hormones on stress reactivity and immune response. On the other hand, this difference in the associations may be related to gender differences in the disclosure of emotion and the effect that self-disclosure has on physical health and immune response.

Depressive symptoms and C-reactive protein in a Brazilian urban community

Psychological depression is an independent risk factor for coronary artery disease. C-reactive protein has been implicated as a mediator of the effect of psychological depression. Several studies have found that individuals, especially men, who report higher levels of psychological depression also have higher levels of C-reactive protein. The current study was undertaken to replicate these results in a Brazilian population, in which there is a much wider range of variation in both background characteristics (such as socioeconomic status) and coronary artery disease risk factors. A sample of 271 individuals was interviewed using the Center for Epidemiological Studies Depression Scale. Fasting blood samples were obtained and evaluated for C-reactive protein (assessed by a turbidimetric immunoassay using a Dade Behring kit) analysis in a subsample (N = 258) of individuals. The mean ± SD C-reactive protein for the entire sample was 0.43 ± 0.44, with 0.42 ± 0.48 for men and 0.43 ± 0.42 mg/L for women. Data were analyzed using multiple regression analysis, controlling for age, sex, body mass index, socioeconomic status, tobacco use, and both total cholesterol and low-density lipoprotein cholesterol. Higher reported depressive symptoms were correlated with higher C-reactive protein for men (partial r = 0.298, P = 0.004) and with lower C-reactive protein for women (partial r = -0.154, P = 0.059). The differences in the associations for men and women could be a result of differential effects of sex hormones on stress reactivity and immune response. On the other hand, this difference in the associations may be related to gender differences in the disclosure of emotion and the effect that self-disclosure has on physical health and immune response.

Culture, socioeconomic status, and physical and mental health in Brazil.

The association of socioeconomic variables with poor health status has been widely observed, if not well understood, and cultural dimensions of socioeconomic differences have rarely been incorporated into research models. In this article, a cultural dimension of socioeconomic status is examined in a Brazilian city through the use of ethnographic and social survey techniques. It suggests that lifestyle, defined in terms of the relative ability to accumulate consumer goods and the adoption of associated behaviors, is an important component of socioeconomic differences. Further research using cultural consensus analysis, a structured ethnographic technique that may be used to study shared cultural knowledge, demonstrates significant consensus regarding the definition of the successful lifestyle. Then, using that culturally defined model of the successful lifestyle as the central tendency, an individual-level measure of approximation to that lifestyle was developed for a representative sample of 250 persons. This culturally defined measure of lifestyle was inversely associated with arterial blood pressure (beta = -.216, p < .01), depressive symptoms (beta = -.236, p < .01), and globally perceived stress (beta = -.358, p < .01); furthermore, it absorbed the explained variability in these outcomes that is associated with conventional socioeconomic variables (occupation, education, income). For arterial pressure, cultural consonance explained almost 10 percent of the differences in blood pressure between individuals; for the psychological outcome variables, cultural consonance explained between 10 percent and 20 percent of the differences between individuals. Finally, its statistical effects were independent of other socioeconomic, dietary, anthropometric, and psychosocial variables. These results suggest that an individual's approximation to the cultural ideal of lifestyle, his or her "cultural consonance," mediates the observed effects of socioeconomic variables on health status.

The cultural construction of social support in Brazil: associations with health outcomes.

The association of social support and health outcomes has received considerable attention in recent years, but the cultural dimension of social support has not been extensively investigated. In this paper, using data collected in a Brazilian city, we present results indicating that those individuals whose reported access to social support more closely approximates an ideal cultural model of access to social support have lower blood pressure and report fewer depressive symptoms and lower levels of perceived stress. The cultural model of social support is derived using a combination of participant observation, semi-structured interviews, and the systematic ethnographic technique of cultural consensus modelling. These results are then used to develop a measure of an individual's approximation to that model of social support in a survey of four diverse neighborhoods in the city (n = 250). We call this approximation to the ideal cultural model of social support "cultural consonance" in social support. The association of health outcomes with cultural consonance in social support is independent of individual differences in the reporting of social support, and of standard covariates. In the case of blood pressure and perceived stress, it is independent of diet, and other socioeconomic and psychosocial variables. The association with depressive symptoms is not independent of other psychosocial variables. The implications of these results are discussed with respect to research on cultural dimensions of the distribution of disease.