Life Course Socioeconomic Conditions and Mental Health Among Older Mexicans and Mexican Americans.

Abstract

We examined the associations between life course socioeconomic position (SEP) and mental health among older Mexicans and Mexican Americans. In the first analysis, we examined how parental education influences late-life cognitive function by comparing participants aged 60+ from the Sacramento Area Latino Study on Aging (SALSA) (N=1,789, U.S.-born or Mexican-born) and the Mexican Health and Aging Study (MHAS) (N=5,253, Mexico-residents or U.S. return-migrants). Cognitive function was measured using standardized z-scores of a short-term verbal recall test. In multivariate linear regression models, participants’ cognitive z-scores were higher among those whose mothers had more than elementary education (β=0.28,p<0.05) compared to those whose mothers had no education. Participant’s education mediated this association. For 5-year difference in participant’s education, the cognitive z-score increased by 0.3 points for a U.S.-born (6.3% on the raw score). Results were similar with father’s education.

In the second analysis, we examined how life course SEP influences the incidence of dementia and cognitive impairment without dementia (CIND), ascertained using standard diagnostic criteria, among SALSA participants. SEP indicators at 3 life stages were used to derive cumulative SEP and SEP mobility. In fully-adjusted Cox proportional hazards regression models, participants with continuously high SEP had lower hazards of dementia/CIND compared to those with continuously low SEP (HR=0.49; 95%CI=0.24, 0.98;P=0.04). Participants experienced a 16% greater hazard of dementia/CIND with every increase in one unit of cumulative SEP disadvantage, in age-adjusted models.

In the third analysis, we examined how life course SEP (described earlier) influences the risk of elevated depressive symptoms, a score ≥16 on the 20-item Center for Epidemiologic Studies and depression scale (CES-D), among SALSA participants. In fully-adjusted Generalized Estimating Equations (GEE) models, the risk of elevated depressive symptoms was 50% lower among participants who maintained high SEP (RR=0.50; 95%CI=0.34, 0.74;p-value=0.0005) compared to those who maintained low SEP, at baseline. In fully-adjusted models, an increase in one standard deviation of cumulative disadvantage was associated with an 11% increase in risk among the U.S.-born and 2% increase among the Mexican-born.

Mental health in late-life is shaped by life course socioeconomic experiences. Future work providing insight into the timing of potential interventions is warranted.