The Association between Cognitive Impairment, Structural and Social Determinants of Health, and Mood Disorder among Black Adults in the Greater St. Louis Metropolitan Area
Bibliographic record
Abstract
BACKGROUND: Black middle-aged and older adults face a significantly higher risk of mood disorders and cognitive impairment compared to non-Hispanic Whites. Prior evidence underscores that the structural and social determinants of health (S/SDOH) are estimated to contribute to 60-80% of all health outcomes. However, evidence examining the intersection of S/SDOH and depression and anxiety remains fragmented, often focusing on limited measures like income or socioeconomic status or using aggregated measures at the census tract. This study utilized a new S/SDOH measure based on the National Institute on Aging Health Disparities Research Framework using individual and household level data to examine the relationship between mood disorders (depression and anxiety), cognitive impairment, and S/SDOH. METHODS: Baseline data from Black participants aged 45 and older (n = 312) in the Greater St. Louis Metropolitan region were examined. A S/SDOH composite index (S/SDOH-CI) was constructed to measure participants' deprivation and unique risk factors. Depression and anxiety symptoms were measured using the Patient Health Questionnaire (PHQ-9) and the Generalized Anxiety Disorder 7 item (GAD-7). Cognitive impairment was assessed using the Montreal Cognitive Assessment (MoCA) and a preclinical Alzheimer's cognitive composite (PACC) score. RESULTS: Among 312 cognitively normal participants, the average age was 64.5 (SD = 9.9), and the average education level was 15 years (SD = 2.82). 77.6% were female, and 108 (35%) had at least mild mood disorder symptoms. Logistic regression analysis indicated that a one SD increase in the burden of deprivation was associated with 3.12 times the odds of having any symptoms (95% CI: 2.13-4.92). Furthermore, contribution to S/SDOH-CI revealed hardship and daily stressors (17%), and discrimination (11%) were the primary factors exacerbating mood disorders. These surpassed the contribution of education (10.67% [years and quality]), particularly among Black men, highlighting racism as a formidable driver of health inequities and lending additional evidence that there may be diminishing returns on human capital investments among Black men. CONCLUSION: These findings emphasize the need for medical advancements to progress together with social justice initiatives. The use of the S/SDOH-CI uncovered within-group differences and identified unique risk and resilience factors for mood disorders in Black older adults.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".