Low socioeconomic position is the source of a host of chronic stressors, including chronic strain and uncertainty surrounding a lack of adequate financial and other instrumental resources necessary to make ends meet (Malik et al., 2007; Muntaner et al., 2004). Given that racial and ethnic minorities are overrepresented among low-income populations, another chronic stressor that has been examined extensively in relation to depression is racial discrimination (Gee et al., 2007). While racial and other forms of discrimination are stressors, and, depending on the type of discrimination, such as racial, gender, age, or even social class, they can be either chronic or acute stressors (Banks and Kohn-Wood, 2007) and can increase risk of depression as such. Discrimination, however, can also impact beliefs, self-concept, and coping in ways that increase risk for mood disorders, including depression (Gee et al., 2007).

A number of institutional and sociocultural barriers are responsible for causing and maintaining existing disparities in access to and quality of mental health services received by minority groups. A succinct summary of the complex constellation of barriers is that “disparities result from ongoing interactions among factors at the levels of the health care environment, health care organization, community, provider, and person throughout the course of the depression development and treatment-seeking process (Chin et al., 2007)” (Van Voorhees et al., 2007, pp. 160S–161S). Social exclusion, which has played a key role in rendering these populations disproportionately vulnerable to and affected by incidence of depression, extends its adverse impact by limiting the engagement of and treatment in these historically unserved and underserved communities (Aguilar-Gaxiola et al., 2008). These groups’ isolation from mainstream society because of linguistic barriers, geographic isolation, history of oppression, racism, discrimination, poverty, and immigration status plays a key role in creating and perpetuating their social exclusion and challenges to receiving treatment.

The environment can act as a source of chronic stressors as well. Extensive research has been devoted to the area of residential neighborhoods and mental well-being (Muntaner et al., 2004; O’Campo, Salmon, and Burke, 2009; O’Campo and Yonas, 2005). While not the only context or environment known to influence mental well-being—workplace organization and characteristics, for example, have also been studied in relation to major mental disorders—residential neighborhoods have been shown to be the source of multiple stressors, including physical incivilities (such as trash, graffiti), high levels of noise, traffic, crime, and delinquency, to name a few (O’Campo, Salmon, and Burke, 2009; Rajaratnam et al., 2008). These stressors should be considered to contribute to the risk of depression independently of, and may even interact with, any family or individual stressors that may place individuals at risk, including but not limited to economic strain and family and parenting stress (Cutrona, Wallace, and



The National Academies | 500 Fifth St. N.W. | Washington, D.C. 20001
Copyright © National Academy of Sciences. All rights reserved.
Terms of Use and Privacy Statement