Depression and Chronic Health Conditions Among Latinos: The Role of Social Networks

Abstract

The purpose of this study was to examine the “buffering hypothesis” of social network characteristics in the association between chronic conditions and depression among Latinos. Cross-sectional self-report data from the San Diego Prevention Research Center’s community survey of Latinos were used (n = 393). Separate multiple logistic regression models tested the role of chronic conditions and social network characteristics in the likelihood of moderate-to-severe depressive symptoms. Having a greater proportion of the network comprised of friends increased the likelihood of depression among those with high cholesterol. Having a greater proportion of women in the social network was directly related to the increased likelihood of depression, regardless of the presence of chronic health conditions. Findings suggest that network characteristics may play a role in the link between chronic conditions and depression among Latinos. Future research should explore strategies targeting the social networks of Latinos to improve health outcomes.

Full text

ORIGINAL PAPER
Depression and Chronic Health Conditions Among Latinos:
The Role of Social Networks
Sandra Soto
1,2
•Elva M. Arredondo
2,3
•Miguel T. Villodas
4
•John P. Elder
2,3
•
Elena Quintanar
5
•Hala Madanat
2,3
ÓSpringer Science+Business Media New York 2016
Abstract The purpose of this study was to examine the
‘‘buffering hypothesis’’ of social network characteristics in
the association between chronic conditions and depression
among Latinos. Cross-sectional self-report data from the
San Diego Prevention Research Center’s community sur-
vey of Latinos were used (n=393). Separate multiple
logistic regression models tested the role of chronic con-
ditions and social network characteristics in the likelihood
of moderate-to-severe depressive symptoms. Having a
greater proportion of the network comprised of friends
increased the likelihood of depression among those with
high cholesterol. Having a greater proportion of women in
the social network was directly related to the increased
likelihood of depression, regardless of the presence of
chronic health conditions. Findings suggest that network
characteristics may play a role in the link between chronic
conditions and depression among Latinos. Future research
should explore strategies targeting the social networks of
Latinos to improve health outcomes.
Keywords Depression Chronic diseases Social
network Social support Latinos
Introduction
The combined rate of mild, moderate, and severe depres-
sion among Latinos is estimated at 26 % [1]. Given that by
2050, 30 % of the total U.S. population is expected to be
Latino [2], understanding the clinical, behavioral, and
social factors associated with depression among this group
is imperative. Studies suggest an association between
chronic conditions and depression [3], in particular among
individuals with diabetes [4], arthritis [5], and a history of
heart disease and stroke [6]. Co-occurrence of physical and
mental health conditions warrant an investigation of the
mechanisms underlying their connection.
Social networks consist of the social relationships that
surround an individual and include family members,
friends, and others [7]. These networks are important
because they facilitate the flow of resources to individuals
that can modify mental and physical health [8]. For
example, networks can either promote or prohibit the flow
of health information, social support, and access to other
resources that can improve or hinder health and health
behaviors [9]. Additionally, social networks can determine
social norms that result in the ‘‘spread’’ of health and health
behaviors (e.g., obesity and tobacco use) [10].
On the whole, research suggests that characteristics of the
social network are related to improved physical [11] and
mental [9] health outcomes. Specifically, social networks
have been shown to buffer, or moderate the relationship
between chronic conditions and mental health [12,13].
Cohen’s [14] ‘‘buffering hypothesis’’ posits that the social
support received from social networks could reduce the
&Sandra Soto
sandra.soto@mail.sdsu.edu
1
San Diego Joint Doctoral Program in Public Health (Health
Behavior), San Diego State University/University of
California, 9245 Sky Park Court, Suite 221, San Diego,
CA 92123-4311, USA
2
Institute for Behavioral and Community Health, San Diego,
CA, USA
3
Division of Health Promotion and Behavioral Science,
Graduate School of Public Health, San Diego State
University, San Diego, CA, USA
4
Department of Psychology, College of Arts and Sciences,
Florida International University, Miami, FL, USA
5
County of San Diego, Health and Human Services Agency,
South Region, San Diego, CA, USA
123
J Immigrant Minority Health
DOI 10.1007/s10903-016-0378-2

negative impact (e.g., depressive symptoms) of difficult
situations (e.g., chronic health conditions). For example,
members of the social network may provide support for
managing the symptoms and burdens of chronic conditions,
thus diminishing the impact of the condition(s) on mental
health [11]. Network members, in particular women, who
tend to adopt a caregiving role [15], may also provide
additional social support in a manner that increases self-
esteem and feelings of hope [16]. Among older adults, living
with a partner and feeling less lonely buffered the associa-
tion between having a chronic condition (e.g., atheroscle-
rosis, lung diseases and arthritis) and reporting depressive
symptoms [17]. In another study, among a sample of adults
with type 2 diabetes (n=119; 29 % Latino), satisfaction
with support and the size of the support network buffered the
burden of having diabetes on diabetes distress [18].
Although there is theoretical and empirical evidence for
the buffering role of social networks in physical and mental
health [9,19], most evidence is among non-Latino white
populations, which fail to acknowledge the interdependent
culture of Latinos [9]. Characteristics of Latino culture,
including familism (i.e., the central role of family in Latino
culture) [20], may enhance the role of the social network,
making the network a more relevant factor in health out-
comes among this population [21,22]. For example, family
support tends to be greater among Latinos compared to non-
Latinos even though support from families lessens as Lati-
nos become more acculturated to U.S. culture [22]. Tight
social networks often found in traditional Latino culture
have been identified as one possible explanation for ‘‘the
Latino paradox’’, which posits that recent Latino immi-
grants tend to have better health outcomes (e.g., lower car-
diovascular disease and all-cause mortality) than non-Latino
whites and other Latinos and minorities of similar socioe-
conomic status [23]. This phenomenon has also been
observed for lower prevalence of mental health disorders
among recent immigrants and Latinos who predominantly
speak Spanish relative to other Latinos [24]. The unraveling
of tight social networks, loss of resources, and reduced
social support experienced by Latinos after prolonged resi-
dence in the U.S. may increase their risk for poor health
outcomes [23]. It is therefore important to investigate if and
how social networks buffer the impact of chronic health
conditions on depression among Latinos residing in the U.S.
Thus, the purpose of this study is to test the ‘‘buffering
hypothesis’’ of social networks in the relationship between
chronic health conditions and depression. It is anticipated
that the presence of a larger social network, more family in
the network (vs. friends), more women in the network (vs.
men), and longer–lasting relationships in the network will
buffer the association between having a chronic condition
and reporting moderate-to-severe depressive symp-
toms among Latinos.
Methods
Design and Procedures
This is a secondary analysis study using cross-sectional
self-report data from the San Diego Prevention Research
Center’s (SDPRC) community survey with 397 predomi-
nantly Mexican-origin Latino residents of southern San
Diego County. Data collection occurred between June and
September 2009 with residents from four communities
close to the U.S.–Mexico border using a multistage sam-
pling method. Initially, 200 out of 1958 census blocks from
the four communities were randomly selected for house-
hold recruitment and houses in the chosen census blocks
were enumerated. Then, a skip pattern was used to ran-
domly select 4123 houses for recruitment.
Participants
Households were eligible for the study if at least one
household member identified as Latino and lived in the
house for at least four or more days per week. After
households were recruited and consented, a list of house-
hold members was obtained and used to randomly select a
Latino member who was at least 18 years old to complete
the survey. Two bilingual and bicultural research assistants
conducted home visits to assist participants with the survey
in either English or Spanish. The study objectives and
procedures were explained to the household member and
verbal consent was obtained. The San Diego State
University and University of California, San Diego Insti-
tutional Review Boards approved the study protocol and
materials.
Measures
Depression
The 9-item Patient Health Questionnaire (PHQ-9) [25]was
used to assess the presence of depressive symptoms in the past
2 weeks. Response options range from 0 (not at all)to3
(nearly every day). The PHQ-9 has been validated among a
racially/ethnically diverse sample of 5053 patients from
obstetrics and gynecology (n=2128) and primary care
(n=1964), consisting of 974 Latinos, 73.6 % of whom
predominantly spoke Spanish [26]. Over 50 % of the primary
care patients had a physician-reported chronic health
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condition (e.g., hypertension, arthritis, diabetes). The authors
noted no racial/ethnic group differences in the higher end of
the scale (moderately severe to severe depressive symptoms)
and internal consistency was .80. Scores range from 0 to 27
with higher scores indicating more depressive symptoms.
Developers identified cut-points to determine the severity of
depression, ranging from none to severe. Given the low
prevalence of more severe categories of depression in the
current sample, the alternative, clinically significant cutoff
value of ten or greater recommended by the developers was
used to indicate moderate-to-severe depressive symptoms.
Among the present sample, internal consistency was .83.
Chronic Conditions
Participants were asked if a healthcare provider had ever told
them that they have the following medical conditions: dia-
betes, heart disease (includes arteriosclerosis, angina/coro-
nary heart disease, or stroke), hypertension, high cholesterol,
asthma, cancer, and/or arthritis or other joint pain. Each health
condition was treated as a separate dichotomous variable. In
addition, a continuous variable was created from the total
number of health conditions reported by the participant.
Social Network
Characteristics of the social network were captured using
an egocentric network approach [27]. In this approach,
participants describe their social network from their per-
spective [28]. Participants were asked to list up to five
individuals that they ‘‘have relied on to talk with about
personal issues or problems’’ during the past year [29]. For
each person listed, participants reported the following: (1)
the gender of the person, (2) their relationship to the person
(e.g., friend), and (3) the length of time in years they have
known the person (length of association). The character-
istics of each individual named in the network were com-
bined to form an egocentric social network for each
participant [28]. For example, the number of friends named
by a participant was used to develop a variable indicating
the proportion of friends in that participant’s network. This
scheme was used for all other members named in the
network. The length of association was averaged across all
individuals named by the participant. The size of the net-
work was assessed by the sum of the number of individuals
listed in the network (ranging from 0 to 5). Finally, marital
status was used to further characterize the social network.
Socio-Demographics
The following demographic information was col-
lected from the participants: age, gender, level of educa-
tion, and employment status. Country of birth and number
of years living in the U.S. were used as proxy measures for
acculturation.
Data Analysis
Descriptive statistics of the sample, the outcome variable
(moderate-to-severe depression) and the predictor variables
(chronic health conditions and social network characteris-
tics) were obtained. Initially, bivariate logistic regression
models were tested with each chronic condition and social
network characteristic separately predicting the depression
variable. Then, multiple logistic regression was used to
model the odds of moderate-to-severe depression, pre-
dicted by each chronic condition and social network
characteristic separately, controlling for the following
demographic variables: age, gender, marital status, number
of years living in the U.S., and employment status. If sta-
tistically significant interactions between a chronic condi-
tion and a social network characteristic was found, it was
probed in post hoc analyses by exploring the simple slopes
of the regression of depression and the chronic health
condition at three levels of the mean-centered social net-
work characteristic: one standard deviation above the
mean, at the mean, and one standard deviation below the
mean [30]. Statistical significance was established at
p\0.05. Analyses were performed using SAS
Ò
Version
9.2.
Results
Four participants were removed from the analysis because
they did not respond to the chronic disease or depression
questions, resulting in a total sample size of 393. Table 1
presents the demographic characteristics of the sample.
Participants were primarily (73 %) female, had an average
age of 44 (±17), were unemployed (54 %), had less than a
high school education (55 %), and were born outside the
U.S. (77 %). More than 75 % of participants who were
born outside the U.S. were born in Mexico and had been
living in the U.S. an average of 21 (±13) years. Twelve
percent of participants reported moderate-to-severe
depressive symptoms and nearly half reported at least one
chronic condition. Due to the low prevalence of cancer and
asthma (3 and 7 %, respectively), these conditions were not
included in the analyses. On average, participants reported
4 individuals in their social network (±1). The majority of
the network was comprised of women (64 %) versus men
and family (55 %) versus others. Sixty percent of partici-
pants were married or cohabitating, and the average
amount of time that participants knew those in their net-
work was 22 (±13) years.
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Table 2presents bivariate results of each chronic con-
dition and social support characteristic and Table 3pre-
sents results combining each of the chronic health
conditions with each social network characteristic, adjust-
ing for covariates. At the bivariate level, individuals with
the following chronic health conditions were more likely to
report moderate-to-severe depression: heart disease (OR
3.58; 95 % CI 1.59–8.05), hypertension (OR 2.05; 95 % CI
1.08–3.88), high cholesterol (OR 2.67; 95 % CI
1.42–5.02), arthritis (OR 4.21; 95 % CI 2.11–8.42), and the
total number of conditions (OR 1.51; 95 % CI 1.24–1.83).
With the exception of hypertension, these chronic condi-
tions remained significantly related to moderate-to-severe
depression in the presence of each social network charac-
teristic and after adjusting for covariates (Table 3). The
association between heart disease and depressive symp-
toms ranged from OR 2.80 (95 % CI 1.03–7.58) with the
size of the network variable in the model to OR 2.99 (95 %
CI 1.09–8.20) with the length of association variable in the
model. For high cholesterol, the association with depres-
sive symptoms ranged from OR 2.94 (95 % CI 1.33–6.48)
with the percentage of women variable in the model to OR
3.91 (95 % CI 1.72–8.91) with the length of association
variable in the model. Between arthritis and depressive
symptoms, the association ranged from OR 5.43 (95 % CI
1.85–15.90) with the percentage of the network comprised
of the partner variable in the model to OR 6.33 (95 % CI
2.02–19.82) with the length of association variable in the
model. Finally, the association between the number of
conditions and moderate-to-severe depressive symptoms
ranged from OR 1.73 (95 % CI 1.26–2.38) with the per-
centage of women variable in the model to OR 1.83 (95 %
CI 1.32–2.54) with the length of association variable in the
model. Individuals with a greater percentage of women in
Table 1 San Diego prevention
research center’s community
survey participant
characteristics (n=393)
Demographic characteristics % (n) or mean ±SD
Female 73 (288)
Mean age 44 ±17
Unemployed (vs. employed) 54 (212)
\High school/GED (vs. Chigh school/GED) 55 (214)
Born outside of the US 77 (304)
Mexico 76 (300)
U.S. 23 (89)
Other 1 (4)
Mean years living in the US (only if foreign-born) 21 ±13
Disease prevalence
Depressive symptoms 4.33 ±4.72
None-to-mild (0–9) 88 (347)
Moderate-to-severe (10–27) 12 (46)
Diabetes 13 (52)
Heart disease, arteriosclerosis, angina/coronary heart disease or stroke 9 (35)
Hypertension 26 (101)
High cholesterol 27 (104)
Arthritis 14 (55)
Presence of at least one of the above diseases
a
46 (182)
Social network characteristics
Social network size 4 ±1
Mean percentage of network comprised of women (vs. men) 64 ±29
Mean percentage of network comprised of:
Family (excludes partner/spouse) 55 ±36
Friends 29 ±35
Partner/spouse 12 ±19
Other 3 ±10
Married or cohabitating (vs. single, divorced, widowed, or separated) 60 (234)
Length of association with network individuals in years 22 ±13
SD standard deviation
a
Does not include depressive symptoms
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the social network were more likely to report moderate-to-
severe depressive symptoms at the bivariate (OR 7.68;
95 % CI 2.21–26.73) and multivariate levels, ranging from
OR 5.17 (95 % CI 1.23–21.71) with high cholesterol in the
model to OR 6.75 (95 % CI 1.53–29.80) with arthritis in
the model. None of the other social network characteristics
were directly related to moderate-to-severe depressive
symptoms.
All possible interactions between the chronic health
conditions and the social network characteristics were
tested. Table 4describes the simple slopes of the only
statistically significant social network moderator found in
this sample. Those with a history of high cholesterol were
more likely to have moderate-to-severe depressive symp-
toms when they had average (OR 3.03; 95 % CI 1.35–6.83)
and above average (OR 6.81; 95 % CI 2.43–19.05) per-
centage of friends in their network, adjusting for age,
marital status, employment status, gender, and the number
of years living in the U.S.
Discussion
The ‘‘buffering hypothesis’’ was confirmed with one social
network characteristic in the relationship between chronic
conditions and moderate-to-severe depressive symptoms.
Although our findings did not support our hypothesis that
having more family in the network would buffer the rela-
tionship between chronic diseases and depressive symp-
toms, having more friends in the network was found to
increase the odds of moderate-to-severe depressive symp-
toms among those with high cholesterol. In other words,
the greater the percentage of the network comprised of
friends, the more likely individuals with high cholesterol
were to report moderate-to-severe depressive symptoms.
This finding is in contrast to previous literature showing
that friendships, rather than family relationships, are more
important in promoting mental health [31,32]. However, it
is important to note that these studies were not conducted
among younger, Latino adults as was the case in the cur-
rent sample. There may be cultural mechanisms for why
the relationship between friends and depressive symptoms
is inverted in the present sample that should be further
explored. Furthermore, researchers have noted that indi-
viduals with high cholesterol are less likely to report
symptoms of depression [33–35], possibly due to the anti-
depressive effect of prescription statins [35]; therefore,
adherence to these medications results in fewer depressive
symptoms. Studies indicate that individuals are more
adherent to their medication regimen if they have strong
family support [36]. Thus, those with more support from
friends may be less adherent to their cholesterol medica-
tions than those with less support from friends (and
potentially more family support), and therefore may not
benefit from the antidepressant effects of their statin
medications. Further research among samples with a higher
prevalence of moderate-to-depressive symptoms is needed
to confirm this theory.
Although there was no additional evidence of the
‘‘buffering hypothesis’’ of social networks between the
association of chronic health conditions and depressive
symptoms, we did find a consistent direct and inverse
association between having women in the network and
moderate-to-severe depressive symptoms. In other words,
the greater the percentage of women in the social network,
the more likely individuals were to report depressive
symptoms. This finding supports the conclusions from a
study of a densely interconnected social network of 12,067,
primarily Caucasian individuals [37]. The authors noted
that female friends were more influential in the spread of
depression than male friends, and reasoned that this was
because women communicate their mood states more
effectively than men. Another possible explanation for our
finding is that women may exert an abundance of support,
perceived as control over one’s health (e.g., changes to the
diet, limiting alcohol consumption), resulting in emotional
distress, feelings of dependency, and helplessness [17,19,
38–40]. On the other hand, researchers have also shown
that women positively influence the mental health of others
by providing more emotional and instrumental support and
Table 2 Bivariate logistic regression results of moderate-severe
depressive symptoms with chronic health conditions and social net-
work characteristics (n=393)
Moderate-severe depressive symptoms
OR (95 % CI)
Chronic health conditions
Diabetes 2.02 (0.93–4.36)
Heart disease 3.58 (1.59–8.05)**
Hypertension 2.05 (1.08–3.88)*
High cholesterol 2.67 (1.42–5.02)**
Arthritis 4.21 (2.11–8.42)***
Number of conditions 1.51 (1.24–1.83)***
Social network characteristics
Size of network 0.83 (0.66–1.04)
Percentage women 7.68 (2.21–26.73)**
Percentage partner 0.11 (0.01–1.05)
Percentage friends 1.97 (0.85–4.56)
Percentage relatives 0.79 (0.34–1.84)
Length of association 0.98 (0.96–1.01)
Marital status
a
0.78 (0.42–1.45)
df degrees of freedom, OR odds ratio, CI confidence interval
*p\0.05; ** p\0.01; *** p\0.001
a
Reference =not married or cohabitating
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Table 3 Multiple logistic regression results between moderate-to-severe depressive symptoms, chronic health conditions, and social network characteristics (n=393)
Moderate-to-severe depressive symptoms
OR
a
(95 % CI)
Model 1:
Size of network
Model 2:
% Women
Model 3:
% Partner
Model 4:
% Friend
Model 5: %
Relative
Model 6:
Marital status
a
Model 7: Length
of association
Diabetes 1.90 (0.74–4.88) 1.75 (0.68–4.49) 1.71 (0.67–4.36) 1.84 (0.72–4.68) 1.86 (0.73–4.74) 1.79 (0.71–4.54) 1.97 (0.77–5.09)
SNC 0.83 (0.63–1.09) 5.84 (1.40–24.35)* 0.34 (0.03–3.91) 1.86 (0.72–4.79) 0.62 (0.24–1.60) 0.70 (0.34–1.42) 0.96 (0.93–0.99)*
Heart disease 2.80 (1.03–7.58)* 2.83 (1.03–7.82)* 2.84 (1.06–7.61)* 2.90 (1.08–7.80)* 2.96 (1.10–7.95)* 2.88 (1.08–7.71)* 2.99 (1.09–8.20)*
SNC 0.85 (0.65–1.13) 5.85 (1.38–24.90)* 0.32 (0.03–3.73) 1.83 (0.71–4.73) 0.62 (0.24–1.60) 0.80 (0.39–1.64) 0.96 (0.93–0.99)*
Hypertension 1.98 (0.79–4.97) 1.83 (0.73–4.57) 1.87 (0.75–4.66) 2.01 (0.81–4.98) 2.09 (0.84–5.21) 1.98 (0.80–4.90) 2.16 (0.85–5.48)
SNC 0.84 (0.64–1.11) 5.64 (1.34–23.74)* 0.36 (0.03–4.35) 1.84 (0.72–4.75) 0.59 (0.23–1.54) 0.77 (0.38–1.56) 0.96 (0.93–0.99)*
High cholesterol 3.20 (1.45–7.07)** 2.94 (1.33–6.48)** 3.07 (1.39–6.79)** 3.37 (1.52–7.49)** 3.54 (1.57–7.96)** 3.19 (1.45–7.03)** 3.91 (1.72–8.91)**
SNC 0.85 (0.65–1.12) 5.17 (1.23–21.71)* 0.43 (0.04–4.98) 2.08 (0.79–5.44) 0.50 (0.19–1.32) 0.75 (0.37–1.54) 0.95 (0.92–0.99)**
Arthritis 5.84 (1.98–17.23)** 6.03 (2.02–18.00)** 5.43 (1.85–15.90)** 6.05 (2.02–18.11)** 6.18 (2.06–18.55)** 5.62** (1.93–16.33) 6.33 (2.02–19.82)**
SNC 0.82 (0.62–1.09) 6.75 (1.53–29.80)* 0.42 (0.04–5.07) 2.02 (0.75–5.44) 0.54 (0.20–1.45) 0.94 (0.45–1.97) 0.96 (0.93–0.99)*
Number of conditions 1.79 (1.30–2.46)*** 1.73 (1.26–2.38)*** 1.74 (1.27–2.39)*** 1.77 (1.29–2.42)*** 1.81 (1.32–2.49)*** 1.76 (1.29–2.41)*** 1.83 (1.32–2.54)***
SNC 0.82 (0.61–1.08) 5.43 (1.25–23.67)* 0.62 (0.05–7.20) 1.91 (0.72–5.10) 0.51 (0.19–1.36) 0.89 (0.43–1.85) 0.96 (0.93–0.99)*
Each model consists of one chronic disease, specified in the left-hand column and one social network characteristic, specified in the top row by the model number. Models were adjusted for age,
gender, marital status, number of years living in the U.S., and employment status
df degrees of freedom, OR
a
adjusted odds ratio, CI confidence interval, SNC social network characteristic specified in the top row
*p\0.05; ** p\0.01; *** p\0.001
a
Reference =not married or cohabitating
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by being more communicative than men [9]. Thus an
alternative explanation for this finding may be that indi-
viduals who are experiencing psychological distress may
seek support from more women than men to receive more
emotional support. Longitudinal research is required to
ascertain the direction of the relationship between support
from women and depression. Studies should also investi-
gate how women deliver support, how Latinos perceive
support, and test strategies that use female-delivered sup-
port to promote emotional well-being.
In the current sample of predominantly Mexican-origin
Latino adults, 12 % reported clinically significant moderate-
to-severe depression, slightly lower than the 14 % preva-
lence found among Latino adults in a previous epidemio-
logical study [41]. Contrary to previous findings [42], this
study did not find an association between diabetes and
depressive symptoms. However, heart disease, high
cholesterol, arthritis, and the total number of conditions were
associated with moderate-to-severe depressive symptoms
before and after controlling for social network characteris-
tics and demographic covariates, indicating the persistence
of the relationship between physical and mental health [6].
There were several limitations that should be considered
when interpreting these results. Other than hypertension
and high cholesterol, the prevalence rates of other condi-
tions were low in this sample. Given the wide confidence
intervals observed, these results should be treated with
caution. Moreover, the low prevalence of conditions per-
haps limited the ability to detect significant findings,
especially with regard to diabetes. A larger sample with a
higher prevalence of chronic health conditions and
depressive symptoms, along with a longitudinal design
could further elucidate the role of the social network.
Another limitation is that chronic health conditions were
self-reported and thus may have been under-reported or
misreported. Our analyses only investigated the presence of
chronic conditions, not the duration or severity of the
conditions, which may impact depressive symptoms and
the need for resources from the social network. Finally, the
current sample is comprised of mostly women, largely of
low socio-economic status (e.g., 54 % unemployed), who
were born in Mexico and live near the U.S.–Mexico border.
Although the prevalence of depression in the present
sample was consistent with that of a previous study on
depression among Latinos [41], our findings may not be
generalizable to other Latino subgroups.
New Contribution to the Literature
These findings suggest that certain aspects of Latinos’
social network characteristics have a direct and moderating
role in the well-established link between chronic health
conditions and depressive symptoms. Exploring these
mechanisms is especially salient given the interdependent
culture prevalent among Latinos. It is important to note that
with a few exceptions [43,44], the majority of literature
investigating the role of social networks in the physical and
mental health of adults has primarily been conducted
among non-Latino white populations [9]. The findings
found in the present study may be attributed to unique
aspects of Latino culture that should be further investi-
gated. Overall, these social network findings are relatively
unique to the literature and should be used as a basis for
future research to identify potentially clinically significant
intervention strategies that promote physical and mental
health among Latinos.
Acknowledgments The data used for this study came from the San
Diego Prevention Research Center’s (SDPRC) 2009 community
survey, funded by the Centers for Disease Control and Prevention
(U48 DP00036-04).
Funding This study was funded by the Centers for Disease Control
and Prevention (U48 DP00036-04).
Compliance with Ethical Standards
Conflict of interest The authors have no conflict of interest to
disclose.
Ethical Standards All procedures performed in studies involving
human participants were in accordance with the ethical standards of
the institutional and/or national research committee and with the 1964
Helsinki declaration and its later amendments or comparable ethical
standards.
Informed Consent Informed consent was obtained from all indi-
vidual participants included in the study.
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symptoms
Level of percentage of friends OR
a
(95 % CI)
High cholesterol 9percentage of friends in the network
Above average 6.81 (2.43–19.05)**
Average 3.03 (1.35–6.83)*
Below average 1.35 (0.44–4.16)
Adjusted for age, marital status, employment status, gender, and years
living in the US
OR
a
adjusted odds ratio, CI confidence interval
*p\0.01; ** p\0.001
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