Effects of Sociospatial Inequality on Exposure to Stress, Symptoms of Depression, and Cortisol Rhythms in Pregnancy.
Crystal Modde Epstein, Thomas P McCoy, Angela M Kabbe and 1 others
PMID 40623445WHAT IT FOUND
Cortisol slope and total output were not linked to sociospatial inequality.
Pregnant women in concentrated privilege areas had fewer lifetime stress exposures, and elevated depression symptoms were more likely in concentrated deprivation. Income extremes showed larger cortisol rhythm fluctuations.
Key findings
01Cortisol diurnal slope and total output were not linked to sociospatial inequality.
02For income-related inequality, the concentrated deprivation and concentrated privilege tertiles had higher estimated cortisol amplitude and earlier peak time than the middle tertile.
03Pregnant women in concentrated privilege areas had fewer lifetime stress exposures, and elevated depression symptoms were more likely in concentrated deprivation.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The study was a secondary cross-sectional analysis of 67 pregnant participants, so it cannot show that place caused stress, depression, or cortisol changes. Participants were convenience recruited from one urban midwestern clinic, and the sample included relatively few non-Hispanic Black participants. Generalizability is limited. Cortisol samples were self-collected at home, so timing, technique, and adherence to the protocol may vary. The sample size was modest, so power to detect small to medium cortisol effects was limited. Depression was screened with a cutoff, not diagnosed, and anxiety, interpersonal violence, and post-traumatic stress disorder were not measured. Inequality was measured by zip code and only during pregnancy, not by cumulative residence over the life course. Preterm birth and infant health outcomes were not assessed.
Declared interests
The authors report no conflicts of interest or relevant financial relationships.
The easy way to misread this
Do not conclude that place of residence caused stress, depression, or altered cortisol. The study was cross-sectional, secondary, and included 67 pregnant participants, so it can show associations but not cause.