{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,21]],"date-time":"2026-10-21T03:37:37Z","timestamp":1792553857910,"version":"4.5.0"},"reference-count":41,"publisher":"MDPI AG","issue":"2","license":[{"start":{"date-parts":[[2025,2,4]],"date-time":"2025-02-04T00:00:00Z","timestamp":1738627200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000001","name":"National Science Foundation","doi-asserted-by":"publisher","award":["RISE-2401878"],"award-info":[{"award-number":["RISE-2401878"]}],"id":[{"id":"10.13039\/100000001","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diseases"],"abstract":"<jats:p>Background: Chronic stress, driven by the persistent activation of the body\u2019s stress response system\u2014including the sympathetic nervous system and hypothalamic\u2013pituitary\u2013adrenal (HPA) axis\u2014has far-reaching effects on both physical and mental health. This study examines the combined effects of social and behavioral factors on a latent variable consisting of stress and depressive symptoms, using a comprehensive framework to explore the complex interactions of these factors. Methods: Leveraging data from the United States Centers for Disease Control and Prevention\u2019s (CDC\u2019s) National Health and Nutrition Examination Survey (NHANES), we operationalized allostatic load\u2014a measure of cumulative physiological stress\u2014through 10 biomarkers spanning cardiovascular, inflammatory, and metabolic systems. Depressive symptoms were measured via the Patient Health Questionnaire-9 (PHQ-9), and a latent variable capturing the shared variance between stress and depressive symptoms was derived using factor analysis. To assess the influence of social (income and education) and behavioral (alcohol consumption and smoking) factors on this latent variable, we employed Bayesian Kernel Machine Regression (BKMR), allowing us to examine potential non-linear and interactive effects among these predictors. Results: Our results revealed a significant positive association between allostatic load and depressive symptoms across the sample, regardless of ethnic background. Alcohol consumption emerged as a key behavioral factor, with significant positive associations with stress. Conversely, education showed a protective effect, with higher education levels associated with decreased stress and depressive symptoms. Conclusions: These findings underscore the importance of addressing both social determinants and behavioral risk factors in mitigating the cumulative impacts of stress and depressive symptoms. By highlighting the roles of alcohol consumption and education, this study provides insights that can inform public health strategies aimed at promoting resilience and reducing stress-related health disparities.<\/jats:p>","DOI":"10.3390\/diseases13020046","type":"journal-article","created":{"date-parts":[[2025,2,4]],"date-time":"2025-02-04T10:57:53Z","timestamp":1738666673000},"page":"46","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Combined Effects of Social and Behavioral Factors on Stress and Depression"],"prefix":"10.3390","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3195-706X","authenticated-orcid":false,"given":"Emmanuel","family":"Obeng-Gyasi","sequence":"first","affiliation":[{"name":"Department of Built Environment, North Carolina A&T State University, Greensboro, NC 27411, USA"},{"name":"Environmental Health and Disease Laboratory, North Carolina A&T State University, Greensboro, NC 27411, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4637-860X","authenticated-orcid":false,"given":"Sonya","family":"Parker","sequence":"additional","affiliation":[{"name":"Department of Built Environment, North Carolina A&T State University, Greensboro, NC 27411, USA"},{"name":"Environmental Health and Disease Laboratory, North Carolina A&T State University, Greensboro, NC 27411, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,2,4]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"169","DOI":"10.1002\/ajpa.1330310509","article-title":"Biocultural perspectives on stress in prehistoric, historical, and contemporary population research","volume":"31","author":"Goodman","year":"1988","journal-title":"Am. 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