Perceived Chronic Stress, Quality of Healthcare Interactions and Brain Health Among Middle-Aged and Older Black Americans: Findings from a Community-Engaged Pilot Study

Background: Chronic stress is a known contributor to brain health disparities; however, perceived healthcare quality plays a crucial role in maintaining health disparities among Black Americans. Clinical encounters are a critical touch point for identifying, managing, and addressing the cognitive concerns of Black patients. We examined whether perceived interpersonal quality of care from a health care provider and chronic stress were associated with cognitive function in a community-based sample of middle-aged and older Black Americans.

Methods: This pilot study included 186 Black American adults aged 45 and older in Southern California. Cognitive function was assessed using the Mini-Mental State Examination (MMSE). Perceived interpersonal quality of care (communication, patient-centered decision making, interpersonal style) was measured using the 13-item Interpersonal Processes of Care (IPC) instrument. Chronic psychosocial stress was assessed using the 51-item NIH Toolbox Chronic Stress measure. Linear regression models estimated associations between IPC scores and MMSE scores: (1) unadjusted, (2) adjusted for age, sex, and education, and (3) further adjusted for chronic stress.

Results: Participants had a mean age of 65 years (SD = 10), were predominantly female (55%), and had relatively high educational attainment (50% with a college degree). Mean MMSE score was 27.1 (SD = 2.1; range 0-30). In bivariate analysis, higher IPC scores (indicating better perceived interpersonal quality of care) were significantly associated with lower MMSE scores (β = −0.031, p = 0.035). This association persisted after adjusting for age, sex, and education (β = −0.032, p = 0.024) and after further adjustment for chronic psychosocial stress (β = −0.033, p = 0.020). Chronic stress was not significantly associated with MMSE. The interaction between work stress and IPC was marginally significant (β = 0.047, p = 0.066). Age and education were significant independent predictors of cognitive function.

Conclusions: More favorable perceptions of interpersonal care were associated with lower risk of cognitive impairment. The marginally significant interaction between IPC and work stress suggests a promising avenue for future research focused on stress domains. Our findings underscore the doctor-patient encounter as an underexplored, potentially modifiable social determinant relevant to brain health equity in Black Americans.