Race, women and depression: The role of marriage and socioeconomic status.

Abstract

The relationship between race and depression in a national population sample of black and white women, 25-64 years old, was investigated. It was hypothesized that black women would report higher levels of depression symptomatology than white women and that race differences in depression would be modified by both socioeconomic status and marital status. Depression was measured by an abbreviated form of the Centers for Epidemiologic Studies Depression scale (CESD-11); those individuals scoring in the upper 20% were classified as depressed. Socioeconomic status was determined by education, income, and poverty measures; marital status was categorized as married or not married; and potential confounders examined were age, support from friends/relatives, number of confidants, religious participation, employment, life events, physical activity, body mass index, and chronic conditions. Results indicated that the crude prevalence of depression for black women was almost twice that for white women (34% versus 19%). Socioeconomic status modified the race difference in depression. Specifically, the significant race difference appeared only among the nonpoor (OR = 2.3, 95% CI: 1.3, 3.8) rather than the poor (OR = 1.3, 95% CI: 0.7, 2.1) and among those with at least some college education (OR = 2.4, 95% CI: 1.6, 3.7) rather than those with less than a high school education (OR = 1.6, 95% CI: 0.8, 1.6). Marital status also modified the race effect, in that a more pronounced race difference was observed for the married (OR = 2.0, 95% CI: 1.4, 3.0) than the unmarried (OR = 1.6, 95% CI: 1.1, 2.5). These effects persisted after controlling for known confounders. Additional exploratory analyses examined marital status within poverty and education strata. These analyses revealed that significant racial differences appeared only among the married nonpoor women (OR = 2.4, 95% CI: 1.6, 3.5) or the married higher educated women (OR = 3.0, 95% CI: 1.7, 5.3), findings which persisted after controlling for known confounders. Three psychosocial factors (financial stress, responsibility for helping others, and quality of the marriage) were subsequently explored as possible explanations for these findings. Financial stress and responsibility for helping others proved unimportant; however, controlling for marital quality reduced the excess odds of depression for nonpoor married black women 34% and the excess for better educated, married black women 27%. Potential methodological and substantive explanations of these findings are discussed and several recommendations for future research are offered.