Social Determinants of Depression among Hispanic Women

Depression is the number one cause of disability in the world, affecting over 350 million people. It is characterized by mood changes, alteration in self-attitude, cognitive functioning, sleep, appetite, and energy level, and causes impairment in social and occupational functioning and a decrease in the quality of life of the depressed person, family, and friends. Across different societies and social contexts throughout the world, depression affects significantly more women than men. The situation is similar in the U.S., where women are 70% more likely than men to experience depression during their lifetime. The age of onset of depression in women is around 32 years. Hispanic women experience depression around twice the rate of Hispanic males and are at a higher risk for depression than Caucasian and African American women due to multiple social determinants of health that affect the individual, family, aggregates, and community. The social determinants of health refer to conditions in which people are born, live, grow, work, and age. Unfortunately, many times individuals do not have direct control over these conditions. There is a scarcity of research related to social determinants of depression among adult Hispanic women; therefore, the conduction of research in this area is urgently needed to contribute to the early identification of the illness and prompt engagement in treatment. The first aim of this study was to explore the predictors of the intrapersonal level social determinants of depression among Hispanic women. These predictors include (a) income, (b) education, (c) acculturation, (d) health status, (e) health insurance status, and (f) employment status. The second aim of this study was to analyze the predictors of the interpersonal level social determinants of depression among Hispanic women. These predictors include (a) relationship status, (b) living with partner, and (c) living with children. The social ecological model (SEM) of McLeroy and colleagues was used to guide this study. The social determinants of depression were organized in the first two levels of the model: (a) intrapersonal (individual or unique characteristics of a person), and (b) interpersonal associations (formal and informal with significant others, social networks, family, and friends). The Patient Health Questionnaire-9 (PHQ-9) was used to measure depression (alpha = .84, English version; alpha = .85, Spanish version). This was a quantitative exploratory secondary analysis study that used cross-sectional data from SEPA III, a randomized controlled experimental study with sexually active Hispanic women between 18-50 years old conducted in South Florida (N = 280). The data were collected by SEPA III trained bilingual assessors using face-to-face interviews from May 2013 through October 2014. This secondary study obtained approval by the Florida Department of Health Institutional Review Board. Statistical analyses were comprised of confirmatory factor analysis (CFA), independent t-tests, and multiple regression. Multiple models were analyzed to test the hypotheses of the study. Findings point out that depression is very prevalent among Hispanic women in South Florida (37.5%), when compared to other recent studies done in the U.S. with similar populations. In addition, CFA showed that the item living with partner loaded significantly (p = .002) on the latent variable interpersonal factors, being the only item that predicted depression in the final model. Independent t-tests was performed in order to compare the means between the two groups (of each categorical variable) and the dependent continuous variable depression. Findings revealed that the difference in the means of the variables education, health status, relationship status, and living with partner were statistically significant with regards to the depression. The multiple regression final model showed that education, health status, relationship status, and living with partner explained 16% of the variance in depression indicative of a medium effect size. The average PHQ-9 score for a woman who had less than high school education, poor/fair health status, and did not live with partner was 9.51 (value of close to 10 is indicative of moderate depression). This study presents a particular way to explore multiple social determinants of depression using a social ecological framework to organize and explain the relationships. In addition to aiding in a meaningful organization of factors, the SEM underscores the interaction and importance of the multilevels on determining depression. The model helps understand the convoluting social analytical levels and how these affect depression. Given the current prevalence of depression among Hispanic women, research in this field is critical and should continue. Based on an extensive literature reviewed, a culturally tailored risk assessment tool that highlights the social determinants of depression in Hispanic women is nonexistent. This tool could be used in conjunction with other screening tools, such as the PHQ-9, in settings where Hispanic women of reproductive age are seen. Other social factors that may be determinants or depression among Hispanic women and merit exploration are familismo, marianismo, machismo, discrimination, separation from family, family and partner conflict. Social factors of health/depression affect predominantly vulnerable people even before birth, through old age. Consequently, nurses, as health care professionals who spend more time with clients and families, need to become aware of the role these social determinants play in the development of depression and need to be proactive when it comes to further screening and referral. Findings of this study bring about multiple compelling implications for nursing practice, policy, education and research