Mental health disparities among women in midlife: A longitudinal study of depressive symptoms, status, and disease in the United States.

다국어 초록 (Multilingual Abstract)

The literature on the effects of depressive symptoms on women's lives is quite extensive. However, much of the focus on depressive symptoms disparities in midlife has been on the role of hormonal changes either at childbirth or during menopause (Freeman et al 2004, 2006; Noble 2005). Many of these studies utilize small, cross-sectional studies to examine women's psychological well being. With over one billion women projected to enter menopause, and subsequently old age, by 2030 (Noble 2005), it is imperative to understand the effects of both social and biological factors on the onset and prevalence of depression among this burgeoning group of women. As the leading cause of disease-related impairments among women worldwide, preventing major episodes of depression will become one of the world's most pertinent health issues.
Drawing primarily upon 6 waves (1993-2003) of the National Longitudinal Surveys Young Women Cohort (NLS-YW), this study expands on previous depression studies by evaluating the impact of socioeconomic status and health-related on explaining differences in depressive symptoms over time. The NLS-YW is a nationally representative sample of women who were initially interviewed during emerging adulthood and where followed until midlife (ages 39 to 51). Specifically, I take a closer look at the depressive symptoms in women over time and how these symptoms vary by key indicators. Furthermore, I examine within-group differences on important demographic, SES, and health-related measures and evaluate which indicators predict membership into a particular trajectory.
Results indicate that four distinct depressive symptoms trajectories emerge over the 11-year span for this group of middle-aged women. Two consistently stable trajectories, stable low and stable high, and two fluctuating trajectories, decreasing and increasing, represent the primary patterns of depressive symptoms in the NLS-YW. A larger percentage of women in the stable high trajectory were black, not married, and had a prior hypertension and heart condition diagnosis. This same group of women, in turn, had the lowest percentage of married women, those with post-secondary education, and those who were employed. By all accounts, the women of the stable low depressive symptoms trajectory are polar opposites of those in the stable high trajectory.
Surprisingly, age was not a significant predictor of trajectory membership in any of the estimated models. In other words, a woman's age did not contribute to whether or not she experienced a less favorable pattern of depressive symptoms over time. Additionally, although within-group differences by race were found in abundance, race was not a significant predictor of group membership once health and SES factors were taken into account.
Socioeconomic status, especially employment, was influential in both within-group variation and in predicting group membership. A large percentage of black women were employed, regardless of their depressive symptoms trajectory. For health-related measures, reports of self-rated health had the biggest impact on predicting trajectory membership. The odds of women in the stable low and decreasing depressive symptoms trajectories indicating favorable health were tremendously higher than the odds of women in the stable high trajectory reporting similar health. Any effect of demographic characteristics on trajectory membership was eliminated once SES was considered. In sum, a model including both SES and health-related predictors showed the complex nature of depressive symptoms reporting over this 11-year time span.
The results from this study show that research integrating socio-demographic and health characteristics are needed to fully capture why some segments of the female population report a given depressive symptoms trajectory. The inability of any of these factors to differentiate the decreasing and increasing depressive symptoms trajectories suggest the need for additional research that incorporates changes in key predictors over time. This line of research is important from a policy standpoint, as it can provide pertinent information in regards to what aspect of certain women's lives we must focus policy-driven prevention programs.