Intersections Between Gender, Race/Ethnicity and Marital Status Associations with Depression Symptoms

Context: Depression remains a prevalent mental health condition, with rates of diagnosis disproportionately increasing for women and Black or Hispanic adults. However, variations in these disparities due to marital status remains unclear.

Objective: To investigate intersections in the associations between gender, race/ethnicity, marital status, and depression symptoms.

Study Design and Analysis: This study utilized survey-based methodology to estimate adjusted odds ratios (OR) and interaction effects using ordinal generalized linear model.

Setting or Dataset: Data were derived from a survey dataset obtained from NHANES, specifically cross-sectional data from the 2013 to 2018 waves.

Population Studied: Community-dwelling, non-institutionalized, United States adults aged 20 years and older (N=14,759).

Instrument: The NHANES assessed depression using the PHQ-9, a nine-item depression screening tool.

Outcome Measures: In our study, using the PHQ-9 scoring, depression outcome was categorized into three groups: no to minimal, mild to moderate, and moderately severe to severe depression symptoms.

Results: In the adjusted analysis, the odds of worse depression symptoms were significantly greater among never married (OR: 1.41), divorced/separated (OR: 1.64), or widowed (OR: 1.31) adults vs. married. Among males, never married (OR: 1.53) and divorced/separated (OR: 1.81) had higher odds; for females, never married (OR: 1.27), cohabiting (OR: 1.30), divorced/separated (OR: 1.53), and widowed (OR: 1.29) individuals had significantly greater odds. Non-Hispanic (NH) White individuals who were never married (OR: 1.29), cohabiting (OR: 1.46), or divorced/separated (OR: 1.66) had greater odds of worse depression vs. married. Never married Asian (OR: 1.52) and African American (AA) (OR: 1.42) populations showed increased odds of worse depression symptoms. Among Hispanics, a status of never married, divorced/separated, and widowed was tied to increased odds of worse depression.

Conclusions: Marital status is strongly linked with depression risk, with never married, divorced/separated, and widowed individuals facing heightened odds. This pattern was true among women and Hispanic participants. However, males, Asian, AA participants, and NH White individuals did not exhibit the same results. Results may identify groups at particular risk of depression; further exploration of sociodemographic intersections and mental health is warranted to fully understand clinical implications.