Depressive Symptoms and Psychological Distress Among Rural African Americans: The Role of Material Hardship

Background & Purpose: Depression and psychological distress are common among Americans and present significant public health concerns. However, rural African Americans’ mental health has been understudied and largely ignored. This is of concern as African Americans and rural residents are more likely to experience conditions associated with increased risk for depression and psychological distress, including higher poverty rates, lower educational attainment, and worse perceived health status when compared to non-Hispanic White and urban peers. Additionally, literature increasingly suggests the importance of examining the relationship between more nuanced indicators of economic well-being, such as material hardship, and mental health. This study examines the association between sociodemographic characteristics, perceived health status, material hardship, and depression and psychological distress among rural African Americans.

Methods: We used National Survey of American Life data (NSAL) to examine the association between sociodemographic characteristics, perceived health status, and material hardship, and depressive symptoms and psychological distress among 222 rural African American respondents. The NSAL is the first and only national survey of African Americans. Given the regional concentration of rural African Americans, all rural NSAL respondents were recruited from the southern United States. Depressive symptoms were measured using the Center for Epidemiological Studies-Depression Scale (CES-D). Psychological distress was measured by the Kessler 6 (K6). Due to over-dispersion of dependent variables, negative binomial regression was performed. Two multivariate regression models were examined for each dependent variable. The first model included sociodemographic variables (age, gender, income, education, and marital status), whereas the second model included variables related to sociodemographic characteristics, perceived health status, and material hardship.

Results: In Model 1, age (IRR=.99; CI=.98-1.00) and family income (IRR=.96; CI=.92-.99) were negatively associated with depressive symptoms among rural African American respondents. In the full model, age (IRR=.98; CI=.97-.99), education (IRR=.94; CI=.93-.98), and self-rated health (IRR=.82; CI=.73-.91) were negatively associated with depression symptoms, whereas material hardship was positively associated with depressive symptoms (IRR=1.13; CI=1.06-1.22). A similar pattern emerged for psychological distress. In Model 1, age (IRR=.98; CI=.97-.99), family income (IRR=.95; CI=.90-.99) and education (IRR=.94; CI-.88-1.00) were negatively associated with psychological distress. Additionally, being separated or divorced was associated with higher rates of psychological distress relative to being married. When perceived health status and material hardship were added in Model 2, age (IRR=.98; CI=.96-.99) and education (IRR=.92; CI=.86-.98) remained negatively associated with psychological distress. Self-rated health (IRR=.77; CI=.67-.89) was negatively associated with psychological distress and there was a positive association between material hardship (IRR=1.20; CI=1.09-1.31) and psychological distress among rural African American respondents.

Conclusions and Implications: Material hardship emerged as a risk factor for depressive symptoms and psychological distress among rural African American respondents and requires further study. It is likely that experiencing sustained material hardship has also contributed to rural Americans’ feeling left behind by policymakers and researchers. Additionally, perceived health status was negatively associated with mental health outcomes, suggesting the importance of implementing integrated healthcare models in rural African American communities. This need is particularly salient given increasing mortality rates, driven by chronic illness and suicide, in rural America.