"Life Ain't No Crystal Stair": Acknowledging the Behavioral Health Risks That Black Women Experience within a National Context

Background/Introduction

Over the past decade, there has been an increase in awareness as it relates to women’s health, specific to the impact of psychosocial risks (Price & Masho, 2014) as it relates to social determinants of health in communities of color. Previous studies have indicated that ethnic minority women in impoverished communities demonstrate rates of depression as high as 30 to 45 percent (Price, Coles, & Wingold, 2017). Given the challenges of racial and economic oppression that Black Americans experience, the weight of societal pressures can lead to one’s inability to maintain their emotional, mental, and physical health. These barriers are unique to women of color and contribute to stressors and impact psychosocial functioning. The primary aim of this study is to: (1) examine the experiences that Black women are having with psychosocial risks factors (i.e. smoking, substance use, and depression) within a national sample; and (2) identify the social determinants of health that Black women are experiencing in rural and urban communities.

Methods

This study employed a secondary data analysis using the 2018 National Survey on Drug Use and Health (N=56,313). For this study, only Black women aged 18 and higher were included (n=3052). Bivariate and multivariate comparisons were conducted by examining the associations among individual behavioral health risks experienced by Black women. Ordinal logistic regression was used to examine whether depression, suicidal ideation, cigarette usage, drug & alcohol usage, geographic location, and recipient of Medicaid along with demographic variables predicted self-reported overall health (1=Excellent, 2=Very Good, 3=Good, 4=Fair/Poor) for Black women.

Results

The collective variables fit the model well (-2LL=4785.97, X2=479.82, df=20, p<.000) with both Pearson and Deviance Goodness-of-Fit test being non-significant. Ultimately,the behavioral health risks of cigarette usage, depression, and suicidal ideation significantly impacted overall health. Depression contributed to the model (ordered log odds =.631, SE = .106, Wald=35.617, p<.000). The estimated odds ratio favored a positive relationship (Exp=1.88, 95% CI (.424, .838)) compared to the reference variable no depression. Suicidal ideation contributed to the model (ordered log odds =.360, SE = .149, Wald=5.803, p=.016. The estimated odds ratio favored a positive relationship (Exp=1.43, 95% CI (.067, .653)) compared to the reference variable no suicidal ideation. Thus the model indicates that if one has experienced depression (1.88 greater odds) or suicidal ideation (1.43 greater odds) they are at risk for being in the next worse overall health category.

Conclusions

Misdiagnosing, underdiagnosing, and failing to capture the nuances of mental health disorders in African American women can have implications for other behavioral health risk factors among this population. These findings demonstrate that not only does context matter, but social determinants of health, such as substance use, community context, and discrimination play an integral role in both physical and mental health outcomes. The study holds potential for not only prevention, but intervention development centered targeting specific social determinants dependent upon specific community context.