Social Science and Medicine
Volume 59, Issue 7, 2004, Pages 1339-1353

Social inequality and depressive disorders in Bahia, Brazil: Interactions of gender, ethnicity, and social class (Article)

Almeida-Filho N.* , Lessa I. , Magalhães L. , Araújo M.J. , Aquino E. , James S.A. , Kawachi I.
  • a Instituto de Saúde Coletiva, Federal University of Bahia, Campus Canela, Salvador, Bahia 40210-070, Brazil, Center for Society and Health, Harvard School of Public Health, Brazil
  • b Instituto de Saúde Coletiva, Federal University of Bahia, Bahia, Brazil
  • c Instituto de Saúde Coletiva, Federal University of Bahia, Bahia, Brazil
  • d Instituto de Saúde Coletiva, Federal University of Bahia, Bahia, Brazil
  • e Instituto de Saúde Coletiva, Federal University of Bahia, Bahia, Brazil
  • f Dept. Epidemiol. Ctr. Res. Ethnicity, University of Michigan, School of Public Health, United States
  • g Center for Society and Health, Dept. of Health and Social Behavior, Harvard School of Public Health, United States

Abstract

We conducted a study of the association between gender, race/ethnicity, and social class and prevalence of depressive disorders in an urban sample (N=2302) in Bahia, Brazil. Individual mental health status was assessed by the PSAD/QMPA scale. Family SES and head of household's schooling and occupation were taken as components for a 4-level social class scale. Race/ethnicity (white, moreno, mulatto, black) was assessed with a combination of self-designation and a system of racial classification. The overall 12-month prevalence of depressive symptoms was 12%, with a female:male ratio of 2:1. Divorced/widowed persons showed the highest prevalence and single the lowest. There was a negative correlation with education: the ratio college educated:illiterate was 4:1. This gradient was stronger for women than men. There was no F:M difference in depression among Whites, upper-middle classes, college-educated, or illiterate. Prevalence ratios for single, widowed and Blacks were well above the overall pattern. Regarding race/ethnicity, higher prevalences of depression were concentrated in the Moreno and Mulatto subgroups. There was a consistent social class and gender interaction, along all race/ethnicity strata. Three-way interaction analyses found strong gender effect for poor and working-class groups, for all race/ethnicity strata but Whites. Black poor yielded the strongest gender effect of all (up to nine-fold). We conclude that even in a highly unequal context such as Bahia, Blacks, Mulattos and women were protected from depression by placement into the local dominant classes; and that the social meaning of ethnic-gender-generation diversity varies with being unemployed or underemployed, poor or miserable, urban or rural, migrant or non-migrant. © 2004 Elsevier Ltd. All rights reserved.

Author Keywords

Brazil Depression Gender Social class inequity Ethnicity

Index Keywords

education urban area unemployment rural area depression Negro household Caucasian college correlation analysis sex ratio mental health human gender disparity psychologic assessment middle aged sample controlled study health status Logistic Models Depressive Disorder ethnology Urban Health migrant worker social status family Humans male occupation female South America Socioeconomic Factors Risk Factors race school prevalence Article adult gender Sex Factors Brazil ethnicity social class Bahia widow divorce
Link
https://www.scopus.com/inward/record.uri?eid=2-s2.0-3042718527&doi=10.1016%2fj.socscimed.2003.11.037&partnerID=40&md5=fc839eb8f6d09747465299aac0fceb21
DOI: 10.1016/j.socscimed.2003.11.037
ISSN: 02779536
Cited by: 87
Original Language: English