Social inequality and depressive disorders in Bahia,Brazil: interactions of gender,ethnicity,and social class

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 ¼ 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. r 2004 Elsevier Ltd. All rights reserved.