title: 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 = 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.
authors.affiliation: Instituto de Saúde Coletiva at the Federal University of Bahia, Campus Canela, Salvador, Bahia 40210-070, Brazil. naomar@ufba.br
authors.forename: Naomar
authors.initials: N
authors.lastname: Almeida-Filho
authors.forename: Ines
authors.initials: I
authors.lastname: Lessa
authors.forename: Lucélia
authors.initials: L
authors.lastname: Magalhães
authors.forename: Maria Jenny
authors.initials: MJ
authors.lastname: Araújo
authors.forename: Estela
authors.initials: E
authors.lastname: Aquino
authors.forename: Sherman A
authors.initials: SA
authors.lastname: James
authors.forename: Ichiro
authors.initials: I
authors.lastname: Kawachi
mesh_terms: D000328:Adult; D001938:Brazil / Q000453:epidemiology; D003866:Depressive Disorder / Q000453:epidemiology* / Q000208:ethnology; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012307:Risk Factors; D012737:Sex Factors; D012923:Social Class; D012959:Socioeconomic Factors; D014504:Urban Health / Q000706:statistics & numerical data*