title: Subjective social status and depression symptoms: a prospective study of women with noncancerous pelvic problems.
abstract: OBJECTIVE
  Subjective social status (SSS) may be a stronger determinant of health than objective measures of socioeconomic status. We sought to examine the effect of community and national SSS on symptoms of depression in a racially/ethnically diverse sample of adult women with noncancerous uterine conditions.
  
  
  METHODS
  We conducted a secondary analysis of data obtained from 634 women who enrolled in the Study of Pelvic Problems, Hysterectomy, and Intervention Alternatives (SOPHIA) in 2003 and 2004. SOPHIA was a longitudinal study of women aged 31 to 54 who were experiencing abnormal uterine bleeding, symptomatic fibroids, or pelvic pain. The primary outcome for this analysis consisted of symptoms suggesting major or other depressive disorder, as measured by the Patient Health Questionnaire-9, 2 years after study enrollment. We hypothesized that women who had low community and national SSS at baseline, as measured by the MacArthur SSS ladder, would be at higher risk of experiencing symptoms of depression at follow-up.
  
  
  RESULTS
  Women with low community SSS had an increased odds of experiencing depression symptoms 2 years later compared with women with high SSS, after adjusting for age, pelvic problem impact and baseline depression (odds ratio, 2.93; 95% CI, 1.11-7.77). Odds remained elevated after further adjusting for income and education. Results for the national ladder were not significant.
  
  
  CONCLUSIONS
  Low perceived community social status is predictive of symptoms suggestive of major or other depressive disorder among women with noncancerous uterine conditions. Asking about perceived community social status can help clinicians to identify patients who may be at increased risk for depressive disorders. Asking about perceived national social status does not seem to add value beyond that provided by income and education.
authors.affiliation: Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco, California; Maternal and Child Health Program, School of Public Health, University of California, Berkeley, California.
authors.forename: O Vanessa
authors.initials: OV
authors.lastname: Diaz
authors.affiliation: Maternal and Child Health Program, School of Public Health, University of California, Berkeley, California.
authors.forename: Sylvia
authors.initials: S
authors.lastname: Guendelman
authors.affiliation: Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco, California; Department of Epidemiology & Biostatistics, School of Medicine, University of California, San Francisco, California; Medical Effectiveness Research Center for Diverse Populations, University of California, San Francisco, California. Electronic address: kuppermannm@obgyn.ucsf.edu.
authors.forename: Miriam
authors.initials: M
authors.lastname: Kuppermann
mesh_terms: D000328:Adult; D002140:California / Q000453:epidemiology; D003430:Cross-Sectional Studies; D003863:Depression / Q000453:epidemiology* / Q000523:psychology; D005260:Female; D006304:Health Status; D006305:Health Status Indicators; D006801:Humans; D007044:Hysterectomy; D007182:Income; D007889:Leiomyoma / Q000453:epidemiology / Q000523:psychology* / Q000601:surgery; D008875:Middle Aged; D016017:Odds Ratio; D017699:Pelvic Pain / Q000453:epidemiology / Q000523:psychology* / Q000601:surgery; D011159:Population Surveillance; D011446:Prospective Studies; D011788:Quality of Life; D012725:Sexual Behavior / Q000502:physiology; D012923:Social Class; D012931:Social Environment; D011795:Surveys and Questionnaires; D014592:Uterine Hemorrhage / Q000453:epidemiology / Q000523:psychology* / Q000601:surgery