Journal of Urban Health

, Volume 90, Issue 1, pp 83–100 | Cite as

Financial Distress and Depressive Symptoms among African American Women: Identifying Financial Priorities and Needs and why it Matters for Mental Health

  • Angelica JoNel StarkeyEmail author
  • Christopher R. Keane
  • Martha Ann Terry
  • John H. Marx
  • Edmund M. Ricci


Prior research found that financial hardship or distress is one of the most important underlying factors for depression/depressive symptoms, yet factors that contribute to financial distress remain unexplored or unaddressed. Given this, the goals of the present study were (1) to examine the relationship between perceived financial distress and depressive symptoms, and (2) to identify financial priorities and needs that may contribute to financial distress. Surveys from 111 African American women, ages 18–44, who reside in Allegheny County, PA, were used to gather demographic information and measures of depressive symptoms and financial distress/financial well-being. Correlation and regression analyses revealed that perceived financial distress was significantly associated with levels of depressive symptoms. To assess financial priorities and needs, responses to two open-ended questions were analyzed and coded for common themes: “Imagine you won a $10,000 prize in a local lottery. What would you do with this money?” and “What kinds of programs or other help would be beneficial to you during times of financial difficulties?” The highest five priorities identified by the participants were paying bills and debt, saving, purchasing a home or making home repairs, and/or helping others. The participant’s perceived needs during times of financial difficulty included tangible assistance and/or financial education. The findings from this study can be used to create new and/or enhance existing programs, services, and/or interventions that focus on the identified financial priorities and needs. Collaborative efforts among professionals in different disciplines are also needed, as ways to manage and alleviate financial distress should be considered and discussed when addressing the mental health of African American women.


African American women Depression Depressive symptoms Risk factors for depression Perceived financial distress Financial strain Economic strain Financial priorities Financial needs 



The authors would like to acknowledge Dr. Richard Day for providing statistical consultation. Appreciation is also expressed to the Personal Finance Employee Education Foundation @ for permission to use the PFW scale.


  1. 1.
    Beato CV. Mental Health and Mental Disorders. Healthy People 2010 Progress Review: U.S. Department of Health and Human Services; 2003.Google Scholar
  2. 2.
    Brown DR, Keith VM. The epidemiology of mental disorders and mental health among African American women. In: Brown DR, Keith VM, eds. In and Out of Our Right Minds. New York: Columbia University Press; 2003: 23–58.Google Scholar
  3. 3.
    Dwight-Johnson M, Lagomasino IT. Addressing depression treatment preferences of ethnic minority patients. Gen Hosp Psychiatry. 2007; 29(3): 179–181.PubMedCrossRefGoogle Scholar
  4. 4.
    Dwight-Johnson M, Sherbourne CD, Liao D, Wells KB. Treatment preferences among depressed primary care patients. J Gen Intern Med. 2000; 15(8): 527–534.PubMedCrossRefGoogle Scholar
  5. 5.
    Givens JL, Katz IR, Bellamy S, Holmes WC. Stigma and the acceptability of depression treatments among African Americans and whites. J Gen Intern Med. 2007; 22(9): 1292–1297.PubMedCrossRefGoogle Scholar
  6. 6.
    Myers HF, Lesser I, Rodriguez N, et al. Ethnic differences in clinical presentation of depression in adult women. Cultur Divers Ethnic Minor Psychol. 2002; 8(2): 138–156.PubMedCrossRefGoogle Scholar
  7. 7.
    Saver BG, Van-Nguyen V, Keppel G, Doescher MP. A qualitative study of depression in primary care: missed opportunities for diagnosis and education. J Am Board Fam Med. 2007; 20(1): 28–35.PubMedCrossRefGoogle Scholar
  8. 8.
    United States Department of Health and Human Services. Healthy People 2010: Understanding and Improving Health. . Mental Health and Mental Disorders. Chapter 18. 2nd ed. Washington, DC: U.S. Government Printing Office; 2000.Google Scholar
  9. 9.
    Carrington CH. Clinical depression in African American women: diagnoses, treatment, and research. J Clin Psychol. 2006; 62(7): 779–791.PubMedCrossRefGoogle Scholar
  10. 10.
    Van Hook MP. Women’s help-seeking patterns for depression. Soc Work Health Care. 1999; 29(1): 15–34.PubMedCrossRefGoogle Scholar
  11. 11.
    Waite R, Killian P. Exploring depression among a cohort of African American women. J Am Psychiatr Nurses Assoc. 2007; 13(3): 161–169.CrossRefGoogle Scholar
  12. 12.
    Ward EC. Examining differential treatment effects for depression in racial and ethnic minority women: a qualitative systematic review. J Natl Med Assoc. 2007; 99(3): 265–274.PubMedGoogle Scholar
  13. 13.
    Black Women and Mental Health. Available at: Accessed January 28, 2008.
  14. 14.
    Baker FM. Diagnosing depression in African Americans. Community Ment Health J. 2001; 37(1): 31–38.PubMedCrossRefGoogle Scholar
  15. 15.
    Brown C, Abe-Kim JS, Barrio C. Depression in ethnically diverse women: implications for treatment in primary care settings. Prof Psychol Res Pract. 2003; 34(1): 10–19.CrossRefGoogle Scholar
  16. 16.
    Das AK, Olfson M, McCurtis HL, Weissman MM. Depression in African Americans: breaking barriers to detection and treatment. J Fam Pract. 2006; 55(1): 30–39.PubMedGoogle Scholar
  17. 17.
    Dubowitz H, Feigelman S, Lane W, et al. Screening for depression in an urban pediatric primary care clinic. Pediatrics. 2007; 119(3): 435–443.PubMedCrossRefGoogle Scholar
  18. 18.
    Jackson AP. The use of psychiatric medications to treat depressive disorders in African American women. J Clin Psychol. 2006; 62(7): 793–800.PubMedCrossRefGoogle Scholar
  19. 19.
    Keeley RD, Smith JL, Nutting PA, Dickinson LM, Dickinson WP, Rost KM. Does a depression intervention result in improved outcomes for patients presenting with physical symptoms? J Gen Intern Med. 2004; 19(6): 615–623.PubMedCrossRefGoogle Scholar
  20. 20.
    Kohn LP, Oden T, Munoz RF, Robinson A, Leavitt D. Adapted cognitive behavioral group therapy for depressed low-income African American women. Community Ment Health J. 2002; 38(6): 497–504.PubMedCrossRefGoogle Scholar
  21. 21.
    Mahan V. Challenges in the treatment of depression. J Am Psychiatr Nurses Assoc. 2006; 11(6): 366–370.CrossRefGoogle Scholar
  22. 22.
    O’Malley AS, Forrest CB, Miranda J. Primary care attributes and care for depression among low-income African American women. Am J Public Health. 2003; 93(8): 1328–1334.PubMedCrossRefGoogle Scholar
  23. 23.
    Reinberg S. Depression May Be World’s Most Disabling Disease: Global Study Finds it takes a bigger toll than other chronic conditions. Available at: Accessed February 1, 2008.
  24. 24.
    Simpson SM, Krishnan LL, Kunik ME, Ruiz P. Racial disparities in diagnosis and treatment of depression: a literature review. Psychiatr Q. 2007; 78(1): 3–14.PubMedCrossRefGoogle Scholar
  25. 25.
    Turner RJ, Lloyd DA. Stress burden and the lifetime incidence of psychiatric disorder in young adults: racial and ethnic contrasts. Arch Gen Psychiatry. 2004; 61(5): 481–488.PubMedCrossRefGoogle Scholar
  26. 26.
    Borowsky SJ, Rubenstein LV, Meredith LS, Camp P, Jackson-Triche M, Wells KB. Who is at risk of nondetection of mental health problems in primary care? J Gen Intern Med. 2000; 15(6): 381–388.PubMedCrossRefGoogle Scholar
  27. 27.
    Hines-Martin V, Malone M, Kim S, Brown-Piper A. Barriers to mental health care access in an African American population. Issues Ment Health Nurs. 2003; 24(3): 237–256.PubMedCrossRefGoogle Scholar
  28. 28.
    Hines-Martin VP. African American consumers: what should we know to meet their mental health needs? J Am Psychiatr Nurses Assoc. 2002; 8(6): 188–193.CrossRefGoogle Scholar
  29. 29.
    Lang AJ. Mental health treatment preferences of primary care patients. J Behav Med. 2005; 28(6): 581–586.PubMedCrossRefGoogle Scholar
  30. 30.
    Snowden LR. Barriers to effective mental health services for African Americans. Ment Health Serv Res. 2001; 3(4): 181–187.PubMedCrossRefGoogle Scholar
  31. 31.
    Keith VM. In and out of our right minds: strengths, vulnerabilities, and the mental well-being of African American women. In: Brown DR, Keith VM, eds. In and Out of Our Right Minds. New York: Columbia University Press; 2003: 277–292.Google Scholar
  32. 32.
    Aldana SG, Liljenquist W. Validity and reliability of a financial strain survey. Financ Counsel Plann. 1998; 9(2): 11–19.Google Scholar
  33. 33.
    O’Neill B, Prawitz AD, Sorhaindo B, Kim J, Garman ET. Financial distress: definition, effects and measurement. Consumer Interest Annual. 2006; 52: 458–465.Google Scholar
  34. 34.
    Coiro MJ. Depressive symptoms among women receiving welfare. Women Health. 2001; 32(1–2): 1–23.PubMedGoogle Scholar
  35. 35.
    Jackson AP, Brooks-Gunn J, Huang CC, Glassman M. Single mothers in low-wage jobs: financial strain, parenting, and preschoolers’ outcomes. Child Dev. 2000; 71(5): 1409–1423.PubMedCrossRefGoogle Scholar
  36. 36.
    Prawitz AD, Garman ET, Sorhaindo B, O’Neill B, Kim J, Drentea P. In charge financial distress/financial well-being scale: development, administration, and score interpretation. Financ Counsel Plann. 2006; 17(1): 34–50.Google Scholar
  37. 37.
    Reading R, Reynolds S. Debt, social disadvantage and maternal depression. Soc Sci Med. 2001; 53(4): 441–453.PubMedCrossRefGoogle Scholar
  38. 38.
    Schulz A, Parker E, Israel DB, Fisher DT. Social context, stressors, and disparities in women’s health. J Am Med Womens Assoc. 2001; 56(4): 143–149.PubMedGoogle Scholar
  39. 39.
    Zimmerman FJ, Katon W. Socioeconomic status, depression disparities, and financial strain: what lies behind the income–depression relationship? Health Econ. 2005; 14(12): 1197–1215.PubMedCrossRefGoogle Scholar
  40. 40.
    Schulz AJ, Israel BA, Zenk SN, et al. Psychosocial stress and social support as mediators of relationships between income, length of residence and depressive symptoms among African American women on Detroit’s eastside. Soc Sci Med. 2006; 62(2): 510–522.PubMedCrossRefGoogle Scholar
  41. 41.
    Lyons AC, Yilmazer T. Health and financial strain: evidence from the survey of consumer finances. South Econ J. 2005; 71(4): 873–890.CrossRefGoogle Scholar
  42. 42.
    O’Neill B, Sorhaindo B, Xiao JJ, Garman ET. Negative health effects of financial stress. Consumer Interest Annual. 2005; 51: 260–262.Google Scholar
  43. 43.
    O’Neill B, Prawitz AD, Sorhaindo B, Kim J, Garman ET. Changes in health/negative financial events, and financial distress/financial well-being for debt management program clients. Financ Counsel Plann. 2006; 17(2): 46–63.Google Scholar
  44. 44.
    Glasmeier AK. An Atlas of Poverty in America: One Nation, Pulling Apart, 1960–2003. New York: Routledge; 2006.Google Scholar
  45. 45.
    Drentea P, Lavrakas PJ. Over the limit: the association among health, race, and debt. Soc Sci Med. 2000; 50(4): 517–529.PubMedCrossRefGoogle Scholar
  46. 46.
    Price RH, Choi JN, Vinokur AD. Links in the chain of adversity following job loss: how financial strain and loss of personal control lead to depression, impaired functioning and poor health. J Occup Health Psychol. 2002; 7(4): 302–312.PubMedCrossRefGoogle Scholar
  47. 47.
    University of Pittsburgh Epidemiology Data Center. Inventory of Depressive Symptomatology (IDS) & Quick Inventory of Depressive Symptomatology (QIDS). 2012. Available at: Accessed August 1, 2008.
  48. 48.
    Field A. Exploring Assumptions. Discovering Statistics Using SPSS. 3rd ed. Thousand Oaks: Sage; 2009: 131–165.Google Scholar
  49. 49.
    Yazici B, Yolacan S. A comparison of various tests of normality. J Stat Comput Simulat. 2007; 77(2): 175–183.CrossRefGoogle Scholar
  50. 50.
    UCLA. SPSS Data Analysis Examples: Ordinal Logistic Regression. UCLA Academic Technology Services, Statistical Consulting Group. Available at: Accessed July 17, 2012.
  51. 51.
    Ferguson CJ. An effect size primer: a guide for clinicians and researchers. Prof Psychol Res Pract. 2009; 40(5): 532–538.CrossRefGoogle Scholar
  52. 52.
    Babbie ER. The Practice of Social Research. 12th ed. Belmont: Wadsworth; 2010.Google Scholar
  53. 53.
    Fowler FJ. Survey Research Methods. Thousand Oaks: Sage; 2002.Google Scholar
  54. 54.
    Taylor-Powell E, Hermann C. Collecting Evaluation Data: Surveys: University of Wisconsin—Extension; 2000.Google Scholar
  55. 55.
    Olney C. Increasing Survey Response Rates [Powerpoint Presentation]. Available at: Accessed July 10, 2012.
  56. 56.
    The University of Texas at Austin. Response Rates. September 21, 2011. Available at: Accessed July 17, 2012.
  57. 57.
    Falconnier L, Elkin I. Addressing economic stress in the treatment of depression. Am J Orthopsychiatry. 2008; 78(1): 37–46.PubMedCrossRefGoogle Scholar
  58. 58.
    Xiao J, O’Neill B, Prochaska J, et al. Application of the transtheoretical model of change to financial behavior. Consumer Interest Annual [serial online]. 2001;47(April 4).Google Scholar
  59. 59.
    Braveman PA, Cubbin C, Egerter S, et al. Socioeconomic status in health research: one size does not fit all. JAMA. 2005; 294(22): 2879–2888.PubMedCrossRefGoogle Scholar
  60. 60.
    Cohen H, Northridge M. Getting political: racism and urban health. Am J Public Health. 2000; 90(6): 841–642.PubMedCrossRefGoogle Scholar
  61. 61.
    Moss N. Socioeconomic disparities in health in the US: an agenda for action. Soc Sci Med. 2000; 51: 1627–1638.PubMedCrossRefGoogle Scholar
  62. 62.
    Levin KA. Study design III: cross-sectional studies. Evid Based Dent. 2006; 7: 24–25.PubMedCrossRefGoogle Scholar
  63. 63.
    Heckathorn DD. Respondent-driven sampling II: deriving valid population estimates from chain-referral samples of hidden populations. Soc Probl. 2002; 49(1): 11–34.CrossRefGoogle Scholar
  64. 64.
    Johnston LG, Sabin K. Sampling hard-to-reach populations with respondent driven sampling. Methodological Innovations Online. 2010; 5(2): 38–48.Google Scholar
  65. 65.
    Aday L, Cornelius L. Designing and Conducting Health Surveys. 3rd ed. San Francisco: Jossey-Bass; 2006: 124–153.Google Scholar
  66. 66.
    Neuman WL. Social Research Methods: Quantitative and Qualitative Approaches. 6 ed. Upper Saddle River: Pearson Education; 2006.Google Scholar
  67. 67. Convenience Sampling. Available at: Accessed July 10, 2012.
  68. 68.
    Faugier J, Sargeant M. Sampling hard to reach populations. J Adv Nurs. 1997; 26: 790–797.PubMedCrossRefGoogle Scholar
  69. 69.
    Goela S, Salganikb MJ. Assessing respondent-driven sampling. Proc Natl Acad Sci U S A. 2010; 107(15): 6743–6747.CrossRefGoogle Scholar

Copyright information

© The New York Academy of Medicine 2012

Authors and Affiliations

  • Angelica JoNel Starkey
    • 1
    Email author
  • Christopher R. Keane
    • 1
  • Martha Ann Terry
    • 1
  • John H. Marx
    • 2
  • Edmund M. Ricci
    • 3
  1. 1.Department of Behavioral and Community Health SciencesUniversity of Pittsburgh, Graduate School of Public HealthPittsburghUSA
  2. 2.Department of SociologyUniversity of Pittsburgh, School of Arts and SciencesPittsburghUSA
  3. 3.Institute for Evaluation Science in Community HealthUniversity of Pittsburgh, Graduate School of Public HealthPittsburghUSA

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