Abstract
Introduction
Research has demonstrated disparities in depressive symptoms among people who are marginalized. However, more work should examine depressive symptoms through an intersectional lens, recognizing that multiple systems of privilege and oppression interlock to create unique struggles where multiple marginalized identities meet. Recent methodological developments have advanced quantitative intersectionality research using multilevel modeling to partition variance in depressive symptoms to person-level sociodemographic variables and intersectional-level social strata. The purpose of this study is to leverage these methods to examine trajectories of depressive symptoms among young adults in Texas through an intersectional lens.
Methods
Multilevel modeling was used to examine the longitudinal trajectories of depressive symptoms among 3575 young adults from 24 colleges in Texas assessed seven times between Fall 2014 and Spring 2018. Intersectional identities included sex, race/ethnicity, and sexual and gender minority identities. The model examined time nested within individuals and individuals nested within intersectional social strata.
Results
Young adults in Texas experienced an increase in depressive symptoms from 2014–2018. Those with female, Hispanic, AAPI, other race/ethnicity, or LGBTQ + identities experienced more depressive symptoms. After controlling for the main effects of the sociodemographic variables, 0.08% of variance in depressive symptoms remained attributed to the effects of intersectional identities.
Conclusion
Evaluating disparities in depressive symptoms through an intersectional lens offers a more complete description of the epidemiology of depressive symptoms. Communities and institutions that serve marginalized people should consider the elevated burden of depressive symptoms that marginalized people may carry, and integrate culturally competent psychoeducation, assessments, and therapies where possible.
Similar content being viewed by others
References
Collins PY et al (2011) Grand challenges in global mental health. Nature. https://doi.org/10.1038/475027a
Ferrari AJ et al (2013) Burden of depressive disorders by country, sex, age, and year: findings from the global burden of disease study 2010. PLoS Med. https://doi.org/10.1371/journal.pmed.1001547
Substance Abuse and Mental Health Services Administration (2019) Results from the 2018 National Survey on Drug Use and Health: detailed tables. Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration, Rockville. https://www.samhsa.gov/data/report/2018-nsduh-detailed-tables. Accessed 15 Jan 2021
Arnett JJ, Žukauskienė R, Sugimura K (2014) The new life stage of emerging adulthood at ages 18–29 years: implications for mental health. Lancet Psychiatry. https://doi.org/10.1016/S2215-0366(14)00080-7
American Psychiatric Association (2013) Diagnostic and statistical manual of mental disorders (DSM-5®). Am Psychiatr Pub. https://doi.org/10.1176/appi.books.9780890425596
Ueno K, Krause A (2020) Occupational attainment and depressive symptoms in young adulthood. Stress Health. https://doi.org/10.1002/smi.2902
Brazendale K et al (2017) Depressive symptoms are positively associated with time spent sedentary in healthy young US adults. Prog Prev Med. https://doi.org/10.1097/pp9.0000000000000004
Smith JP, Smith GC (2010) Long-term economic costs of psychological problems during childhood. Soc Sci Med. https://doi.org/10.1016/j.socscimed.2010.02.046
Radloff LS (1977) The CES-D scale: a self-report depression scale for research in the general population. Appl Psychol Meas. https://doi.org/10.1177/014662167700100306
Vilagut G, Forero CG, Barbaglia G, Alonso J (2016) Screening for depression in the general population with the Center for Epidemiologic Studies Depression (CES-D): a systematic review with meta-analysis. PLoS ONE. https://doi.org/10.1371/journal.pone.0155431
DeVellis RF (2016) Scale development: theory and applications, vol 26. Sage publications. http://lccn.loc.gov/2015043839
Salk RH, Hyde JS, Abramson LY (2017) Gender differences in depression in representative national samples: meta-analyses of diagnoses and symptoms. Psychol Bull. https://doi.org/10.1037/bul0000102
Bailey RK, Mokonogho J, Kumar A (2019) Racial and ethnic differences in depression: current perspectives. Neuropsychiatr Dis Treat. https://doi.org/10.2147/NDT.S128584
Kates J, Ranji U, Beamesderfer A, Salganicoff A, Dawson L (2018) Health and access to care and coverage for lesbian, gay, bisexual, and transgender individuals in the US Henry J Kaiser Family Foundation Issue Brief. http://files.kff.org/attachment/Issue-Brief-Health-and-Access-to-Care-and-Coverage-for-LGBT-Individuals-in-the-US. Accessed 15 Jan 2021
Hyde JS, Mezulis AH, Abramson LY (2008) The ABCs of depression: integrating affective, biological, and cognitive models to explain the emergence of the gender difference in depression. Psychol Rev. https://doi.org/10.1037/0033-295X.115.2.291
Overstreet C, Berenz EC, Kendler KS, Dick DM, Amstadter AB (2017) Predictors and mental health outcomes of potentially traumatic event exposure. Psychiatry Res. https://doi.org/10.1016/j.psychres.2016.10.047
Basile KC et al (2011) National intimate partner and sexual violence survey; 2010 summary report. https://www.cdc.gov/violenceprevention/pdf/nisvs_report2010-a.pdf. Accessed 15 Jan 2021
Hill C, Kearl H (2011) Crossing the line: sexual harassment at school. American Association of University Women, Washington, DC. https://eric.ed.gov/?id=ED525785
Homan P (2019) Structural sexism and health in the United States: a new perspective on health inequality and the gender system. Am Sociol Rev. https://doi.org/10.1177/0003122419848723
Hammen C (2005) Stress and depression. Annu Rev Clin Psychol. https://doi.org/10.1146/annurev.clinpsy.1.102803.143938
Shavers VL, Fagan P, Jones D, Klein WM, Boyington J, Moten C, Rorie E (2012) The state of research on racial/ethnic discrimination in the receipt of health care. Am J Public Health. https://doi.org/10.2105/AJPH.2012.300773
Earnshaw VA, Rosenthal L, Carroll-Scott A, Santilli A, Gilstad-Hayden K, Ickovics JR (2016) Everyday discrimination and physical health: exploring mental health processes. J Health Psychol. https://doi.org/10.1177/1359105315572456
Bowleg L, Maria del Río-González A, Mbaba M, Boone CA, Holt SL (2020) Negative police encounters and police avoidance as pathways to depressive symptoms among US black men, 2015–2016. Am J Public Health. https://doi.org/10.2105/AJPH.2019.305460
Hajnal Z, Lajevardi N, Nielson L (2017) Voter identification laws and the suppression of minority votes. J Polit. https://doi.org/10.1086/688343
Ayón C, García SJ (2019) Latino immigrant parents’ experiences with discrimination: implications for parenting in a hostile immigration policy context. J Fam Issues. https://doi.org/10.1177/0192513X19827988
Ellermann A (2020) Discrimination in migration and citizenship. J Ethn Migr Stud. https://doi.org/10.1080/1369183X.2018.1561053
Carter RT, Lau MY, Johnson V, Kirkinis K (2017) Racial discrimination and health outcomes among racial/ethnic minorities: a meta-analytic review. J Multicult Couns Dev. https://doi.org/10.1002/jmcd.12076
Stephens B (2020) Where were the states? Same-sex marriage before Obergefell. International handbook on the demography of marriage and the family. Springer, Berlin, pp 273–284. https://doi.org/10.1007/978-3-030-35079-6_18
Payne E, Smith M (2013) LGBTQ kids, school safety, and missing the big picture: How the dominant bullying discourse prevents school professionals from thinking about systemic marginalization or… why we need to rethink LGBTQ bullying. QED J GLBTQ Worldmak. https://doi.org/10.14321/qed.0001
Nadal KL (2019) A decade of microaggression research and LGBTQ communities: an introduction to the special issue. J Homosex. https://doi.org/10.1080/00918369.2018.1539582
Mink MD, Lindley LL, Weinstein AA (2014) Stress, stigma, and sexual minority status: the intersectional ecology model of LGBTQ health. J Gay Lesbian Soc Serv. https://doi.org/10.1080/10538720.2014.953660
Russell ST, Fish JN (2016) Mental health in lesbian, gay, bisexual, and transgender (LGBT) youth. Annu Rev Clin Psychol. https://doi.org/10.1146/annurev-clinpsy-021815-093153
Meyer IH (2003) Prejudice, social stress, and mental health in lesbian, gay, and bisexual populations: conceptual issues and research evidence. Psychol Bull. https://doi.org/10.1037/2329-0382.1.S.3
Clark R et al (1999) Racism as a stressor for African Americans: a biopsychosocial model. Am Psychol. https://doi.org/10.1037//0003-066x.54.10.805
Crenshaw K (1989) Demarginalizing the intersection of race and sex: a black feminist critique of antidiscrimination doctrine, feminist theory and antiracist politics. University of Chicago Legal Forum, vol 1989, issue 1, Article 8. Available at: http://chicagounbound.uchicago.edu/uclf/vol1989/iss1/8
McCall L (2005) The complexity of intersectionality. Signs J Women Cult Soc. https://doi.org/10.1086/426800
Bauer GR (2014) Incorporating intersectionality theory into population health research methodology: challenges and the potential to advance health equity. Soc Sci Med. https://doi.org/10.1016/j.socscimed.2014.03.022
Bowleg L (2008) When Black + lesbian + woman ≠ black lesbian woman: the methodological challenges of qualitative and quantitative intersectionality research. Sex Roles. https://doi.org/10.1007/s11199-008-9400-z
Patil PA, Porche MV, Shippen NA, Dallenbach NT, Fortuna LR (2018) Which girls, which boys? The intersectional risk for depression by race and ethnicity, and gender in the US. Clin Psychol Rev. https://doi.org/10.1016/j.cpr.2017.12.003
Evans CR, Erickson N (2019) Intersectionality and depression in adolescence and early adulthood: a MAIHDA analysis of the national longitudinal study of adolescent to adult health, 1995–2008. Soc Sci Med. https://doi.org/10.1016/j.socscimed.2018.10.019
Merlo J (2018) Multilevel analysis of individual heterogeneity and discriminatory accuracy (MAIHDA) within an intersectional framework. Soc Sci Med. https://doi.org/10.1016/j.socscimed.2017.12.026
Merlo J, Wagner P, Leckie G (2019) A simple multilevel approach for analysing geographical inequalities in public health reports: the case of municipality differences in obesity. Health Place. https://doi.org/10.1016/j.healthplace.2019.102145
Evans CR (2019) Adding interactions to models of intersectional health inequalities: comparing multilevel and conventional methods. Soc Sci Med. https://doi.org/10.1016/j.socscimed.2018.11.036
Blair KL (2017) Did Secretary Clinton lose to a ‘basket of deplorables’? An examination of islamophobia, homophobia, sexism and conservative ideology in the 2016 US presidential election. Psychol Sex. https://doi.org/10.1080/19419899.2017.1397051
Bobo LD (2017) Racism in Trump’s America: reflections on culture, sociology, and the 2016 US presidential election. Br J Sociol. https://doi.org/10.1111/1468-4446.12324
Gonzalez KA, Pulice-Farrow L, Galupo MP (2018) “My aunt unfriended me:” narratives of GLBTQ family relationships post 2016 presidential election. J GLBT Fam Stud. https://doi.org/10.1080/1550428X.2017.1420845
Gambrell K (Ed.) (2018) Interrogating the place of hate in the 2016 presidential campaign. J Hate Stud. https://jhs.press.gonzaga.edu/1/volume/14/issue/1/. Accessed 15 Jan 2021
Sanchez JC (2018) Trump, the KKK, and the versatility of white supremacy rhetoric. J Contemp Rhetor. http://contemporaryrhetoric.com/wp-content/uploads/2018/02/Sanchez8_1_2_4.pdf. Accessed 15 Jan 2021
Bonilla-Silva E (2019) “Racists”, “Class Anxieties”, hegemonic racism, and democracy in Trump’s America. Soc Curr. https://doi.org/10.1177/2329496518804558
Matthew DB (2020) Healing hate: a public health perspective on civil rights in America. VA J Soc Policy Law. http://vjspl.org/issue-27-1/. Accessed 15 Jan 2021
Southern Poverty Law Center (2021) Hate map. https://www.splcenter.org/hate-map. Accessed 28 June 2021
National Center for Education Statistics (2020) On-campus hate crimes at degree-granting postsecondary institutions, by level and control of institution, type of crime, and category of bias motivating the crime: selected years, 2010 through 2018. https://nces.ed.gov/programs/digest/d20/tables/dt20_329.30.asp. Accessed 5 July 2021
Loukas A et al (2016) College students’ polytobacco use, cigarette cessation, and dependence. Am J Health Behav. https://doi.org/10.5993/AJHB.40.4.13
Creamer MR et al (2018) Longitudinal predictors of cigarette use among students from 24 Texas colleges. J Am Coll Health. https://doi.org/10.1080/07448481.2018.1431907
Loukas A, Marti CN, Perry CL (2019) Trajectories of tobacco and nicotine use across young adulthood, Texas, 2014–2017. Am J Public Health. https://doi.org/10.2105/AJPH.2018.304850
Van Dam NT, Earleywine M (2011) Validation of the Center for Epidemiologic Studies Depression Scale-Revised (CESD-R): pragmatic depression assessment in the general population. Psychiatry Res. https://doi.org/10.1016/j.psychres.2010.08.018
Evans CR, Williams DR, Onnela JP, Subramanian SV (2018) A multilevel approach to modeling health inequalities at the intersection of multiple social identities. Soc Sci Med. https://doi.org/10.1016/j.socscimed.2017.11.011
StataCorp LLC (2017) Stata statistical software: release 15. College Station, TX. https://www.stata.com
Weinberger AH et al (2018) Trends in depression prevalence in the USA from 2005 to 2015: widening disparities in vulnerable groups. Psychol Med. https://doi.org/10.1017/S0033291717002781
Bishop MD, Ioverno S, Russell ST (2021) Sexual minority youth’s mental health and substance use: the roles of victimization, cybervictimization, and non-parental adult support. Curr Psychol. https://doi.org/10.1007/s12144-021-01812-6
Rouse SM, Ross AD (2018) The politics of millennials: political beliefs and policy preferences of America's most diverse generation. University of Michigan Press. https://muse.jhu.edu/book/60352
Pew Research Center (2020) On the cusp of adulthood and facing an uncertain future: what we know about Gen Z So Far. https://www.pewsocialtrends.org/essay/on-the-cusp-of-adulthood-and-facing-an-uncertain-future-what-we-know-about-gen-z-so-far/. Accessed 15 Jan 2021
Pew Research Center (2019) Generation Z looks a lot like millennials on key social and political issues. https://www.pewsocialtrends.org/2019/01/17/generation-z-looks-a-lot-like-millennials-on-key-social-and-political-issues/. Accessed 15 Jan 2021
Wu C, Chao RK (2011) Intergenerational cultural dissonance in parent–adolescent relationships among Chinese and European Americans. Dev Psychol. https://doi.org/10.1037/a0021063
Bámaca-Colbert MY, Umaña-Taylor AJ, Gayles JG (2012) A developmental-contextual model of depressive symptoms in Mexican-origin female adolescents. Dev Psychol. https://doi.org/10.1037/a0025666
Texas Legislature Online (2021) HB 3979: relating to the social studies curriculum in public schools. https://capitol.texas.gov/BillLookup/History.aspx?LegSess=87R&Bill=HB3979. Accessed 28 June 2021
Texas Legislature Online (2021) SB 8: relating to abortion, including abortions after detection of an unborn child's heartbeat; authorizing a private civil right of action. https://capitol.texas.gov/BillLookup/History.aspx?LegSess=87R&Bill=SB8. Accessed 28 June 2021
Texas Legislature Online (2021) SB 1311: relating to the provision of and professional liability insurance coverage for gender transitioning or gender reassignment medical procedures and treatments for certain children. https://capitol.texas.gov/BillLookup/History.aspx?LegSess=87R&Bill=SB1311. Accessed 28 June 2021
Texas Legislature Online (2021) SB 7: relating to election integrity and security, including by preventing fraud in the conduct of elections in this state; increasing criminal penalties; creating criminal offenses. https://capitol.texas.gov/BillLookup/History.aspx?LegSess=87R&Bill=SB7. Accessed 28 June 2021
Ballotpedia (2021) Party control of Texas state government. https://ballotpedia.org/Party_control_of_Texas_state_government. Accessed 28 june 2021
Battiste m (2017) decolonizing education: nourishing the learning spirit. Ubc Press. https://www.ubcpress.ca/decolonizing-education
Biggs MA, Upadhyay UD, McCulloch CE, Foster DG (2017) Women’s mental health and well-being 5 years after receiving or being denied an abortion: a prospective, longitudinal cohort study. JAMA Psychiat. https://doi.org/10.1001/jamapsychiatry.2016.3478
Ting HH, Brito JP, Montori VM (2014) Shared decision making: science and action. Circ Cardiovasc Qual Outcomes. https://doi.org/10.1161/CIRCOUTCOMES.113.000288
van de Grift TC, Mullender MG, Bouman MB (2018) Shared decision making in gender-affirming surgery: implications for research and standards of care. J Sex Med. https://doi.org/10.1016/j.jsxm.2018.03.088
Hing AK (2018) The right to vote, the right to health: voter suppression as a determinant of racial health disparities. J Health Dispar Res Pract. https://digitalscholarship.unlv.edu/jhdrp/vol12/iss6/5/
Stotland NL (2017) Reproductive rights and women’s mental health. Psychiatr Clin North Am. https://doi.org/10.1016/j.psc.2017.01.010
Almeida P, Chase-Dunn C (2018) Globalization and social movements. Annu Rev Sociol. https://doi.org/10.1146/annurev-soc-073117-041307
Levin B, Reitzel JD (2018) Report to the nation: hate crimes rise in US cities and counties in time of division and foreign interference. Center for the Study of Hate and Extremism; California State University, San Bernardino. http://hdl.handle.net/20.500.11990/975. Accessed 15 Jan 2021
Noh S, Kaspar V (2003) Perceived discrimination and depression: moderating effects of coping, acculturation, and ethnic support. Am J Public Health. https://doi.org/10.2105/AJPH.93.2.232
Jefferson K, Neilands T, Sevelius J (2013) Transgender women of color: discrimination and depressive symptoms. Ethn Inequal Health Soc Care. https://doi.org/10.1108/eihsc-08-2013-0013
The GenIUS Group (2014) Best practices for asking questions to identify transgender and other gender minority respondents on population-based surveys. The Williams Institute, Los Angeles. https://williamsinstitute.law.ucla.edu/publications/geniuss-trans-pop-based-survey/
Suen LW et al (2020) What sexual and gender minority people want researchers to know about sexual orientation and gender identity questions: a qualitative study. Arch Sex Behav. https://doi.org/10.1007/s10508-020-01810-y
Funding
This work was supported by the National Institutes of Health [1 P50 CA180906, and 1 R01 CA249883-01A1], from the National Cancer Institute (NCI) and the FDA Center for Tobacco Products (CTP). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health (NIH) or the Food and Drug Administration (FDA). Neither NIH nor FDA had any role in the study design, data collection, analysis, or writing of this paper. JH is supported by Grant number [T32HL140290] from the National Heart, Lung, and Blood Institute at the Steve Hicks School of Social Work at the University of Texas at Austin, as well as Grant [P2CHD042849] awarded to the Population Research Center at The University of Texas at Austin by the Eunice Kennedy Shriver National Institute of Child Health and Human Development.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
On behalf of all authors, the corresponding author states that there is no conflict of interest.
Rights and permissions
About this article
Cite this article
Thomas, J.E., Pasch, K.E., Marti, C.N. et al. Trajectories of depressive symptoms among young adults in Texas 2014–2018: a multilevel growth curve analysis using an intersectional lens. Soc Psychiatry Psychiatr Epidemiol 57, 749–760 (2022). https://doi.org/10.1007/s00127-022-02217-x
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00127-022-02217-x