Maternal depression in low-income women is a significant problem because of its negative consequences for both mothers and their children. Economic stress increases risk for depression; however, mechanisms linking economic stress and depression are not well understood. The social support deterioration model suggests that chronic stressors can exert effects on psychological well-being directly) and, also, indirectly when stressors undermine social support. The analysis presented in this article tested the relationships suggested by the social support deterioration model by examining the direct and indirect links among economic stress, social support, and depressive symptoms in a sample of 336 mothers with children in mental health care. Structural equation modeling was used to examine the hypothesized paths depicted by this model and the relevant demographic variables. Economic stress was associated with depressive symptoms and appeared to exert part of its influence by reducing social support. Future research should consider social support and economic stress as potential targets for prevention of and intervention regarding maternal depression.
KEY WORDS: economic stress; maternal depression; mental health; social support; socioeconomic status
Maternal depression is a significant public mental health problem that can negatively affect mothers and children. Besides the direct negative effects that mothers can experience, such as lowered quality of life and potential deficits in workplace and home settings (Druss, Rosenheck, & Sledge, 2000; Judd et al., 2000; Stewart, Ricci, Chee, Hahn, & Morganstein, 2003), children of depressed mothers are at greater risk for behavioral and emotional problems (Ashman, Dawson, & Panagiotides, 2008; Weissman et al., 2006). Although the mechanisms linking mothers' and children's behavioral health outcomes are not yet clearly understood, it appears that parenting is negatively affected by the symptoms of depression and that children may also model cognitions, behaviors, and affect consistent with the illness (S. H. Goodman, 2007; S. H. Goodman & Gotlib, 1999). Understanding the role of factors that may contribute to maternal depression is an important task to ultimately developing treatment and preventive strategies to alleviate this problem. This article examines the effects of economic stress and social support on maternal depressive symptoms in a group of predominantly low-income mothers whose children are receiving mental health care.
A number of important studies have documented the link between economic stress and depressive illness. Since Brown, Bhrolchain, and Harris's (1975) study of psychiatric symptoms in working-class and middle-class women, research has continued to accumulate linking economic stress and the risk of experiencing depressive illness. In a meta-analysis of 60 studies examining socioeconomic inequalities and depression, individuals in the lowest socioeconomic status (SES) group were nearly twice as likely to experience a current depressive episode as those in the highest SES group (Lorant et al., 2003). Longitudinal studies have also confirmed that sustained economic stress increases the risk of experiencing depressive symptoms (Dearing, Taylor, & McCartney, 2004; Lynch, Kaplan, & Shema, 1997). The alarming rate of depressive symptoms in low-income community samples of mothers also suggests a link between economic stress and depression. In a variety of studies specific to low-income mothers, 35% to 52% of women were found to be at risk for clinical depression (Coiro, 2001; Kalil, Born, Kunz, & Caudill, 2001; Pascoe, Stolfi, & Ormond, 2006).
Despite the detrimental impact of economic stress, it appears that social support may provide some protection from maternal depression. Studies specifically addressing social support and maternal depression have confirmed that high levels of social support are associated with significantly lower levels of depressive symptoms and a lower risk of depressive illness (Cairney, Boyle, Offord, & Racine, 2003; Siefert, Bowman, Heflin, Danziger, &Williams, 2000; Surkan, Peterson, Hughes, & Gottlieb, 2006). Although there are a small number of longitudinal studies examining maternal depression and social support, research on postpartum mothers has found low social support to be predictive of high levels of depressive symptoms (Ritter, Hobfoll, Lavin, Cameron, & Hulsizer, 2000; Xie, He, Koszycki, Walker, & Wen, 2009).
Although both economic stress and social support have been shown to predict depressive symptoms and illness, little research has examined the interlocking relationships between economic stress and social support. The social support deterioration model (Barrera, 1986; Ensel & Lin, 1991) proposes that the relationship between stress (for example, economic stress) and psychological distress (for example, depressive symptoms) can be partially explained by the impact of stress on social support. In other words, economic stress may have a direct effect on depressive symptoms but may also negatively affect an important protective factor, social support. To our knowledge, only Schulz et al. (2006) have examined this model with a specific interest in economic stress. In their research on 679 African American mothers living in Detroit, low social support was found to be partially responsible for the relationship between the economic stress of these mothers and their depressive symptoms, supporting the social support deterioration model.
Although little research has considered social support as a mediating variable in the economic stress-depression relationship, other researchers have demonstrated that stressful events can negatively influence social support (Lepore, Evans, & Schneider, 1991 ; Norris & Kaniasty, 1996; Quittner, Glueckauf, &Jackson, 1990). Ensel and Lin (1991), in their longitudinal study of 677 New York residents, examined a number of social support models. They found that weakened social support perceptions partially mediated the relationship between negative life events and depression.
Besides relationships suggested by social support deterioration, the present analysis included demographic variables previously found to be associated with depressive symptoms: marital status and employment status. Working mothers and married mothers have lower levels of depression and higher levels of social support than do unemployed and unmarried mothers (Hope, Power, & Rodgers, 1999; Pascoe et al., 2006; Sachs-Ericsson & Ciarlo, 2000; Turner & Marino, 1994).
Our analysis examined the relationships predicted by the social support deterioration model in our sample of mothers. For this model to be confirmed, four conditions had to be met, per Baron and Kenny's (1986) criteria for mediation: (1) economic stress had to negatively predict depressive symptoms, (2) economic stress had to negatively predict social support, (3) social support had to negatively predict depressive symptoms, and (4) social support had to mediate the relationship between economic stress and depressive symptoms--that is, a significant indirect effect had to be found to demonstrate that the initial relationship between the independent and dependent variable had been reduced by the mediator's presence.
Study Design and Sample
This research used data collected for a study funded by the National Institute of Mental Health, with methods approved by the University of Pittsburgh Institutional Review Board. The initial aims of this project were the following: identification of major barriers to mental health treatment engagement of mothers and their children and assessment of the impact of social and environmental factors on mothers' psychiatric status, children's psychiatric status, and treatment attendance. Mothers were recruited...