The main goal of the study was to examine the extent to which chronic stress is predictive of depression, relative to acute stress, in low-income African American and White women. Most previous studies on stress and depression have examined primarily the role of acute stress, while neglecting the impact of chronic stress. There are multiple chronic stressors and daily hassles associated with being poor and/or with disenfranchised racial status in our society. Chronic stressors can heighten the unfavorable implications of acute stressors, exacerbating their effects (Brown & Harris, 1978). We predicted that 1) chronic stress will make a larger contribution to depression than acute stress and 2) chronic stress will amplify the effects of acute stress on depression.
Our sample consisted of 97 African American and 97 White patients, 25 years old on average, who were recruited from those seeking services in the public care obstetrics clinic of a large urban hospital in Pittsburgh, PA. After signing an informed consent form, the women completed a survey for which they received $5. We collected the following information: demographic data; well-established measures of depression severity, perceived stress, and acute stress. For the purposes of this study, we modified the African American Women’s Stress Scale (AWSS; Watt-Jones, 1990) that measures chronic and acute stress, to include more chronic stressors and to be relevant to White women, as well as African American women.
Fifty-two percent of the sample was never married, 55% was pregnant, and 71% had completed high school or some years in college. More African American women than White women, had annual incomes under $10,000, were unemployed, and had more children with fewer adults in the home. African American women reported a greater number of chronic and acute stressors and a greater degree of chronic and acute stress than White women and tended to have more depressive symptoms (controlling for income). Mediational analyses showed that number of stressors (acute and chronic) and degree of stress (acute and chronic) explained the association between race and depression in this sample. We also found that both chronic and acute stress predicted higher levels of depressive symptoms, with chronic stress accounting for more of the variance than acute stress. Finally, the data were consistent with the prediction that chronic stress exacerbates the effects of acute stress on depression.
Clinicians need to appreciate the chronic stressors in the lives of their low-income, depressed patients, particularly those who are victims of racism and discrimination, in order to better engage and retain them in treatment (cf., Department of Health and Human Services, 1999). It is recommended that treatment for depression include advocacy and facilitation of access to social services to enable the patients to better manage these stressors.