Substance Use Mediates the Association of Experiences of Racial Discrimination With Depression Symptoms Among Pregnant, African American Women

Abstract

To examine whether substance use mediated the association of racial discrimination with depression symptoms among pregnant, African American women. Cross-sectional. Prenatal clinics in metro Detroit, Michigan, and Columbus, Ohio. A sample of 203 pregnant, African American women completed questionnaires. Participants were asked about a range of health behaviors, including use of cigarettes/e-cigarettes, marijuana, and any other drugs, during the pregnancy. A composite score for substance use was created by summing cigarette, electric cigarette, Black & Mild cigars, alcohol, marijuana, and other drugs. Lifetime experiences of racial discrimination were assessed by the Experiences of Discrimination Scale (Cronbach’s α = .83). Depression symptoms were measured by the Center for Epidemiologic Studies Depression Scale (CES-D, Cronbach’s α = .89). Mediation analysis were performed using the PROCESS macro in the statistical software package, SPSS. The mean maternal age was 26.9 ± 5.65 years (range = 18–42 years), and the mean gestational age at data collection was 15.9 ± 5.82 weeks (range = 8–29 weeks). Approximately 17% of pregnant women reported cigarette smoking, 17% reported marijuana use, 58% reported experiencing discrimination in at least one domain (e.g., at work), and 27% reported CES-D scores of 23 or greater, which have been correlated with depression diagnosis. Mediation analysis results indicated that the indirect effect (b = .1256, 95% CI [.0037, .3101]) of racial discrimination on depression symptoms through substance use was statistically significant (p < .001). Substance use may mediate the association of racial discrimination with depression symptoms among pregnant, African American women. Women’s experiences of racial discrimination need to be addressed when delivering substance use prevention programs to pregnant, African American women.