Multimorbidity and depression severity among Black populations in the United States: an intersectionality approach

Multimorbidity, otherwise referred to as multiple chronic conditions (MCCs), is defined as the presence of two or more chronic conditions and has been linked to an increased risk of depression in many parts of the world. Disadvantaged social identities potentially play an important role in shaping this association. However, these associations are poorly understood in situations of multiple disadvantaged social identities, especially among Black populations in the United States of America. This study examined the association between multimorbidity and depression severity among Black populations in the United States using the intersectionality approach.

This study utilized IPUMS-NHIS datasets from 2009 to 2019. A weighted sample of 5,745 respondents aged 18 years and above was extracted from the data and analyzed using multinomial logistic regression models.

The study found that although multimorbid individuals had a higher risk of severe depression (RRR = 1.93; p < 0.001; 95% CI:1.58-2.35), there are variations by individual's social identities. The risk was higher among Black Americans (RRR = 2.40; p < 0.001; 95% C.I = 1.89-3.07) with MCCs compared to Black immigrants; and among females (RRR = 2.73; p < 0.001; 95% C.I = 2.11-3.54) and unemployed (RRR = 2.69; p < 0.001; 95% C.I = 2.07-3.51) compared to their male and employed counterparts, respectively. Those with multiple disadvantaged social identities yet had MCCs, especially, unemployed Black American females (RRR = 3.43; p < 0.001; 95% C.I = 2.54-4.63) and males who were unemployed (RRR = 2.02; p < 0.05; 95% C.I = 1.42-2.87) had elevated risk of experiencing severe depression compared to those who had no MCCs and Black immigrants.

The findings suggest the need to focus attention on the complex effects of multiple disadvantaged social identities in shaping mental health outcomes, particularly among individuals experiencing chronic health conditions.