Discrimination, social support, and mental health in reproductive-aged women: the All of Us research program

Discrimination and social isolation during the coronavirus disease (COVID-19) pandemic exacerbated mental health challenges in the United States (U.S.). Such exposures may have compounded effects for reproductive-aged women who are at increased risk of adverse mental health outcomes due to their unique psychosocial vulnerabilities. The purpose was to describe the prevalence of depression and anxiety symptoms in reproductive-aged women during the pandemic, and examine associations between discrimination, social support, and depression/anxiety symptoms.

Data were retrieved from the National Institutes of Health (NIH) All of Us Research program. Of the 14,250 participants who met the inclusion criteria-completion of the first COPE survey in May, June, or July 2020, assigned female sex at birth, and age 18-50 years-12,904 remained for final analysis after excluding those with missing data. The Everyday Discrimination Scale measured experiences of discrimination. Social support was evaluated using the Medical Outcomes Study Social Support Scale. The Patient Health Questionnaire-9 (PHQ-9) and Generalized Anxiety Disorder-7 (GAD-7) assessed depression (mean ± SD = 7.04 ± 5.67) and anxiety symptoms (mean ± SD = 7.14 ± 5.30). Descriptive statistics, linear regression, and mediation analyses were conducted.

Approximately one-third of reproductive-aged women reported moderate-to-severe depression or anxiety symptoms. Women identifying as Other or Mixed race/ethnicity exhibited the highest rates. Higher discrimination was significantly associated with greater depression (b = 0.45, p < 0.001) and anxiety symptoms (b = 0.40, p < 0.001). Social support mediated the association between discrimination and depression symptoms (mediation effect: b = 0.10, p < 0.001) and between discrimination and anxiety symptoms (mediation effect: b = 0.06, p < 0.001).

This study revealed the interplay between discrimination, social support, and mental health. Women experiencing discrimination tended to perceive less available social support, which was associated with higher depression/anxiety symptoms. These results provide preliminary evidence that social support may serve as a key strategy to counteract the detrimental effects of discrimination on mental health for reproductive-aged women in the U.S. These findings emphasize the need for holistic mental health care incorporating comprehensive assessments and personalized interventions to effectively manage mental health symptoms and address the social determinants of health.