Risks and Protective Factors Associated With Symptoms of Depression in Low-Income African American and Caucasian Women During Pregnancy


  • D. Elizabeth Jesse CNM, PhD,

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    • D. Elizabeth Jesse, CNM, PhD, is an assistant professor at East Carolina University School of Nursing teaching nurse-midwifery and other advanced practice nurses. Her research focus is on psychosocial risks for preterm birth among vulnerable women and depression in pregnancy.

  • Jacqueline Walcott-McQuigg RN, PhD,

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    • Jacqueline Walcott-McQuigg, RN, PhD, is President and CEO of Reconciliation Incorporated. Her research interests include socioeconomic and cultural diversity health issues related to cardiovascular disease, diabetes, and obesity.

  • Anne Mariella CNM, PhD,

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    • Anne Mariella, CNM, PhD, is a clinical assistant professor at University of Colorado Hospitals.

  • Melvin S. Swanson PhD

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    • Melvin S. Swanson, PhD, is a professor of statistics in the Research Department of East Carolina University School of Nursing.

D. Elizabeth Jesse, CNM, PhD, East Carolina University School of Nursing, Rivers Building, Greenville, NC 27858. E-mail: jessed@mail.ecu.edu


This article describes the risks and protective factors for symptoms of depression in pregnancy among low-income African American and Caucasian women. Data were collected from 130 women who were between 16 and 28 weeks' gestation and enrolled in an urban prenatal clinic. The questionnaires used in the face-to-face interviews consisted of sociodemographic items, the Beck Depression Inventory (BDI-II), the Prenatal Psychosocial Profile (PPP), 3 items from the Jarel Spiritual Well-Being Scale, the Spiritual Perspective Scale, and 4 items on health risk behaviors. Twenty-seven percent of the women reported depressive symptoms at levels indicating risk for clinical depression. However, there were no significant differences between African American and Caucasian women. Sociodemographic factors accounted for 13% of the variance (P < .01) in BDI-II scores. Psychosocial and behavioral risk factors accounted for an additional 19% of the BDI-II variance (P < .001), and psychosocial and spiritual resources accounted for 7% of the variance (P < .001), resulting in these variables accounting for 54% of the total variance in BDI-II scores. Higher levels of stress, lower levels of self-esteem and social support, and higher religiosity had a significant relationship with more symptoms of depression. This supports the need to routinely screen for and to assess factors associated with depressive symptoms in pregnant low-income women.