Predictors of Depressive Predictors of Depressive Symptoms and Obesity in Symptoms and Obesity in African-American Women African-American Women

Transitioning from Welfare to Transitioning from Welfare to WorkWork

Mayola Rowser PhDc, DNP, FNP-BC, Mayola Rowser PhDc, DNP, FNP-BC, PMHNPPMHNP

BackgroundBackground

Rates of depression and obesity increasing in the Rates of depression and obesity increasing in the U.S.U.S.

Rates are higher among welfare recipientsRates are higher among welfare recipients

39% of recipients are African-American women39% of recipients are African-American women

African American women have more health African American women have more health problemsproblems

than women of other racesthan women of other races

BackgroundBackground

Depression and obesity associated with many Depression and obesity associated with many chronic diseaseschronic diseases

Employment outcomes negatively impactedEmployment outcomes negatively impacted

Depression and obesity associated with Depression and obesity associated with increased health care costsincreased health care costs

Few studies on depression and obesity among Few studies on depression and obesity among African-American women leaving welfareAfrican-American women leaving welfare

Conceptual FrameworkConceptual Framework

Adaptation of Dr. Rice’s Health Assessment Status Adaptation of Dr. Rice’s Health Assessment Status modelmodel

Rice’s model influenced by the Health Promotion Rice’s model influenced by the Health Promotion modelmodel

Components of the model for the current study include Components of the model for the current study include – health risk behaviorshealth risk behaviors– personal risk factorspersonal risk factors– perceived health statusperceived health status– situational influencessituational influences

Conceptual ModelConceptual Model

Personal Risk FactorsDemographic •AgeEducation

Biological Body mass index

Perceived Health Status

Health Risk Behaviors•Physical inactivityPoor nutritionSmokingAlcohol consumption

Situational InfluencesTransition from welfare to work

Depressive Symptoms

Obesity

SignificanceSignificance

Welfare benefits are time limitedWelfare benefits are time limited

Recipients forced to find jobsRecipients forced to find jobs

90% of recipients have one or more barriers 90% of recipients have one or more barriers to workto work

Depression and obesity are barriers to Depression and obesity are barriers to sustained employmentsustained employment

Research QuestionsResearch Questions

1. 1. What is the prevalence of What is the prevalence of depressive symptomsdepressive symptoms in in

African-American women transitioning from welfare to work?African-American women transitioning from welfare to work?

2. What is the prevalence of 2. What is the prevalence of obesityobesity in African-American women in African-American women

transitioning from welfare to work?transitioning from welfare to work?

3. What is the association between 3. What is the association between depressive symptoms depressive symptoms andand

obesityobesity in African-American women transitioning from welfare in African-American women transitioning from welfare toto

work?work?

Research QuestionsResearch Questions

44. . What is the prevalence of What is the prevalence of health risk behaviors health risk behaviors

in African-American women transitioning from in African-American women transitioning from

welfare to work?welfare to work?

5. To what extent do health risk behaviors, personal risk 5. To what extent do health risk behaviors, personal risk factors, and perceived health status predict factors, and perceived health status predict depressive depressive symptoms symptoms ??

6. To what extent do health risk behaviors, personal risk 6. To what extent do health risk behaviors, personal risk factors, and perceived health status predict factors, and perceived health status predict obesityobesity??

MethodologyMethodology

DesignDesign

Retrospective cross-sectional, descriptive, Retrospective cross-sectional, descriptive, correlation studycorrelation study

Sample and SettingSample and Setting

Convenience sample of 162 welfare recipients Convenience sample of 162 welfare recipients

UTHSC Health Works Program participantsUTHSC Health Works Program participants

Data obtained from health assessmentsData obtained from health assessments

CriteriaCriteria

African-American womenAfrican-American women

18 years of age or older18 years of age or older

Able to speak and read EnglishAble to speak and read English

Enrolled in the UTHSC Health Works ProgramEnrolled in the UTHSC Health Works Program

InstrumentsInstruments

The Healthier People Network Health Risk The Healthier People Network Health Risk AppraisalAppraisal

The Health Self ReportThe Health Self Report

The Center for Epidemiologic Studies The Center for Epidemiologic Studies Depression Scale (CES-D)Depression Scale (CES-D)

Data AnalysisData Analysis

Statistical Package for Social Sciences Statistical Package for Social Sciences (SPSS)(SPSS)

Descriptive StatisticsDescriptive Statistics

Pearson CorrelationPearson Correlation

Stepwise Multiple RegressionStepwise Multiple Regression

Logistic RegressionLogistic Regression

Sample CharacteristicsSample Characteristics

N = 162N = 162

Ages ranged from 18 – 55Ages ranged from 18 – 55

Mean age 28.87 Mean age 28.87

32% completed high school32% completed high school

24% reported “some college”24% reported “some college”

37% rated their health poor-fair37% rated their health poor-fair

Prevalence of Depressive Symptoms Prevalence of Depressive Symptoms in African-American Women in African-American Women

Transitioning from Welfare to WorkTransitioning from Welfare to Work

73%

27%

Yes

No

Prevalence of Obesity in African-Prevalence of Obesity in African-American Women Transitioning American Women Transitioning

from Welfare to Workfrom Welfare to Work

0

5

10

15

20

25

30

Percent

Body Mass Index

Underweight

Normal weight

Overweight

Obese I (30-34.9 kg/ m²)

Obese II (35-39.9 kg/ m²)

Obese III (≥40 kg/ m2)

Association between Depressive Association between Depressive Symptoms and Obesity in African-Symptoms and Obesity in African-

American Women Transitioning from American Women Transitioning from Welfare to WorkWelfare to Work

Correlation Analysis between Correlation Analysis between Sample Characteristics and Sample Characteristics and Depressive Symptoms and Depressive Symptoms and

ObesityObesityDepressive

Symptoms

Obesity

Age -.077-.077 .167*.167*

†Perceivedhealth status

-.302** .005

† † Physical activity (n=157)Physical activity (n=157)

*p≤.05 *p≤.05

**p≤.01**p≤.01

Prevalence of Health Risk Behavior Prevalence of Health Risk Behavior in African-American Women in African-American Women

Transitioning from Welfare to WorkTransitioning from Welfare to Work

0

20

40

60

80

100

120

140

160

Physical Activity Nutritional Intake(Fiber)

Nutritional Intake(Cholesterol)

Smoking AlcoholConsumption

Yes

No

Predictors of Depressive Symptoms Predictors of Depressive Symptoms in African-American Women in African-American Women

Transitioning from Welfare to WorkTransitioning from Welfare to Work

Table 4. Optimal Regression of Depressive Table 4. Optimal Regression of Depressive SymptomsSymptoms

Independent Independent VariableVariable

BetaBeta p-valuep-value

Perceived healthPerceived health -.355-.355 .000.000

BMI 30 kg/mBMI 30 kg/m² or ² or higherhigher

-.153-.153 .049.049

Predictors of Obesity in African-Predictors of Obesity in African-American Women Transitioning American Women Transitioning

from Welfare to Workfrom Welfare to Work

Table 6.Table 6. Analysis of Maximum Likelihood EstimatesAnalysis of Maximum Likelihood Estimates

ParameterParameter EstimatEstimatee

Standard Standard ErrorError

Wald Chi-Wald Chi-SquareSquare

p-valuep-value

InterceptIntercept 1.0551.055 1.4011.401 0.5670.567 0.4520.452

Perceived Perceived healthhealth

-0.225-0.225 0.1010.101 4.9634.963 0.0260.026

Depressive Depressive symptomssymptoms

-0.923-0.923 0.4220.422 4.7774.777 0.0290.029

Predictors of Obesity in African-Predictors of Obesity in African-American Women Transitioning American Women Transitioning

from Welfare to Workfrom Welfare to Work

Table 6. Odds Ratio EstimatesTable 6. Odds Ratio Estimates

EffectEffect Point EstimatePoint Estimate 95% Wald Confidence 95% Wald Confidence LimitsLimits

Perceived Perceived healthhealth

0.7980.798 0.655 – 0.9730.655 – 0.973

Depressive Depressive SymptomsSymptoms

0.3970.397 0.174 – 0.9090.174 – 0.909

ConclusionsConclusions

High levels of education among the womenHigh levels of education among the women

Age correlated with obesityAge correlated with obesity

No correlation between depressive symptoms No correlation between depressive symptoms and obesityand obesity

Perceived health correlated with depressive Perceived health correlated with depressive symptoms and obesitysymptoms and obesity

LimitationsLimitations

InstrumentationInstrumentation

Convenience sampleConvenience sample

Cross sectional designCross sectional design

StrengthsStrengths

Limited studies conducted on African-Limited studies conducted on African-American women on welfareAmerican women on welfare

Few studies on depressive symptoms and Few studies on depressive symptoms and obesity in African-American women preparing obesity in African-American women preparing for workfor work

Predictors of depressive symptoms and Predictors of depressive symptoms and obesity examinedobesity examined

Practice and Policy Practice and Policy ImplicationsImplications

Recognition of depressive symptoms among Recognition of depressive symptoms among African-American womenAfrican-American women

Unmet need for mental health servicesUnmet need for mental health services

Awareness of sociocultural influence on Awareness of sociocultural influence on perceptions of weightperceptions of weight

Funding for programs to address barriers to Funding for programs to address barriers to workwork

Implications for Future Implications for Future ResearchResearch

Prospective studies needed to determine Prospective studies needed to determine causal relationshipscausal relationships

Qualitative studies to address perceptions of Qualitative studies to address perceptions of healthhealth

Risk reduction interventionsRisk reduction interventions

QuestionsQuestions

Thank you!!!