Open Access Research article

The effect of depression symptoms and social support on black-white differences in health-related quality of life in early pregnancy: the health status in pregnancy (HIP) study

Li Liu1, Rosanna Setse2, Ruby Grogan34, Neil R Powe3 and Wanda K Nicholson456*

Author Affiliations

1 Department of International Health, Johns Hopkins University, Baltimore, USA

2 Department of Epidemiology, Johns Hopkins University, Baltimore, USA

3 Department of Medicine University of California, San Francisco, USA

4 Department of Obstetrics and Gynecology, University of North Carolina, Chapel Hill, USA

5 Center for Women’s Health Research, University of North Carolina, Chapel Hill, USA

6 Diabetes Center, University of North Carolina, Chapel Hill, USA

For all author emails, please log on.

BMC Pregnancy and Childbirth 2013, 13:125  doi:10.1186/1471-2393-13-125

Published: 3 June 2013

Abstract

Background

Lower physical and social functioning in pregnancy has been linked to an increased risk of preterm delivery and low birth weight infants, butt few studies have examined racial differences in pregnant women’s perception of their functioning. Even fewer studies have elucidated the demographic and clinical factors contributing to racial differences in functioning. Our objective was to determine whether there are racial differences in health-related quality of life (HRQoL) in early pregnancy; and if so, to identify the contributions of socio-demographic characteristics, depression symptoms, social support and clinical factors to these differences.

Methods

Cross-sectional study of 175 women in early pregnancy attending prenatal clinics in urban setting. In multivariate analysis, we assessed the independent relation of black race (compared to white) to HRQoL scores from the eight domains of the Medical Outcomes (SF-36) Survey: Physical Functioning, Role-Physical, Bodily Pain, Vitality, General Health, Social Functioning, Role-Emotional, and Mental Health. We compared socio-demographic and clinical factors and depression symptoms between black and white women and assessed the relative importance of these factors in explaining racial differences in physical and social functioning.

Results

Black women comprised 59% of the sample; white women comprised 41%. Before adjustment, black women had scores that were 14 points lower in Physical Function and Bodily Pain, 8 points lower in General Health, 4 points lower in Vitality and 7 points lower in Social Functioning. After adjustment for depression symptoms, social support and clinical factors, black women still had HRQoL scores that were 4 to 10 points lower than white women, but the differences were no longer statistically significant. Level of social support and payment source accounted for most of the variation in Physical Functioning, Bodily Pain and General Health. Social support accounted for most of the differences in Vitality and Social Functioning.

Conclusions

Payment source and social support accounted for much of the racial differences in physical and social function scores. Efforts to reduce racial differences might focus on improving social support networks and Socio-economic barriers.

Keywords:
Depressive symptoms; Race; Pregnancy and health-related quality of life