The Association Between Structural and Social Determinants of Health and Mood Disorder Symptoms Among Black Adults in the Greater St. Louis Metropolitan Area

Black middle-aged and older adults face significantly higher risks of mood disorders compared to non-Hispanic Whites. However, these conditions are often underdiagnosed and undertreated among Black Americans. Prior evidence has underscored the importance of structural and social determinants of health (S/SDOH), estimated to contribute to 60–80% of all health outcomes. This study examined the relationship between mood disorder symptoms (depression and anxiety) and S/SDOH. We assessed 312 Black participants aged 45 and older living in the Greater St. Louis Metropolitan region, an area deeply affected by historic and contemporary racism. A S/SDOH composite index (S/SDOH-CI) was constructed based on a series of individual and household-level indicators to measure deprivation and unique risk factors among participants. We found a strong association between mood symptoms, their frequency, and S/SDOH deprivation. Furthermore, contribution to S/SDOH-CI revealed that a social factor encompassing hardship and daily stressors (17%) and discrimination (11%) were the primary factors exacerbating mood disorder symptoms. These surpassed the contribution of education (10.67% [years and quality]), particularly among Black men, highlighting structural racism as a formidable driver of health inequities and lending additional evidence that there may be diminishing returns on human capital investments among Black men. These findings emphasize the need for medical advancements to progress together with social justice initiatives. The use of the S/SDOH-CI uncovered within-group differences and identified unique risk and resilience factors for mood disorders in Black older adults.