Anxiety and Depression amongst African-Americans Living in Rural Black Belt Areas of Alabama: Use of Social Determinants of Health Framework

The present study utilised the social determinants of health (SDH) framework to see whether indicators of the framework have an impact on anxiety and depression of people living in rural Black Belt communities in Alabama. Data from a convenient sample of 159 African-Americans aged 18 or older were from two sites in rural Alabama. The levels of anxiety and depression were measured by the Patient Health Questionnaire-9 (PHQ9). Multiple linear regression model was used to examine the association between SDH and anxiety and depression level of participants. The mean PHQ9 score of participants was 5.57 out of twenty-seven. Four SDH were significantly related to PHQ9 levels amongst participants: participants with higher food insecurity scores, higher transportation needs and higher threats to interpersonal safety tended to have higher scores in PHQ9. Moreover, health literacy levels were negatively associated with PHQ9 scores amongst participants. Our study highlights understanding SDH specifically for residents in rural communities that are socially and culturally isolated is important for developing preventive approaches that enhance access to mental health treatments. A comprehensive public health policy that incorporates our study findings is needed for the rural areas of the USA. In spite of the prevalence of mental health issue and poor accessibility of mental health care services in rural areas, previous studies have not focused much on rural areas, particularly, the southeastern region of the USA. To the best of our knowledge, this is the first study of residents living in rural Alabama to examine the impact of social determinants on mental health. Interestingly, our study revealed that variations in the levels of anxiety and depression were significantly associated with variations in five factors, including a demographic (i.e. age) and four determinants (i.e. food security, transportation needs, health literacy and interpersonal safety).