Social Determinants of Health and Depressive Symptoms Among Married Women In Zambia

Background and Purpose: Depression is one of the major public health concerns linked to reduced quality of life and other poor health conditions for vulnerable individuals. In Zambia, married women may experience multiple social and structural stressors, including economic hardship, gender inequality, and intimate partner violence (IPV), which may increase their risk of depression. Despite growing attention to mental health in Zambia, few nationally representative studies have examined the social determinants of depressive symptoms among married women. Therefore, guided by the social determinants of health framework, this study examined several characteristics associated with depressive symptoms among married women in Zambia.

Methods: This cross-sectional study used data from the 2024 Zambia Demographic and Health Survey (ZDHS), a nationally representative survey of married women aged 15-49 years who completed Patient Health Questionnaire (PHQ-9) (N ≈ 7,358). Depressive symptoms were assessed using PHQ-9, and were dichotomized as none/minimal ( 0–4) versus mild to severe (5–27) based on PHQ-9 scores ranging from 0 to 27. Independent variables included women’s sociodemographic characteristics (age group, education level, work status, household wealth index, resident type, health insurance, self‑rated health status, media use, and IPV experience), and husband characteristics (age group, education level, work status, and alcohol use). Weighted multivariate logistic regression was conducted to determine the significant associations between primary predictors and depressive symptoms using SPSS vs.31.0 (p<.05).

Results: Out of 7,358 married women, 9.5% reported mild-to-severe depressive symptoms during the past 2 weeks. In terms of women’s characteristics, women who were aged 20-29 (OR=2.45; p<.008), 30-39 years old (OR=2.87; p <.004), and 40-49 years old (OR=2.96; p<.005) had greater odds of reporting depressive symptoms compared to those aged 15-19 years. In addition, women who reported their physical health status as “good” (OR=0.67; p<.001) or “very good” (OR=0.48; p<.001) had lower odds of reporting depressive symptoms compared to those with poor health status. However, women who used media almost every day, to once per week had higher odds of reporting depressive symptoms, compared to those who never used media (OR=1.35; p<.05). Additionally, women who experienced any IPV had higher odds of reporting depressive symptoms compared to those who did not (OR=1.81; p<.001). In terms of husbands’ characteristics, women whose husbands consumed alcohol had higher odds of depressive symptoms compared to those whose husbands did not (OR=1.22; p<.05).

Conclusions and Implications: This study demonstrated that depressive symptoms are influenced by multiple social determinants such as age, health status, media exposure, IPV, and partner-related factors in Zambia. IPV and partner alcohol use emerged as major risk factors for depressive symptoms, while better self-rated health was protective factor from depression. These findings underscore the need to prioritize routine mental health screening, IPV prevention, and community-based support services. Equally important, policy efforts are needed to strengthen enforcement of gender-based violence laws, expand access to mental health care in primary health systems, and implement alcohol regulation strategies to reduce partner-related risks associated with depressive symptoms for vulnerable, particularly for married women living in low-resource settings in Zambia.