Environmental Stressors, Anemia, and Depressive Symptoms in Pregnancy: Unpacking the Combined Risks

Ruth A. Pobee (), Rebecca K. Campbell, Prathiba Balakumar, Yongchao Huang, Beatriz Peñalver Bernabé and Mary Dawn Koenig
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Ruth A. Pobee: Department of Emergency Medicine, College of Medicine, University of Illinois Chicago, 808 S Wood St., Chicago, IL 60612, USA
Rebecca K. Campbell: Division of Epidemiology and Biostatistics, University of Illinois Chicago, 1603 W Taylor St., Chicago, IL 60612, USA
Prathiba Balakumar: Division of Epidemiology and Biostatistics, University of Illinois Chicago, 1603 W Taylor St., Chicago, IL 60612, USA
Yongchao Huang: Department of Biomedical Engineering, Colleges of Engineering and Medicine; University of Illinois Chicago, 851 S Morgan St., Chicago, IL 60607, USA
Beatriz Peñalver Bernabé: Department of Biomedical Engineering, Colleges of Engineering and Medicine; University of Illinois Chicago, 851 S Morgan St., Chicago, IL 60607, USA
Mary Dawn Koenig: Department Human Development Nursing Science, College of Nursing, University of Illinois Chicago, 845 South Damen Avenue, Chicago, IL 60612, USA

IJERPH, 2025, vol. 22, issue 11, 1-12

Abstract: Chronic exposure to structural violence and environmental hazards may disrupt stress regulation, trigger inflammation, and impair iron metabolism in women. Iron deficiency has been associated with depression, but the combined impact of environmental stressors and anemia on maternal mental health remains understudied. We analyzed associations between 28 neighborhood-level environmental stressors, hemoglobin levels, and depressive symptoms (measured by the Patient Health Questionnaire-9) during early pregnancy, using retrospective data from 1964 pregnant patients (2015–2019) at an urban health center in Chicago. Demographic and residential data were linked to environmental indicators from the Chicago Health Atlas. Factor analysis reduced the environmental variables, and multivariable regression models examined associations with PHQ-9 scores at first pregnancy encounter. Participants were predominantly non-Hispanic Black (56%) and Hispanic (27%), with 13% anemic and 16% screening positive for depressive symptoms. Poverty, non-Hispanic Black race, single status, public or no insurance, and unemployment were associated with higher depressive symptoms. Among anemic individuals, neighborhood crime was significantly associated with depressive symptoms, while hemoglobin levels and gestational age were not. These findings highlight how environmental and social inequities contribute to maternal mental health disparities and support the need for integrated, equity-focused prenatal care interventions.

Keywords: maternal depressive symptoms; anemia; environmental stressors; health disparities (search for similar items in EconPapers)
JEL-codes: I I1 I3 Q Q5 (search for similar items in EconPapers)
Date: 2025
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