Sociodemographic and Psychosocial Predictors and Chronic Illness Outcomes of Depression in Black Women with Hypertension: A Secondary Analysis of Health and Retirement Study Data

Hypertension and cardiovascular disease remain major health concerns for Black women in the United States. Black women experience disproportionate rates of hypertension, stroke, and heart failure and are also vulnerable to depression and loneliness, two conditions that may worsen chronic illness outcomes. Existing literature has examined depression, stress, and hypertension separately, but limited research has clarified how loneliness and depression function within the same conceptual model in Black women with and without hypertension. Guided by the health belief model, this study examined predictors, responses, and outcomes to clarify how sociodemographic and psychosocial factors relate to depression and loneliness and how loneliness modifies responses and health outcomes. The purpose of this study was to identify predictors of depression and loneliness in Black women with and without hypertension and to determine the moderating impact of loneliness and depression on responses to each condition and on selected health outcomes. This completed secondary analysis used retrospective cross-sectional and longitudinal data from the Health and Retirement Study. The sample included 641 Black women aged 50 years and older who completed measures of depression and loneliness in Wave 13 (2016) and Wave 14 (2018). Predictor variables represented individual, relationship, and social factors. Response variables included psychological, physiological, behavioral, and social indicators. Outcomes included cardiovascular, psychological, and quality-of-life measures. Descriptive statistics, t tests, chi-square tests, correlations, and multivariable regression models were used. Moderation was tested through interaction terms that examined loneliness in relation to key responses and outcomes and by comparing women with and without hypertension. Black women with hypertension reported slightly higher depression scores, more chronic conditions, lower cognitive scores, and poorer physiological indicators than women without hypertension. Across the sample, lower income, lower education, poorer self-reported health, multimorbidity, discrimination, and family strain were associated with higher loneliness and depression scores. Loneliness and depression were strongly related to one another. Multimorbidity emerged as a consistent predictor across models, contributing to stroke, heart problems, body mass index, inflammatory and metabolic biomarkers, and worsening depression. Loneliness also functioned as an important modifier. Interaction models showed that loneliness amplified the effects of relationship problems, chronic stress, housing and financial problems, and reduced social contact on negative affect, self-isolation, functional difficulty, and quality of life. These findings suggest that loneliness, depression, and multimorbidity are interconnected contributors to cardiovascular and psychosocial vulnerability in Black women. Greater attention to loneliness and depression screening may improve understanding of CVD risk and chronic illness burden in this population.