Disparities in depression at the intersect of Indigenous status and gender in Sweden: a cross-sectional study

Introduction: Depression is a leading cause of disability globally, with disparities evident across gender and ethnicity. Indigenous populations, including the Sámi people in Sweden, face compounded disadvantages due to intersecting social inequalities. This study aimed to estimate the differences in depression prevalence across different intersectional groups defined by Indigenous status and gender in Sweden. Methods: Data on participants (N = 19,839) aged 18–84 years were obtained from two cross-sectional surveys conducted in 2021: the SámiHET study and the Health on Equal Terms (HET) survey. Depression prevalence was assessed using self-reported doctor-diagnosed depression. Four intersectional categories were created representing Sámi women, Sámi men, non-Sámi women, and non-Sámi men. Intersectional disparities (joint, referent, and excess) were estimated to examine the combined effects of Indigenous status and gender on depression prevalence. Results: Sámi women reported the highest prevalence of depression (26%), while Sámi men had the lowest (12%). The joint disparity in depression prevalence was 10 percentage points (pp) (95% CI: 8.4 to 12, adjusted), reflecting a higher prevalence of depression among Sámi women compared with non-Sámi men. Most of the joint disparity was explained by the referent disparities for Indigenous status (-2.6 pp, 95% CI: -4.7 to -0.49) and gender (9.7 pp, 95% CI: 8.5 to 11). The excess intersectional disparity, reflecting the compounded effects of being Indigenous and gender, accounted for a third of the joint disparity (3.3 pp, 95% CI: 0.48 to 6.1, adjusted). Conclusion: Sámi women experienced a disproportionate burden of depression due to intersectional disadvantages. These findings highlight the importance of culturally sensitive mental health strategies and the need for further qualitative research to explore their lived experiences.