Over the past decade, the public child welfare system has increasingly relied upon female African American caregivers to provide out-of-home placements for relative children removed from their homes because of child maltreatment. African American women who care for relative children are also known as "Othermothers" (Troester, 1984) and a growing body of research reveals that this population is at risk for psychological distress, particularly depression. Depressed Othermothers can pose a serious public health concern for women and children in state care. African American women often use social support and spirituality to foster emotional resilience. Drawing upon concepts of the Transactional Stress-Coping Model and the Africentric Paradigm, this study examined the role social support and spirituality played in mediating or moderating the relationship between caregiver stress and depressive symptomatology. Data from an on-going Title IV-E federal demonstration project on families in Maryland's foster care system were analyzed. The sample included 116 African American Othermothers. A Social Embeddedness/Sense of Community scale and Density of Support scale measured social support; the Short Form of the Brief RCOPE, Daily Spiritual Experiences Scale and Organizational Religiousness Items measured spirituality; a Cumulative Stress Index measured caregiver stressors; the CES-D measured depressive symptomatology. Twenty-seven percent of the Othermothers had a positive screening for depression. Increased caregiver stress was associated with increased levels of depressive symptomatology (r = .373, p < .0005). Spirituality in the form of negative spiritual coping strategies and church attendance partially mediated the relationship between caregiver stress and depressive symptomatology. Lower levels of church attendance and neighborhood involvement were associated with elevated levels of depressive symptomatology (p < .10). This research suggests that spirituality and neighborhood factors play important roles in the psychological adjustment of African American Other-mothers. Maternal and child health, social work education, as well as child welfare implications are reviewed for African American caregivers and families in foster care.