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This study examined the extent to which race/ethnicity is a risk factor for depressed mood in late pregnancy and the early postpartum period apart from its relationship with other demographic and infant outcome variables. Data obtained from 26,877 women with newborns in Iowa indicate that 15.7% endorsed a single depression item. Logistic regression results indicate that race/ethnicity was a significant predictor of depressed mood, controlling for age, marital status, income and educational level, and infant health outcome. Compared to White women, African-American women were significantly more likely to report depressed mood (OR51.25, 95% CI51.03–1.52). Hispanic women were significantly less likely to report being depressed (OR50.74, 95% CI50.61–0.88). The role of social support in understanding these findings is explored.
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BRIEF REPORT
Race/ethnicity and perinatal depressed mood
LISA S. SEGRE
Psychology Department, University of Iowa, Iowa, USA
MARY E. LOSCH
Department of Psychology and Center for Social and Behavioral Research, University of Northern
Iowa, Iowa, USA
MICHAEL W. O’HARA
Psychology Department, University of Iowa, Iowa, USA
Abstract This study examined the extent to which race/ethnicity is a risk factor for
depressed mood in late pregnancy and the early postpartum period apart from its relationship
with other demographic and infant outcome variables. Data obtained from 26,877 women
with newborns in Iowa indicate that 15.7% endorsed a single depression item. Logistic
regression results indicate that race/ethnicity was a significant predictor of depressed mood,
controlling for age, marital status, income and educational level, and infant health outcome.
Compared to White women, African-American women were significantly more likely to report
depressed mood (OR51.25, 95% CI51.03–1.52). Hispanic women were significantly less
likely to report being depressed (OR50.74, 95% CI50.61–0.88). The role of social support in
understanding these findings is explored.
Introduction
Although the prevalence of perinatal depression in the general population is well-
established (Gaynes et al., 2005; O’Hara & Swain, 1996), the question of whether this
disorder differentially affects women from specific racial or ethnic groups remains open.
The significant negative effects of maternal depressed mood on children (Gelfand & Teti,
1990; Murray et al., 1996) underscores the importance of identifying at-risk mothers.
Address for correspondence: Lisa S. Segre, Department of Psychology, University of Iowa, Iowa City, IA 52246,
USA. Tel: +1 319 335 2442; Fax: +1 319 335 0191; Email: lisa-segre@uiowa.edu
Received: 14 July 2005. Accepted: 2 December 2005.
JOURNAL OF REPRODUCTIVE AND INFANT PSYCHOLOGY,
VOL. 24, NO. 2, MAY 2006, pp. 99–106
ISSN 0264-6838/print/ISSN 1469-672X/online/06/020099-08
#
2006 Society for Reproductive and Infant Psychology
DOI: 10.1080/02646830600643908
Available research is uninformative because race/ethnicity is either confounded with
other demographic characteristics (Logsdon & Usui, 2001; Yonkers et al., 2001; Zayas
et al., 2003) or the studies are limited to lower income women (Hobfoll et al., 1995; Ritter
et al., 2000). The two studies with adequate samples report conflicting results. Although
Gross et al. (2002) found nonsignificant differences among racial groups, the stringent
depression classification criteria may have obscured significant results. Given the strong
bivariate trend (11.6% of African-American women versus 5% of White women were
classified as depressed); race may have been a significant risk factor using a less
conservative depression classification. In contrast, Howell et al. (2005) found significantly
increased risk of depression in African-American (OR52.16) and Hispanic (OR51.89)
women relative to White women, controlling for major demographic differences.
The present study capitalized on the availability of a large, economically
heterogeneous and demographically representative sample to examine the relationship
between race/ethnicity and self reported depressed-mood during a period encompass-
ing late pregnancy and the early postpartum period. As in Gross et al. (2002) and
Howell et al. (2005), the mood assessment was brief: one item assessing the core
symptom of depressed mood.
Method
Participants
Data for this study were collected as part of the Iowa Barriers to Prenatal Care Project,
a cooperative venture among all of Iowa’s maternity hospitals, the Statewide Perinatal
Program, and the Iowa Department of Public Health. Participants were 32,495 English
speaking women with newborns who gave birth in one of Iowa’s maternity hospitals
and who completed the Barriers surveillance questionnaire in 2001 and 2002.
Measure
Depressed mood. The Barriers questionnaire assessed a broad range of health indicators
and required approximately 10 minutes to complete. Women were identified as
‘depressed’ if they positively endorsed the item: ‘have you felt sad or miserable much of
the time over the past two weeks’. This item assesses two critical features of syndromal
depression: the core symptom of sad mood and duration of at least two weeks.
Demographics. Women provided the following demographic information: race/ethnicity
(by choosing White, Black, American Indian/Native Alaskan, Hispanic, or Asian/
Pacific Islander), educational level, total family income, marital status, and age. Two
indices of birth outcome were obtained: birth weight and whether the infant left the
hospital with the mother.
Procedure
The study procedure and questionnaire were approved by the University of Northern
Iowa’s Institutional Review Board. The questionnaire was distributed to all maternity
hospitals in Iowa (N598). Informed consent was obtained from all subjects. Except in
the case of a mother who was too ill to complete the questionnaire, the hospital staff
member in charge of obtaining birth certificate information invited all women with
100 L. S. SEGRE ET AL.
newborns to participate. The questionnaire was completed in the hospital approxi-
mately 24 hours after delivery. Women with Cesarean deliveries completed it
approximately 2 days post-delivery.
Statistical analyses
SPSS (2003) was used to examine the overall return rate, the demographic
characteristics of the sample, the prevalence of depressed mood overall, and the
prevalence of depressed mood by each demographic characteristic. Hierarchical logistic
regression was used to assess whether race/ethnicity was independently associated with
the endorsement of the single depression item.
Results
The response rate (questionnaires returned/total births in the state) for 2001 and 2002
was 43%, or 32,495 completed questionnaires. The Barriers sample closely matched
the overall statewide profile of births (Iowa Department of Public Health, 2001, 2002).
This report is based on a reduced sample of 26,877 cases with complete data for two
reasons. Some respondents did not identify their race/ethnicity. The Spanish
translation of the questionnaire did not include the depression item. Therefore the
181 Hispanic women who completed the Spanish version of the questionnaire
(representing 12% of the Hispanic participants) did not complete this item. As
indicated in Table 1, women who provided complete data were slightly more likely to
Table 1. Percentage of women with complete and missing data within each demographic category.
Percentage of women with
complete data (N526,877)
Percentage of women with
missing data (N53803)
Age
,20 8.9 11.2
20–30 66.6 63.6
31–35 19.2 16.8
.35 7.6 8.5
Race/Ethnicity
White 91.2 88.5
Black 2.2 2.5
Asian/Pacific Islander 1.6 1.9
American Indian/Native Alaskan 1.4 1.3
Hispanic 5.7 3.7
Income
,$10,000 12.7 15.4
$10,000–$19,000 12.0 13.0
$20,000–$29,000 12.8 12.8
$30,000–$39,000 14.2 13.9
$40,000–$49,000 13.6 13.1
$50,000+ 34.8 31.8
Education
,HS 11.2 14.6
High School 25.6 27.2
Some College 35.1 33.7
Bachelor’s Degree 22.1 19.5
Graduate or Professional Degree 5.9 5.0
RACE/ETHNICITY AND PERINATAL DEPRESSED MOOD 101
be older, White, and with higher income and educational levels. However, these
differences were modest in magnitude.
Overall, 15.7% of the women responded ‘yes’ to the single depression item. The
positive endorsement rate within each demographic characteristic and infant health
category is provided in Table 2. Positive endorsement rates of the single depression
item were highest for those 19 years or younger, those with few economic resources,
those who had not completed high school, the unmarried, and mothers who left the
hospital without their infant or who had infants that weighed less than five pounds.
African-American women and American Indian/Native Alaskan women were more
likely to endorse the single depression item compared to White women.
Hierarchical logistic regression analysis was used to determine the relationship
between race/ethnicity and the endorsement of the single depression item, controlling
Table 2. Percentage of women endorsing the single depression item within categories of demographic and child
outcome variables.
Percent
Age
,18 20.5
18–19 21.9
20–25 18.5
26–30 14.6
31–35 13.3
.35 13.3
Race/Ethnicity
White 15.5
Black 25.2
Asian/Pacific Islander 11.5
American Indian/Native Alaskan 22.9
Hispanic 15.3
Income
,$10,000 24.3
$10,000–$19,000 20.0
$20,000–$29,000 18.8
$30,000–$39,000 15.3
$40,000–$49,000 13.7
$50,000+ 10.8
Education
,HS 22.2
High School 20.1
Some College 15.6
Bachelor’s Degree 9.5
Graduate or Professional Degree 5.9
Marital status
Married 13.3
Not Married 21.6
Baby going home with mother
Yes 15.3
No 21.8
Baby’s weight
,2268 g 19.1
2268–3175 g 17.3
.3175 g 15.4
102 L. S. SEGRE ET AL.
for other demographic and infant health outcome variables. Income, educational level,
marital status, age, and the infant health status variables were entered into the
regression equation as well as race/ethnicity. The full model is shown in Table 3. The
results reveal several significant risk factors for endorsing the single depression item:
less than college education, having an annual income below $30,000, being single, not
having the infant go home with the mother, and being African-American. In contrast,
Hispanic women were significantly less likely than White women to endorse the
depression item, while endorsement rates for Native American/Alaskan and Asian
women did not significantly differ from that of White women. Neither age nor infant
birth-weight was a significant predictor of positively endorsing this item.
Discussion
African-American and Native American women reported much more depression than
White, Hispanic, and Asian women. When important social factors such as age,
income, education, marital status, and baby’s health were controlled in a logistic
regression, African-American women still emerged with significantly increased risk for
reporting depressed mood in late pregnancy and the early postpartum period. Given
that, in 2003, African-Americans accounted for nearly 600,000 of the approximately
four million births in the United States (Henry J. Kaiser Family Foundation, 2003), an
Table 3. Logistic regression results (full model): coefficients (C), odds ratios (OR), and confidence intervals (CI)
for demographic and infant health outcome variables as predictors of endorsement of a single depression item.
CORCI
Age 0.04 1.04 1.00–1.08
Education
,HS 0.72*** 2.40 1.78–2.35
High School 0.66*** 1.92 1.72–2.14
Some College 0.43*** 1.54 1.39–1.70
College Graduate
Income
,$10,000 0.48*** 1.54 1.36–1.75
$10,000–$19,000 0.29*** 1.33 1.18–1.50
$20,000–$29,000 0.31*** 1.36 1.21–1.52
$30,000–$39,000 0.14 1.15 1.02–1.28
$40,000–$49,000 0.08 1.08 0.96–1.21
$50,000+
Married –1.9*** 0.82 0.75–0.90
Baby not going home 0.45*** 1.56 1.37–1.79
Baby weight
,2268 g –0.10 0.90 0.72–1.13
2268–3175 g –0.02 0.982 0.91–1.05
.3175 g
Race/Ethnicity
Asian Pacific Islander –0.28 0.75 0.56–1.00
Black 0.23** 1.25 1.03–1.52
American Indian Native Alaskan 0.08 1.08 0.83–1.40
Hispanic –0.30*** 0.74 0.61–0.88
White
*P(0.05; **P(0.01; ***P(0.001.
RACE/ETHNICITY AND PERINATAL DEPRESSED MOOD 103
adjusted odds ratio of 1.25 means that an additional nearly 20,000 cases of depression
are solely attributed to ethnicity. Because African-American women often do not seek
treatment for depression (Alvidrez, 1999), these women, their partners, and children
are at special risk for the ill effects of maternal depression. In contrast to the case for
African-American women and consistent with the Hispanic Paradox (Farley et al., 2005;
Markides & Coreil, 1986), Hispanic women were at significantly decreased risk for
reporting depressed mood after adjusting for the study covariates.
What might account for the difference in risk for postpartum depression mood
between African-American and Hispanic women? Social support emerges as a potential
explanatory variable. It is negatively correlated with maternal depression (Dunkel-
Schetter et al., 1996) in all ethnic groups (Howell et al., 2005). Having a supportive
partner, which appears to be particularly protective (O’Hara, 1986), also varies by
racial/ethnic group, with Hispanic women reporting the highest levels of partner
support followed by White and then African-American women, who report very low
levels of emotional support from the baby’s father (Dunkel-Schetter et al., 1996).
Hispanic women often have additional social support, particularly in their roles as
mothers. La familia, or the centrality of family, is well documented in the Hispanic
immigrant culture (Callister & Birkhead, 2002). In stark contrast, African-American
women endure the dual vulnerability of having significant less partner support and
more stressful lives than White and Hispanic women (Jackson-Triche et al., 2000),
perhaps accounting for their increased risk.
There were several limitations with the current study. First, since the data did not
permit separating White from Black Hispanics, race and ethnicity are confounded for
Hispanic women. Second, while being Hispanic was a protective factor in the current
study, it was a risk factor in the study by Howell et al. (2005). The samples of these two
studies likely differed both in terms of amount of acculturation and country of origin.
Those in the Howell et al. (2005) study were from New York and therefore were
primarily from Puerto Rico (Markides & Coreil, 1986), while the current sample is
primarily from Mexico. To clarify the relationship of Hispanic ethnicity to maternal
depressed mood, future research needs to account for birthplace and level of
acculturation/recency of immigration as these factors are known to affect mental
health outcome (Callister & Birkhead, 2002).
Finally, the one-item assessment of depressed mood limits conclusions about the
relationship of ethnicity to clinically significant maternal depression. However, given the
large sample of the present study and the comprehensive control for potential
confounding variables, there is little reason to believe that the present results would not
be replicated. Additionally, our findings of a significant correlation between single
depression items and total scores on both the Beck Depression Inventory (Beck et al.,
1961) and the Edinburgh Postnatal Depression Scale (Cox et al., 1987), 0.65 and 0.71,
respectively, suggests that a single depression item may be a robust substitute for the
entire scale (O’Hara & Stuart, 2005). Future research needs to replicate the findings of
the current study using more sophisticated depression assessments and/or by following-
up women who positively endorse a single screening item to determine its clinical
significance.
Ultimately, the current findings as well as those reported by Howell et al. (2005),
suggest that there are significant racial/ethnic disparities to be addressed with mental
health care in the immediate postpartum period. In the same way that African-
American babies are handicapped by relatively high rates of low birth weight and
104 L. S. SEGRE ET AL.
premature delivery (Hamilton et al., 2003), they may also be handicapped by relatively
high rates of exposure to maternal depression. In an effort to mitigate these potentially
negative impacts on our next generation of African-American youth, programs such as
the U.S. National Healthy Start Initiative have already incorporated perinatal
depression screening and referral programs into their current case management
protocols (Segre & O’Hara, 2005). Interventions aimed at strengthening protective
social factors and decreasing social risk factors may be especially useful in the care of
African-American women. Our findings suggest that these efforts are well placed and
should be continued.
Acknowledgements
The Iowa Barriers to Prenatal Care Project is funded by the Iowa Department of Public
Health. The views expressed in this manuscript do not necessarily reflect those of the
Department of Public Health or the State of Iowa. This work was also supported by
grant MH59668 from the National Institute of Mental Health, Bethesda, MD (Scott
Stuart, M.D.). The authors would like to thank Charles Lynch, M.D. Ph.D. and
Stephan Arndt Ph.D. for their help with the preparation of this manuscript. Portions of
the data reported here were presented at the 2nd World Congress on Women’s Mental
Health (March 17–20, 2004) in Washington, DC. An extended version of this report is
available upon request.
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... Although there is evidence to suggest that on the whole research is disproportionality carried out on white, middle class participants (Graham, 1992), the generalisability of our findings remain limited by the narrow ethnic characteristics and socioeconomic status of our sample. Future research would need to consider improving sampling techniques in order to capture a more diverse sample, an issue of paramount importance given associations between both low socioeconomic status, as well as certain black and minority ethnicities, and perinatal mental health (Goyal, Gay, & Lee, 2010& Segre, O'Hara, & Losch, 2006. ...
Thesis
This thesis submission comprises of two chapters. The first chapter is a systematic review and meta-analysis exploring the association between maternal perfectionism and symptoms of common mental health problems (depression and anxiety) in the perinatal period. In the absence of a prior review and meta-analysis, we aimed to ascertain whether trait perfectionism and/or parenting specific perfectionism was associated with perinatal symptoms of depression and anxiety in mothers, estimating a weighted effect size and additionally exploring possible moderators of timing (pre or post- natal), scales used to measure constructs, infant gender, temperament and age, in this relationship. A total of 14 studies met eligibility criteria for the meta-analysis and were subject to quality assessment and review. Perfectionism as a whole and the perfectionistic concerns sub-factor were found to be moderately correlated with common maternal perinatal mental health difficulties (in particular depression). No moderators reached significance. Findings support a focus on both the early identification of perfectionism and preventative interventions for associated common mental health difficulties in perinatal mothers. Our meta-analysis revealed both methodological and conceptual limitations of included studies and there is a need for further research in this area; with consistent exploration of perfectionistic concerns and strivings factors, as well as anxiety in addition to perinatal depression required. The second chapter sought to explore the relationships between infantile colic, perfectionism and postnatal mental health difficulties (depression, anxiety and reduced well-being). A cross-sectional design was implemented to explore whether there were associations between prolonged infantile colic, perfectionism and postnatal mental health difficulties, as well as investigate whether perfectionism moderated the relationship between colic and mental health issues. 137 women with infants between the aged of 12-26 weeks and suffering from prolonged infantile colic were recruited through two streams, including online advertisement and placement of posters in community settings. Prevalence of clinical depression was 66.43% and anxiety 89.29% within our sample of women with a baby experiencing prolonged colic, with high comorbidity of both conditions. Hypotheses suggesting that prolonged infantile colic and all types of perfectionism (trait and parenting specific, inclusive of socially prescribed and self-oriented factors) would be correlated with postnatal depression and reduced well-being, were supported. Those in clinical groups for both depression and anxiety were found to have significantly higher scores for socially prescribed perfectionism (perfectionistic concerns). Significantly higher scores for self-oriented perfectionism (perfectionistic strivings) were found only in the clinical anxiety group. The hypotheses that perfectionism (in its different forms), would moderate the relationship between prolonged infantile colic and postnatal mental health difficulties were not supported. Perfectionism was found to have direct effects on postnatal mental health. Clinical and theoretical implications, as well future directions for research are discussed. Keywords: perfectionism, perinatal, postnatal, mental health, depression, anxiety
Article
Background: Mothers who identify as Black or African American are more likely to report depressed moods in late pregnancy and early postpartum and have the lowest rates of human milk feeding compared with all other racial groups in the United States. Internet interventions offer the potential to extend preventative and supportive services as they address key barriers, particularly for those navigating the complex and vulnerable early postpartum period. However, there is limited evidence on the feasibility of such interventions for preventing perinatal mental health disorders and improving human milk feeding outcomes in Black mothers. Objective: This pilot study aimed to assess the feasibility and preliminary findings of a web-based cognitive behavioral therapy-based internet intervention, with and without human milk feeding education and support, to prevent perinatal depression and promote human milk feeding in Black mothers. Methods: Participants were Black-identifying individuals between 20 and 28 weeks of pregnancy with human milk feeding intention and mild to moderate depressive symptoms (Patient Health Questionnaire scores 5-14). Participants were randomized to either Sunnyside, a 6-week cognitive behavioral therapy-based web-based intervention, or Sunnyside Plus, which included additional education and support to promote human milk feeding. Assessments occurred at baseline, third trimester (end of antenatal treatment), 6 weeks postpartum (end of postpartum treatment), and 12 weeks postpartum. The primary focus of this randomized pilot trial was the feasibility and preliminary outcomes of mental health and human milk feeding. Results: A total of 22 tertiary-educated participants were randomized. The mean number of log-ins was 7.3 (SD 5.3) for Sunnyside and 13.8 (SD 10.5) for Sunnyside Plus. Scores of depression and anxiety measures remained below the clinical threshold for referral to treatment in both groups. All the participants initiated human milk feeding (18/18, 100%). Most participants reported at least some human milk feeding at both 6 and 12 weeks postpartum (6/7, 86%; 11/11, 100%, or 10/10, 100%, for Sunnyside and Sunnyside Plus, respectively). Conclusions: The results suggest that tertiary-educated Black mothers at risk for perinatal depression and who intended to human milk feed were receptive to and satisfied with a web-based cognitive behavioral therapy-based internet intervention, with and without human milk feeding education and support. Preliminary findings indicate that both Sunnyside and Sunnyside Plus interventions have the potential to affect symptoms of depression, anxiety, and human milk feeding outcomes. Trial registration: ClinicalTrials.gov NCT04128202; https://www.clinicaltrials.gov/ct2/show/NCT04128202.
Article
Objective Perinatal mood and anxiety disorders (PMADs) are common and can interfere with pregnancy, delivery and the postpartum period. Best practice includes symptom screening, patient education and appropriate referrals, however, many hospitals struggle to identify and support PMAD patients. Therefore, the Cedars-Sinai Postpartum Depression Screening, Education and Referral Program was initiated. Methods Using the Standards for QUality Improvement Reporting Excellence (SQUIRE 2.0) guidelines, we report outcomes (N=19,564 deliveries) from four interventions; (1) nurse champion training; (2) Use of the 9-item PHQ-9 in postpartum unit; (3) a series of brief in-service trainings; and (4) a 10 minute video training. We collected data including nurse feedback, screening rates, screen positive rates and social work consultation rates. Results The four interventions improved (1) nurse champion screening comfort and PMAD knowledge; (2) PHQ-9 screening rates from 10% to 99% and screen positive rates from 0.04% to 2.9%; and (3) increased rates of social work consultation from 1.7% to 8.4%. Conclusions Quality improvement results from the first three years of the program suggest that four interventions improved screening rate, screen positive rate and social work consultation rate. Future work will focus on method of screening, patients at highest risk of PMADs and ongoing nurse training.
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Relationship conflict and lack of partner support are risk factors for perinatal mood and anxiety disorders. An intervention to strengthen couples’ relationships before birth may reduce relationship risk factors for perinatal mood and anxiety disorders, though no research has explored this to date. The aims of this Stage 1 open-series non-experimental proof of concept study were to adapt the ‘Marriage Checkup’, an evidence-based intervention for relationship distress, as a preventative intervention for perinatal mood and anxiety disorders and to assess its feasibility and acceptability. Pregnant women receiving care at a university-based obstetric practice, and their partners, were recruited. Ten couples participated in the Before Baby Relationship Checkup, a personalized relationship health service offered in the obstetric clinic. Quantitative and qualitative data gathered suggests the intervention is feasible to implement in an obstetric setting, and acceptable to perinatal couples. Specific adaptations to the Marriage Checkup for perinatal couples are warranted and further testing is needed to evaluate efficacy.
Article
Background: Depression is the most common complication postpartum affecting 10%–15% of women, contributing greatly to maternal mortality and morbidity, but the care availed is very low among the women who suffer. Aim and Objectives: The current study aimed to study the prevalence and associated risk factors of postpartum depression among recently delivered women in a tertiary care hospital of North India. Material and Methods: This was a hospital based cross-sectional study done between May 2019 and January 2020. All women in the study area who had a pregnancy outcome during the past 6 months and have completed 42 days since their last delivery were included in the study. The data on postpartum depression were collected using the Edinburgh Postnatal Depression Scale (EPDS). Results: There were 300 postpartum women in the study area who participated in the study. Mean age of the study participants was 24.5 years. The deliveries were Institutional in 98% of women. The prevalence of depression among the study women (an EPDS score of 10 and above) was 10%. Among women with depression, a history of depression before the last delivery was given by 40% of women. Only 7.5% of women had sought some form of health care for their problem. Conclusion: The study shows that the prevalence of depression among postpartum women is quite high and the health seeking for depression is very low. Health professionals and workers have to be trained to raise awareness, detect, and treat depression among postpartum women promptly
Article
Background: Postpartum depression (PPD) is a devastating mental illness associated with adverse health outcomes for mother, child, and family. Higher PPD prevalence in First American women suggests a racial/ethnic disparity, yet little is known about how PPD is experienced from their perspective. Purpose: To 1) describe First American women's PPD experiences and the meanings they ascribe to those experiences and 2) describe the cultural knowledge, influences, and practices during the perinatal period. Study design and methods: This phenomenological study used a community-based participatory research approach. Criterion and snowball sampling captured First American women who had PPD now or in the past (N = 8). Interviews used a semistructured guide and thematic analysis followed. Results: Mean age was 30.25 years. Most women were multigravidas (n = 7) and rated themselves as "very" (n = 4) or "mostly" (n = 3) Native American. Women were mostly of low socioeconomic status and had a history of depression (n = 7) and/or a history of prenatal depression (n = 6). Themes: 1) stressors that contributed to PPD; 2) how PPD made me feel; 3) what made my PPD better; 4) heritage-centered practices; 5) support through PPD; 6) how I felt after PPD; and 7) am I a good mother? Clinical implications: This study provides a better understanding of some First American women's PPD experiences that facilitates judgment of the importance of PPD within a cultural context. Clinicians need to create culturally appropriate responses to First American women's PPD needs.
Article
We must reconceive the ethical relationship between mothers and their newborn babies. The intertwinement of mother and baby does not disappear with birth but rather persists in the form of postpartum maternal tethering. Drawing upon three years of ethnographic fieldwork and training in the United States and China, I argue that dependencies associated with postpartum maternal tethering make it extremely difficult for postpartum mothers to act autonomously, even in the relational sense. Breaching this tether opens up new possibilities for thinking about the bioethics of vulnerability, dependency, and care by denaturalizing and desanctifying the mother-baby relationship and diversifying newborn care.
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Recent reports in the literature on the health status of southwestern Hispanics, most of whom are Mexican Americans, are reviewed critically. The review is organized into the following sections: infant mortality, mortality at other ages, cardiovascular diseases, cancer, diabetes, other diseases, interview data on physical health, and mental health. Despite methodological limitations of much of the research, it can be concluded with some certainty that the health status of Hispanics in the Southwest is much more similar to the health status of other whites than that of blacks although socioeconomically, the status of Hispanics is closer to that of blacks. This observation is supported by evidence on such key health indicators as infant mortality, life-expectancy, mortality from cardiovascular diseases, mortality from major types of cancer, and measures of functional health. On other health indicators, such as diabetes and infectious and parasitic diseases, Hispanics appear to be clearly disadvantaged relative to other whites. Factors explaining the relative advantages or disadvantages of Hispanics include cultural practices, family supports, selective migration, diet, and genetic heritage. The recently completed Hispanic Health and Nutrition Examination Survey will go a long way to provide answers to many questions regarding the health of Hispanics in the Southwest or elsewhere.
Chapter
In the 1970s, following the publication of influential papers by authors such as Caplan (1974), Cassel (1976), and Cobb (1976), investigators began to study social support (Norbeck, 1988). One oft-cited early study highlighted the potential importance of social support in pregnancy by considering social support as an element of “psychosocial assets” and showing that pregnant women with a combination of high life stress and few psychosocial assets experienced more pregnancy complications than did women with low life stress and a higher level of psychosocial assets (Nuckolls, Cassel, & Kaplan, 1972). Since then, a number of studies have attempted to clarify the role of social support in pregnancy outcomes.
Article
The difficulties inherent in obtaining consistent and adequate diagnoses for the purposes of research and therapy have been pointed out by a number of authors. Pasamanick12 in a recent article viewed the low interclinician agreement on diagnosis as an indictment of the present state of psychiatry and called for "the development of objective, measurable and verifiable criteria of classification based not on personal or parochial considerations, but on behavioral and other objectively measurable manifestations."Attempts by other investigators to subject clinical observations and judgments to objective measurement have resulted in a wide variety of psychiatric rating scales.4,15 These have been well summarized in a review article by Lorr11 on "Rating Scales and Check Lists for the Evaluation of Psychopathology." In the area of psychological testing, a variety of paper-and-pencil tests have been devised for the purpose of measuring specific
This longitudinal study examined depression symptoms among pregnant, low-income, urban Latinas, primarily Puerto Ricans and Dominicans, receiving obstetrical services in community health centers. In all, 106 women were interviewed in late pregnancy, 47 were interviewed again 2 to 3 weeks postpartum, and 42 three months postpartum. Elevated levels of depressive symptoms were evident in 53% of the original sample. Across time, depressive symptoms decreased significantly; however, a decreased score was strongly related to number of negative life events. Social support scores were minimally related to depressive symptomatology. Service recommendations based on these findings include conducting third-trimester assessments of life events experienced during the past year and screening for depression to better identify women at risk of late pregnancy to postpartum–persistent depressive symptoms. More research and clinical attention on dysphoric states in pregnant Latinas and understanding the consequences of impaired perinatal mental health on maternal well-being and infant outcomes are needed.
Article
reviews past research on social support during pregnancy in 2 sections: (1) research on social support and birth outcomes and (2) research linking social support to maternal emotions and behavior in pregnancy / with these reviews as an empirical basis clearly documenting the importance of support in pregnancy, a third section . . . examines ethnic and cultural issues integral to understanding social support processes in pregnancy / [the authors' emphasis] is on Latino or Hispanic culture (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Article
The impact of maternal depression and adversity on mother-infant face-to-face interactions at 2 months, and on subsequent infant cognitive development and attachment, was examined in a low-risk sample of primiparous women and their infants. The severe disturbances in mother-infant engagement characteristic of depressed groups in disadvantaged populations were not evident in the context of postpartum mood disorder in the present study. However, compared to well women, depressed mothers were less sensitively attuned to their infants, and were less affirming and more negating of infant experience. Similar difficulties in maternal interactions were also evident in the context of social and personal adversity. Disturbances in early mother-infant interactions were found to be predictive of poorer infant cognitive outcome at 18 months. Infant attachment, by contrast, was not related to the quality of 2-month interactions, but was significantly associated with the occurrence of adversity, as well as postpartum depression.
Article
This review examines whether children of depressed mothers have elevated rates of psychopathology, and if so, why. The mothers studied ranged from the clinically depressed to those with depressed mood only, and both empirical and theoretical literatures were reviewed. Maternal depression was associated with undesirable parenting practices such as unresponsiveness, inattentiveness, intrusiveness, inept discipline, and negative perceptions of children. Age-typical forms of child psychopathology accompanied maternal depression and associated stressors such as marital discord. Methodological limitations include small, unrepresentative, and heterogeneous samples, depressed parents' unverified reports of child problems, and insensitivity to developmental differences. Incomplete theoretical explanations focus on limited sets of maternal characteristics or highly restricted child age ranges. Needed are methods to predict child adjustment outcomes, attending particularly to parent-child goodness-of-fit, and the role of the father and siblings.
Article
The development of a 10-item self-report scale (EPDS) to screen for Postnatal Depression in the community is described. After extensive pilot interviews a validation study was carried out on 84 mothers using the Research Diagnostic Criteria for depressive illness obtained from Goldberg's Standardised Psychiatric Interview. The EPDS was found to have satisfactory sensitivity and specificity, and was also sensitive to change in the severity of depression over time. The scale can be completed in about 5 minutes and has a simple method of scoring. The use of the EPDS in the secondary prevention of Postnatal Depression is discussed.