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Okeafor IN, Hair NL, Chen B, Hung P. Racial and Ethnic Disparities in Postpartum Depressive Symptoms Before and During the COVID-19 Pandemic. J Womens Health (Larchmt) 2024. [PMID: 38757651 DOI: 10.1089/jwh.2023.0908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/18/2024] Open
Abstract
Background: Existing evidence regarding the impact of the COVID-19 pandemic on postpartum mental health is mixed, with disparate studies showing increased, stable, or even reduced risk of postpartum depression (PPD) amid the pandemic. Furthermore, although it is plausible that the pandemic impacted the mental health of mothers from vulnerable and underserved communities differentially, few studies have characterized racial and ethnic differences in the impact of the COVID-19 pandemic on PPD. Materials and Methods: Pregnancy Risk Assessment Monitoring System data for 2018-2019 (pre-pandemic period) and 2020 (peri-pandemic period) from 40 sites (n = 110,779, representing 5,485,137 postpartum women) were used to determine whether rates of PPD changed during the first year of the pandemic. Postpartum depressive symptoms were assessed using the Patient Health Questionnaire 2-item. Average marginal effects and contrasts of predictive margins derived from a multivariable logistic regression model were used to compare the risk of PPD before and during the pandemic in the overall sample and across racial/ethnic subgroups. Results: Adjusting for sociodemographic and clinical characteristics, we found that the overall risk for PPD remained stable (0.0 percentage points [pp]; 95% confidence interval [CI]: -0.7, 0.6 pp) in the first year of the pandemic. We detected no statistically significant changes in risk for PPD across seven of eight racial/ethnic groups considered; however, the risk of PPD among non-Hispanic Black women fell by 2.0 pp (95% CI: -3.5, -0.4 pp) relative to the pre-pandemic period. Conclusion: We identified important subgroup differences in pandemic-related changes in risk for PPD.
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Affiliation(s)
- Ibitein N Okeafor
- Department of Health Services Policy and Management, University of South Carolina Arnold School of Public Health, Columbia, South Carolina, USA
| | - Nicole L Hair
- Department of Health Services Policy and Management, University of South Carolina Arnold School of Public Health, Columbia, South Carolina, USA
| | - Brian Chen
- Department of Health Services Policy and Management, University of South Carolina Arnold School of Public Health, Columbia, South Carolina, USA
| | - Peiyin Hung
- Department of Health Services Policy and Management, University of South Carolina Arnold School of Public Health, Columbia, South Carolina, USA
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2
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Brooks KM, Charlot-Swilley D, Robertson HA, Bodrick N, Danielson AL, Genovez M, Boogaard C, Morris S, Deshmukh S, Kiker L, Green O, Le HN. "A Judgment-Free Zone": Adaptation and Pilot Study of a Virtual Wellness Group for African American Mothers with Young Children. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:390. [PMID: 38673302 PMCID: PMC11049826 DOI: 10.3390/ijerph21040390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Revised: 03/09/2024] [Accepted: 03/20/2024] [Indexed: 04/28/2024]
Abstract
The COVID-19 pandemic has been particularly challenging for the mental health of African American (AA) birthing people. The pandemic necessitated shifting mental health care to online interventions. The goals of this study were to (1) describe an adapted evidence-based group preventive intervention for AA mothers with young children within a pediatric setting and (2) evaluate the feasibility, acceptability, and preliminary effectiveness of this virtual intervention. Phase 1 describes the adaptation of the HealthySteps Mom's Virtual Wellness Group, including eight weekly sessions based on the Mothers and Babies Course. Phase 2 was a mixed-methods, pre-post intervention design. Six AA mothers with young children completed questionnaires related to depression, anxiety, and parenting competence at three time points: pre-intervention (T1), post-intervention (T2), and 3 months post-intervention (T3). The participants also completed a focus group post-T2 to gather qualitative feedback regarding the intervention. The median scores for depression were lower at T2 and increased at T3, and for anxiety, they increased at T2 and decreased at T3. The median scores for parenting competence increased across the three time points. The participants attended a mean of 7.2 sessions (SD = 0.74). The qualitative results indicate that the participants gained a sense of empowerment, enjoyed connecting with other mothers, and acquired information. This pilot study suggests that a virtual intervention is feasible, acceptable, and can increase parenting competence and support among AA mothers with young children.
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Affiliation(s)
- Kimberly M. Brooks
- Children’s National Hospital, 1 Inventa Place 5th Floor, Silver Spring, MD 20910, USA; (N.B.); (M.G.); (C.B.); (S.D.)
| | - Dominique Charlot-Swilley
- Department of Psychiatry, Medstar Georgetown University Hospital, Washington, DC 20007, USA; (D.C.-S.); (H.A.R.); (A.L.D.)
| | - Hillary A. Robertson
- Department of Psychiatry, Medstar Georgetown University Hospital, Washington, DC 20007, USA; (D.C.-S.); (H.A.R.); (A.L.D.)
| | - Nia Bodrick
- Children’s National Hospital, 1 Inventa Place 5th Floor, Silver Spring, MD 20910, USA; (N.B.); (M.G.); (C.B.); (S.D.)
| | - Aimee L. Danielson
- Department of Psychiatry, Medstar Georgetown University Hospital, Washington, DC 20007, USA; (D.C.-S.); (H.A.R.); (A.L.D.)
| | - Marta Genovez
- Children’s National Hospital, 1 Inventa Place 5th Floor, Silver Spring, MD 20910, USA; (N.B.); (M.G.); (C.B.); (S.D.)
| | - Claire Boogaard
- Children’s National Hospital, 1 Inventa Place 5th Floor, Silver Spring, MD 20910, USA; (N.B.); (M.G.); (C.B.); (S.D.)
| | - Sydney Morris
- Department of Psychology, Palo Alto University, Palo Alto, CA 94308, USA;
| | - Sanyukta Deshmukh
- Children’s National Hospital, 1 Inventa Place 5th Floor, Silver Spring, MD 20910, USA; (N.B.); (M.G.); (C.B.); (S.D.)
| | - Lauren Kiker
- Department of Psychological and Brain Sciences, George Washington University, Washington, DC 20013, USA; (L.K.); (O.G.); (H.-N.L.)
| | - Olukemi Green
- Department of Psychological and Brain Sciences, George Washington University, Washington, DC 20013, USA; (L.K.); (O.G.); (H.-N.L.)
| | - Huynh-Nhu Le
- Department of Psychological and Brain Sciences, George Washington University, Washington, DC 20013, USA; (L.K.); (O.G.); (H.-N.L.)
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3
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Gilliam SM, Hylick K, Taylor EN, La Barrie DL, Hatchett EE, Finch MY, Kavalakuntla Y. Intersectionality in Black Maternal Health Experiences: Implications for Intersectional Maternal Mental Health Research, Policy, and Practice. J Midwifery Womens Health 2024. [PMID: 38319012 DOI: 10.1111/jmwh.13609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 12/11/2023] [Indexed: 02/07/2024]
Abstract
INTRODUCTION Black women experience significant maternal mortality and morbidity disparities in the United States. Although emerging research has focused on reducing maternal mortality rates among Black birthing individuals, we must explore structural and social factors contributing to mental health outcomes during the perinatal period. Gaps exist where intersectional identities and experiences in maternal and child health are examined. This study explores the intersectional stress experiences of Black perinatal women in the South. METHODS We collected qualitative data through virtual semistructured interviews with 9 pregnant and 7 postpartum participants (N = 16).These interviews assessed feelings, attitudes, and perceptions about psychological stress due to their intersectional experiences of being Black, pregnant, and a woman in the United States. Findings were analyzed through the lens of critical race theory and intersectionality. RESULTS We identified 5 overarching themes: (1) perinatal mental health experiences, (2) birthing and parenting while Black, (3) socioeconomic factors, (4) how we cope, and (5) community and social support. DISCUSSION Overall, this study revealed how the layers of race, gender, pregnancy, and socioeconomic status influence mental health during the perinatal period. These findings show the need for antiracist and intersectional maternal mental health policies and practices.
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Affiliation(s)
| | - Kandyce Hylick
- Department of Health Promotion and Behavior, University of Georgia, Athens, Georgia
| | - Erica N Taylor
- Department of Health Promotion and Behavior, University of Georgia, Athens, Georgia
| | | | - Emily E Hatchett
- Department of Health Promotion and Behavior, University of Georgia, Athens, Georgia
| | - Morgan Y Finch
- Department of Health Promotion and Behavior, University of Georgia, Athens, Georgia
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4
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Tong M, Hurtado A, Deshpande R, Pietrzak RH, He C, Kaplan C, Kaplan S, Akhtar S, Feder A, Feingold JH, Ripp JA, Peccoralo LA. Psychological Burden of Systemic Racism-Related Distress in New York City Healthcare Workers During the COVID-19 Pandemic. J Gen Intern Med 2024; 39:450-459. [PMID: 37845586 PMCID: PMC10897117 DOI: 10.1007/s11606-023-08422-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 09/07/2023] [Indexed: 10/18/2023]
Abstract
BACKGROUND Little is known about the relationship among systemic racism, psychological symptoms (depression, anxiety, and/or post-traumatic stress disorders), and burnout in healthcare workers (HCWs). OBJECTIVE To determine whether distress related to awareness of systemic racism contributes to psychological symptoms and/or burnout in HCWs. We explored whether this form of racism-related distress may moderate the relationship between race, ethnicity, psychological symptoms, and burnout. DESIGN A cross-sectional survey was conducted from November 19, 2020, through January 11, 2021. Statistical analysis was conducted from May 3, 2022, to June 15, 2022. PARTICIPANTS Frontline HCWs at an urban tertiary care hospital in New York City. MAIN MEASURES Distress related to awareness of systemic racism (SR) and racial disparities in COVID-19 outcomes (RD), psychological symptoms, and burnout. KEY RESULTS Two thousand one of 4654 HCWs completed the survey (response rate 43.0%). Most HCWs reported experiencing distress related to awareness of systemic racism (1329 [66.4%]) and to racial disparities in COVID-19 outcomes (1137 [56.8%]). Non-Hispanic Black participants (SR odds ratio (OR) 2.84, p < .001; RD OR 2.34, p < .001), women (SR OR 1.35, p = .01; RD OR 1.67, p < .001), and those with history of mental illness (SR OR 2.13, p < .001; RD OR 1.66, p < .001) were more likely to report SR- and RD-related distress, respectively. HCWs who experienced "quite-a-bit to extreme" SR-related distress were more likely to screen positive for psychological symptoms (OR 5.90, p < .001) and burnout (OR 2.26, p < .001). CONCLUSIONS Our findings suggest that distress related to awareness of systemic racism, not race/ethnicity, was associated with experiencing psychological symptoms and burnout in HCWs. As the medical community continues to critically examine the role of systemic racism in healthcare, our work is a first step in characterizing its toll on the psychological well-being of HCWs.
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Affiliation(s)
- Michelle Tong
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Medical Education, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1087, New York, NY, 10029, USA
| | - Alicia Hurtado
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Medical Education, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1087, New York, NY, 10029, USA
| | - Richa Deshpande
- Center for Biostatistics, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Robert H Pietrzak
- U.S. Department of Veterans Affairs National Center for Posttraumatic Stress Disorder, VA Connecticut Healthcare System, West Haven, CT, USA
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT, USA
| | - Celestine He
- Department of Medical Education, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1087, New York, NY, 10029, USA
| | - Carly Kaplan
- Department of Medical Education, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1087, New York, NY, 10029, USA
| | - Sabrina Kaplan
- Department of Medical Education, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1087, New York, NY, 10029, USA
| | - Saadia Akhtar
- Department of Medical Education, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1087, New York, NY, 10029, USA
- Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Adriana Feder
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Jordyn H Feingold
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Jonathan A Ripp
- Department of Medical Education, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1087, New York, NY, 10029, USA
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Lauren A Peccoralo
- Department of Medical Education, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1087, New York, NY, 10029, USA.
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
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Lenze SN, McKay-Gist K, Paul R, Tepe M, Mathews K, Kornfield S, Phillips C, Smith R, Stoermer A, Carter EB. Elevating Voices, Addressing Depression, Toxic Stress, and Equity Through Group Prenatal Care: A Pilot Study. Health Equity 2024; 8:87-95. [PMID: 38287981 PMCID: PMC10823176 DOI: 10.1089/heq.2023.0160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/08/2023] [Indexed: 01/31/2024] Open
Abstract
Introduction Elevating Voices, Addressing Depression, Toxic Stress and Equity (EleVATE) is a group prenatal care (GC) model designed to improve pregnancy outcomes and promote health equity for Black birthing people. This article outlines the foundational community-engaged process to develop EleVATE GC and pilot study results. Methods We used community-based participatory research principles and the Ferguson Commission Report to guide creation of EleVATE GC. The intervention, designed by and for Black birthing people, centers trauma-informed care, antiracism, and integrates behavioral health strategies into group prenatal care to address unmet mental health needs. Using a convenience sample of patients seeking care at one of three safety-net health care sites, we compared preterm birth, small for gestational age, depression scores, and other pregnancy outcomes between patients in individual care (IC), CenteringPregnancy™ (CP), and EleVATE GC. Results Forty-eight patients enrolled in the study (n=11 IC; n=14 CP; n=23 EleVATE GC) and 86% self-identified as Black. Patients participating in group prenatal care (EleVATE GC or CP) were significantly less likely to experience a preterm birth <34 weeks. Rates of small for gestational age, preterm birth <37 weeks, depression scores, and other pregnancy outcomes were similar across groups. Participants in CP and EleVATE GC were more likely to attend their postpartum visit and breastfeed at hospital discharge than those in IC. Discussion Our findings model a systematic approach to design a feasible, patient-centered, community-based, trauma-informed, antiracist intervention. Further study is needed to determine whether EleVATE GC improves perinatal outcomes and promotes health equity.
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Affiliation(s)
- Shannon N. Lenze
- Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri, USA
| | | | - Rachel Paul
- Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, Missouri, USA
| | | | - Katherine Mathews
- SSM Health St. Mary's and Department of Obstetrics, Gynecology, and Women's Health, St. Louis University, St. Louis, Missouri, USA
| | - Sara Kornfield
- Center for Women's Behavioral Wellness, Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Cheron Phillips
- St. Louis Integrated Health Network, St. Louis, Missouri, USA
| | - Richelle Smith
- St. Louis Integrated Health Network, St. Louis, Missouri, USA
| | - Amanda Stoermer
- St. Louis Integrated Health Network, St. Louis, Missouri, USA
| | - Ebony B. Carter
- Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, Missouri, USA
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6
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Waller R, Paz Y, Himes MM, White LK, Rodriguez Y, Gorgone A, Luby J, Gerstein ED, Brady RG, Chaiyachati BH, Duncan A, Barzilay R, Kornfield SL, Burris HH, Seidlitz J, Parish-Morris J, Laney N, Gur RE, Njoroge WFM. Observations of Positive Parenting from Online Parent-Child Interactions at Age 1. PARENTING, SCIENCE AND PRACTICE 2024; 24:39-65. [PMID: 38188653 PMCID: PMC10766433 DOI: 10.1080/15295192.2023.2286454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/09/2024]
Abstract
Objective Brief, reliable, and cost-effective methods to assess parenting are critical for advancing parenting research. Design We adapted the Three Bags task and Parent Child Interaction Rating System (PCIRS) for rating online visits with 219 parent-child dyads (White, n = 104 [47.5%], Black, n = 115 [52.5%]) and combined the video data with survey data collected during pregnancy and when children were aged 1. Results The PCIRS codes of positive regard, stimulation of child cognitive development, and sensitivity showed high reliability across the three parent-child interaction tasks. A latent positive parenting factor combining ratings across codes and tasks showed good model fit, which was similar regardless of parent self-identified race or ethnicity, age, socioeconomic disadvantage, marital/partnered status, and parity, as well as methodological factors relevant to the online video assessment method (e.g., phone vs. laptop/tablet). In support of construct validity, observed positive parenting was related to parent-reported positive parenting and child socioemotional development. Finally, parent reports of supportive relationships in pregnancy, but not neighborhood safety or pandemic worries, were prospectively related to higher positive parenting observed at age 1. With the exception of older parental age and married/partnered status, no other parent, child, sociodemographic, or methodological variables were related to higher overall video exclusions across tasks. Conclusions PCIRS may provide a reliable approach to rate positive parenting at age 1, providing future avenues for developing more ecologically valid assessments and implementing interventions through online encounters that may be more acceptable, accessible, or preferred among parents of young children.
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Affiliation(s)
- Rebecca Waller
- Department of Psychology, University of Pennsylvania, Stephen A Levin Building, 425 S University Ave, Philadelphia, PA 19104, USA
| | | | | | | | | | | | - Joan Luby
- Washington University School of Medicine
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7
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Elias A, Ben J. Pandemic Racism: Lessons on the Nature, Structures, and Trajectories of Racism During COVID-19. JOURNAL OF BIOETHICAL INQUIRY 2023; 20:617-623. [PMID: 37917295 PMCID: PMC10942924 DOI: 10.1007/s11673-023-10312-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 10/10/2023] [Indexed: 11/04/2023]
Abstract
The COVID-19 pandemic has been one of the most acute global crises in recent history, which profoundly impacted the world across many dimensions. During this period, racism manifested in ways specifically related to the pandemic, including xenophobic sentiments, racial attacks, discriminatory policies, and disparate outcomes across racial/ethnic groups. This paper examines some of the pressing questions about pandemic racism and inequity. We review what research has revealed about the nature and manifestations of racism, the entrenchment of structural racism, and trajectories of racism during COVID-19.
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Affiliation(s)
- A Elias
- Alfred Deakin Institute for Citizenship and Globalisation, Deakin University, 221 Burwood HWY, Burwood, Victoria, 3125, Australia.
| | - J Ben
- Alfred Deakin Institute for Citizenship and Globalisation, Deakin University, 221 Burwood HWY, Burwood, Victoria, 3125, Australia
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8
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Hill AV, Balascio P, Moore M, Hossain F, Dwarkananth M, De Genna NM. Young black women's desired pregnancy and birthing support during coronavirus disease 2019 pandemic. SSM. QUALITATIVE RESEARCH IN HEALTH 2023; 4:100333. [PMID: 38106375 PMCID: PMC10722556 DOI: 10.1016/j.ssmqr.2023.100333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/19/2023]
Abstract
Objective To document pregnancy and birthing experiences of young, Black pregnant women in one geographic area to make recommendations for improving young Black women's pregnancy and birthing experiences. Methods Participants were recruited through The YoungMoms Study (R01 DA04640101A1) in Pittsburgh, Pennsylvania, and included Black or biracial participants ages 16-23 (n = 25). Individual interviews were conducted from March 2022-July 2022 to assess pre-, peri-, and post-natal healthcare system encounters; experiences of structural and obstetric racism and discrimination in healthcare settings while obtaining prenatal care; attitudes around healthcare systems and medical professionals; effects of COVID-19 pandemic on participants lives and the impact of enacted healthcare policies in their perinatal experience; substance use changes during pregnancy; and coping mechanisms for stress. NVivo 13 was used to code transcripts, then major themes and subthemes were identified using thematic content analysis and based on grounded theory. Results Twenty-five interviews were conducted, and four themes emerged from participant experiences of racial discrimination in healthcare settings; (1) awareness of historical racism that influences perinatal care; (2) clinical providers assume participant substance use and enact reproductive coercion; (3) clinical providers question validity of Black women's birthing complaint; and (4) Young Black pregnant women know and will express what they desire in their perinatal experience if asked. Conclusions Young Black pregnant women encounter structural racism and intersectional bias from healthcare providers. By centering the perspectives and experiences of this overlooked population, public health researchers and clinical providers can utilize anti-racist frameworks to create more equitable, just practices in reproductive healthcare.
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Affiliation(s)
- Ashley V. Hill
- Department of Epidemiology, University of Pittsburgh School of Public Health, Pittsburgh, PA, USA
| | - Phoebe Balascio
- Department of Epidemiology, University of Pittsburgh School of Public Health, Pittsburgh, PA, USA
| | - Mikaela Moore
- Department of Epidemiology, University of Pittsburgh School of Public Health, Pittsburgh, PA, USA
| | - Fahmida Hossain
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Megana Dwarkananth
- Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Natacha M. De Genna
- Department of Epidemiology, University of Pittsburgh School of Public Health, Pittsburgh, PA, USA
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
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9
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Meeker JR, Strid P, Simeone R, D'Angelo DV, Dieke A, von Essen BS, Galang RR, Zapata LB, Ellington S. Pandemic-related stressors and mental health among women with a live birth in 2020. Arch Womens Ment Health 2023; 26:767-776. [PMID: 37608095 PMCID: PMC11025528 DOI: 10.1007/s00737-023-01364-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 08/12/2023] [Indexed: 08/24/2023]
Abstract
The objective of this analysis was to assess the associations between pandemic-related stressors and feeling more anxious/depressed, among women with a live birth. We analyzed data from the Pregnancy Risk Assessment Monitoring System (PRAMS) COVID-19 maternal experiences supplement, implemented in 29 U.S. jurisdictions from October 2020-June 2021, among women with a live birth during April-December 2020. We examined stressors by type (economic, housing, childcare, food insecurity, partner, COVID-19 illness) and score (number of stressor types experienced [none, 1-2, 3-4, or 5-6]). Outcomes were feeling 1) more anxious and 2) more depressed than usual due to the pandemic. We calculated adjusted prevalence ratios estimating associations between stressors and outcomes. Among 12,525 respondents, half reported feeling more anxious and 28% more depressed than usual. The prevalence of stressor types was 50% economic, 41% childcare, 18% partner, 17% food insecurity, 12% housing, and 10% COVID-19 illness. Respondents who experienced partner stressors (anxious aPR: 1.81, 95% CI: 1.73-1.90; depressed aPR: 3.01, 95% CI: 2.78-3.25) and food insecurity (anxious aPR: 1.79, 95% CI: 1.71-1.88; depressed aPR: 2.32, 95% CI: 2.13-2.53) had the largest associations with feeling more anxious and depressed than usual. As stressor scores increased, so did the aPRs for feeling more anxious and more depressed due to the pandemic. COVID-19 stressors, not COVID-19 illness, were found to be significantly associated with feeling more anxious and depressed. Pregnant and postpartum women might benefit from access to supports and services to address pandemic-related stressors/social-determinants and feelings of anxiety and depression.
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Affiliation(s)
- Jessica R Meeker
- USA Centers for Disease Control and Prevention, 4770 Buford Highway, MS 107-2, Atlanta, GA, 30341, USA.
| | - Penelope Strid
- USA Centers for Disease Control and Prevention, 4770 Buford Highway, MS 107-2, Atlanta, GA, 30341, USA
| | - Regina Simeone
- USA Centers for Disease Control and Prevention, 4770 Buford Highway, MS 107-2, Atlanta, GA, 30341, USA
| | - Denise V D'Angelo
- USA Centers for Disease Control and Prevention, 4770 Buford Highway, MS 107-2, Atlanta, GA, 30341, USA
| | - Ada Dieke
- USA Centers for Disease Control and Prevention, 4770 Buford Highway, MS 107-2, Atlanta, GA, 30341, USA
| | | | - Romeo R Galang
- USA Centers for Disease Control and Prevention, 4770 Buford Highway, MS 107-2, Atlanta, GA, 30341, USA
| | - Lauren B Zapata
- USA Centers for Disease Control and Prevention, 4770 Buford Highway, MS 107-2, Atlanta, GA, 30341, USA
| | - Sascha Ellington
- USA Centers for Disease Control and Prevention, 4770 Buford Highway, MS 107-2, Atlanta, GA, 30341, USA
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10
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Gizamba JM, Wilson JP, Mendenhall E, Ferguson L. A review of place-related contextual factors in syndemics research. Health Place 2023; 83:103084. [PMID: 37437495 DOI: 10.1016/j.healthplace.2023.103084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 06/16/2023] [Accepted: 07/04/2023] [Indexed: 07/14/2023]
Abstract
This review investigates the extent to which a place-based approach has been used to conceptualize context, as well as the place-related contextual factors explored in studies that explicitly invoked a syndemic framework. The literature search focused on 29 peer-reviewed empirical syndemic studies. Only 11 studies used a place-based approach to define and measure contextual factors and the spatial context was denoted using administrative boundaries such as census tracts, counties, and countries. A narrow range of place-related contextual factors were explored and most of them were related to social and economic factors that were used to define a place. Methodological gaps like a paucity of multilevel studies and studies using a place-based approach to measure context were identified. Future syndemics research should leverage multidimensional geospatial approaches to decipher the role of place-related contextual factors in syndemic dynamics.
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Affiliation(s)
| | - John P Wilson
- Spatial Science Institute, University of Southern California, Los Angeles, USA
| | - Emily Mendenhall
- School of Foreign Service, Georgetown University, Washington, DC, USA
| | - Laura Ferguson
- Institute on Inequalities in Global Health, Keck School of Medicine, University of Southern California, Los Angeles, USA
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11
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Santos IS, Tovo-Rodrigues L, Maruyama JM, Barros AJD, Bierhals I, Del Ponte B, Matijasevich A. Impact of covid-19 pandemic over depressive symptoms among mothers from a population-based birth cohort in southern brazil. Arch Womens Ment Health 2023:10.1007/s00737-023-01331-2. [PMID: 37225910 DOI: 10.1007/s00737-023-01331-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 05/19/2023] [Indexed: 05/26/2023]
Abstract
PURPOSE Our aim was to assess the impact of COVID-19 on depressive symptoms among mothers from a population-based birth cohort in Pelotas, Southern Brazil. METHODS A subgroup of mothers from the Pelotas 2004 Birth Cohort was assessed pre-pandemic (November,2019 to March,2020) and mid-pandemic (August-December,2021). In both follow-ups, depressive symptoms were assessed using the Edinburgh Postnatal Depression Scale (EPDS). Pre-pandemic (T1) and pandemic-related predictors (T2) were analyzed. Prevalence of depression (EPDS score ≥ 13) at T1 and T2 were compared with chi-square test. Changes in EPDS from T1 to T2 were estimated by multivariate latent change score modelling. RESULTS 1,550 women were assessed. Prevalence of depression increased 38.1% (from 18.9% at T1 to 26.1% at T2) (p < 0.001). At T1, higher schooling, higher family income and being employed or working were related to lower EPDS, whereas being beneficiary of a cash transfer program and a larger number of people living in the household predicted higher EPDS. The deterioration of ones' own perception of quality of overall health (β = 0.191; SE = 0.028; p < 0.001) and worst family financial situation due to the pandemic (β = 0.083; SE = 0.024; p = 0.001) predicted the increase in EPDS from T1 to T2. CONCLUSION Almost two years after the beginning of the pandemic, the prevalence of depressive symptoms among the women was higher than before the pandemic. The deterioration of ones' own perception of quality of overall health and worst family financial situation due to the pandemic are proxies for the effect of COVID-19 pandemic (the true exposure of interest) in the women mental health.
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Affiliation(s)
- Iná S Santos
- Programa de Pós-Graduação Em Epidemiologia, Faculdade de Medicina, Universidade Federal de Pelotas, Rua Marechal Deodoro, 1160, 3º Piso, Pelotas, RS, CEP 96020-220, Brazil.
| | - Luciana Tovo-Rodrigues
- Programa de Pós-Graduação Em Epidemiologia, Faculdade de Medicina, Universidade Federal de Pelotas, Rua Marechal Deodoro, 1160, 3º Piso, Pelotas, RS, CEP 96020-220, Brazil
| | - Jessica M Maruyama
- Departamento de Medicina Preventiva, Faculdade de Medicina FMUSP, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Aluísio J D Barros
- Programa de Pós-Graduação Em Epidemiologia, Faculdade de Medicina, Universidade Federal de Pelotas, Rua Marechal Deodoro, 1160, 3º Piso, Pelotas, RS, CEP 96020-220, Brazil
| | - Isabel Bierhals
- Programa de Pós-Graduação Em Epidemiologia, Faculdade de Medicina, Universidade Federal de Pelotas, Rua Marechal Deodoro, 1160, 3º Piso, Pelotas, RS, CEP 96020-220, Brazil
| | - Bianca Del Ponte
- Programa de Pós-Graduação Em Epidemiologia, Faculdade de Medicina, Universidade Federal de Pelotas, Rua Marechal Deodoro, 1160, 3º Piso, Pelotas, RS, CEP 96020-220, Brazil
| | - Alicia Matijasevich
- Departamento de Medicina Preventiva, Faculdade de Medicina FMUSP, Universidade de São Paulo, São Paulo, SP, Brazil
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Turpin R, Giorgi S, Curtis B. Pandemic distress associated with segregation and social stressors. Front Public Health 2023; 11:1092269. [PMID: 37033081 PMCID: PMC10080044 DOI: 10.3389/fpubh.2023.1092269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 03/03/2023] [Indexed: 04/11/2023] Open
Abstract
Background Racial/ethnic minorities are disproportionately impacted by the COVID-19 pandemic, as they are more likely to experience structural and interpersonal racial discrimination, and thus social marginalization. Based on this, we tested for associations between pandemic distress outcomes and four exposures: racial segregation, coronavirus-related racial bias, social status, and social support. Methods Data were collected as part of a larger longitudinal national study on mental health during the pandemic (n = 1,309). We tested if county-level segregation and individual-level social status, social support, and coronavirus racial bias were associated with pandemic distress using cumulative ordinal regression models, both unadjusted and adjusted for covariates (gender, age, education, and income). Results Both the segregation index (PR = 1.19; 95% CI 1.03, 1.36) and the coronavirus racial bias scale (PR = 1.17; 95% CI 1.06, 1.29) were significantly associated with pandemic distress. Estimates were similar, after adjusting for covariates, for both segregation (aPR = 1.15; 95% CI 1.01, 1.31) and coronavirus racial bias (PR = 1.12; 95% CI 1.02, 1.24). Higher social status (aPR = 0.74; 95% CI 0.64, 0.86) and social support (aPR = 0.81; 95% CI 0.73, 0.90) were associated with lower pandemic distress after adjustment. Conclusion Segregation and coronavirus racial bias are relevant pandemic stressors, and thus have implications for minority health. Future research exploring potential mechanisms of this relationship, including specific forms of racial discrimination related to pandemic distress and implications for social justice efforts, are recommended.
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Affiliation(s)
- Rodman Turpin
- Department of Global and Community Health, College of Public Health, George Mason University, Fairfax, VA, United States
- *Correspondence: Rodman Turpin, ; Brenda Curtis,
| | - Salvatore Giorgi
- National Institute on Drug Abuse, National Institutes of Health, Bethesda, MD, United States
| | - Brenda Curtis
- National Institute on Drug Abuse, National Institutes of Health, Bethesda, MD, United States
- *Correspondence: Rodman Turpin, ; Brenda Curtis,
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Abstract
Importance The COVID-19 pandemic has prompted an unprecedented need to rapidly investigate the potential consequences for maternal mental health, infant and child development, and the mother-infant relationship. Observations Globally, the mental health of pregnant and postpartum individuals has worsened during the pandemic regardless of infection status, and these concerning changes have disproportionally affected racial and ethnic minoritized people from underserved populations. Early indicators of infant neurobehavioral outcomes suggest that while in utero exposure to a maternal SARS-CoV-2 infection is likely negligible, limited data are available regarding the neurodevelopmental consequences for the generation of infants born during the pandemic. High maternal depression and grief during the COVID-19 pandemic are associated with lower levels of self-reported maternal-infant bonding. Yet nearly all published reports of child neurodevelopmental outcomes and dyadic functioning in the context of the pandemic rely on self-reported and parent-reported measures, which are subject to bias. Conclusions and Relevance In the context of prior research, and considering the paucity of research on infant neurodevelopment following prenatal SARS-CoV-2 exposure and birth during the pandemic, robust scientific investigation is needed to detect indicators of compromised early outcomes that could inform widespread assessment and accessible intervention. We simultaneously caution against reflexive apprehension regarding the generation of children born during the COVID-19 pandemic.
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Affiliation(s)
- Morgan R Firestein
- Division of Developmental Neuroscience, Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York, New York
| | - Dani Dumitriu
- Division of Developmental Neuroscience, Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York, New York
- Division of Child and Adolescent Health, Department of Pediatrics, Columbia University Vagelos College of Physicians and Surgeons and NewYork-Presbyterian, New York
| | - Rachel Marsh
- Division of Child and Adolescent Psychiatry, Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York, New York
- New York State Psychiatric Institute, New York
| | - Catherine Monk
- New York State Psychiatric Institute, New York
- Division of Behavioral Medicine, Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York, New York
- Department of Obstetrics and Gynecology, Columbia University Vagelos College of Physicians and Surgeons, New York, New York
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Clinician-reported childbirth outcomes, patient-reported childbirth trauma, and risk for postpartum depression. Arch Womens Ment Health 2022; 25:985-993. [PMID: 36030417 PMCID: PMC9420181 DOI: 10.1007/s00737-022-01263-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 08/23/2022] [Indexed: 11/02/2022]
Abstract
Childbirth trauma is common and increases risk for postpartum depression (PPD). However, we lack brief measures to reliably identify individuals who experience childbirth trauma and who may be at greater prospective risk for PPD. To address this gap, we used data from a racially diverse prospective cohort (n=1082). We collected survey data during pregnancy and at 12 weeks postpartum, as well as clinician-reported data from medical records. A new three-item measure of patient-reported childbirth trauma was a robust and independent risk factor for PPD, above and beyond other known risk factors for PPD, including prenatal anxiety and depression. Cesarean birth, greater blood loss, and preterm birth were each associated with greater patient-reported childbirth trauma. Finally, there were prospective indirect pathways whereby cesarean birth and higher blood loss were related to higher patient-reported childbirth trauma, in turn predicting greater risk for PPD. Early universal postpartum screening for childbirth trauma, targeted attention to individuals with childbirth complications, and continued screening for depression and anxiety can identify individuals at risk for PPD. Such efforts can inform targeted interventions to improve maternal mental health, which plays a vital role in infant development.
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