Social support and self-esteem as mediators between stress and antepartum depressive symptoms in rural pregnant women

Experiential avoidance as a mediator of risk factors for higher order internalizing psychopathology in the perinatal period

OBJECTIVES

Perinatal psychopathology can be damaging. This study examined the strength of the associations between risk factors and all perinatal mood and anxiety disorder symptoms while assessing the mediating effect of experiential avoidance.

METHOD

Participants (N = 246) completed assessments during pregnancy (28-32 weeks) and the postpartum (6-8 weeks). Structural equation modeling (SEM) was used to examine associations between risk factors and latent factors: distress (composed of depression, generalized anxiety, irritability, and panic symptoms); fear (social anxiety, agoraphobia, specific phobia, and obsessive-compulsive); and bipolar (mania and obsessive-compulsive).

RESULTS

During pregnancy, past psychiatric history, anxiety sensitivity, maladaptive coping, and age were significant risk factors. In the postpartum, negative maternal attitudes and past psychiatric history were only risk factors for symptoms that composed distress. Experiential avoidance mediated the relation between maladaptive coping and symptoms that composed fear.

CONCLUSION

It is important to assess for psychological risk factors starting in pregnancy. This study identified critical risk factors that are associated with the underlying commonality among perinatal mood and anxiety symptoms. Some of the risk factors as well as the mediator are malleable (negative maternal attitudes, experiential avoidance), creating new possibilities for prevention and treatment of perinatal mood and anxiety disorder symptoms.

Perceived stress and life satisfaction in pregnant women during the COVID-19 pandemic: the mediating role of fear of childbirth and self-esteem

BACKGROUND

The COVID-19 pandemic adversely affected the functioning and well-being of pregnant women. Negative feelings during pregnancy and the difficult pandemic situation may be the reason behind the perceived fear of childbirth, which can negatively affect the pregnant women's life satisfaction. On the other hand, some protective factors, such as self-esteem, might mediate the relationship between perceived stress and well-being in pregnant women.

PARTICIPANTS AND PROCEDURE

Our study aimed to determine the relationship between perceived stress, fear of childbirth, self-esteem and life satisfaction. A total of 262 Polish pregnant women participated in this study. The Perceived Stress Scale (PSS-10), Fear of Childbirth Scale (KLP II), Self-Esteem Scale (SES) and Satisfaction with Life Scale (SWLS) were used in the study.

RESULTS

The results showed that perceived stress, fear of childbirth and self-esteem acted as significant predictors of life satisfaction in the tested group of pregnant women. Additionally, fear of childbirth and self-esteem played a mediational role in the relationship between perceived stress and life satisfaction.

CONCLUSIONS

According to Diener's concept, life satisfaction is an important component of one's subjective well-being and health. Therefore, it is important to analyse factors that may mediate the impact of stress on pregnant women's life satisfaction. The present results might suggest that during pregnancy and preparation for childbirth, women should be provided with appropriate psychological care. Support from medical and psychological specialists, as well as from relatives, can reduce the level of perceived fears and strengthen personal resources. Based on the present results, we conclude that the fear of childbirth and the self-esteem of pregnant women should not be underestimated, as they are important predictors of their life satisfaction.

Occupational stress and mental health among civil servants during COVID-19 in China: The mediation effect of social support and work-family conflict

Mental health problems of various populations during the COVID-19 pandemic have received high attention, but there is little research on the mental health of Chinese civil servants. The present study investigated occupational stress, mental health problems (i.e., anxiety, depression, and insomnia), social support, and work-family conflict in Chinese civil servants during the COVID-19 pandemic. A total of 327 civil servants in Wenzhou city, China, participated in an online survey, which collected data on socio-demographic characteristics, occupational stress, mental health problems (i.e., anxiety, depression, and insomnia), social support, and work-family conflict. Data were analyzed using non-parametric tests and a multiple mediation model. Self-reported risk at work and support from mental health workers were relatively low. Anxiety, depression, and insomnia prevalence were 49.24 %, 47.1 %, and 20.48 %, respectively. Those who held higher ranks at work had lower levels of anxiety and depression. In addition, those who felt bad about their health status had more mental health problems. Social support and work-family conflict mediated the relationship between occupational stress and mental health problems significantly. Stress management training, organizational-level improvement in work arrangements, and professional mental health services are warranted for Chinese civil servants during the pandemic.

The Relationship between Competitive Class Climate and Cyberloafing among Chinese Adolescents: A Curvilinear Moderated Mediation Model

Since COVID-19 was officially listed as a pandemic, online schooling has become a more pervasive form of learning, and cyberloafing has become a widespread behavior, even among adolescents. However, less research has explored the influencing mechanism of adolescents' cyberloafing. Based on relevant studies and the real lives of adolescents, this study aimed to examine the association between a competitive class climate and cyberloafing among adolescents, its underlying mechanism, the mediating role of perceived stress and the moderating role of self-esteem. A total of 686 adolescents were recruited to complete a set of questionnaires assessing cyberloafing, perceived stress, self-esteem, and perceived competitive class climate. The results showed that a competitive class climate was positively associated with perceived stress, and the U-shaped relationship between perceived stress and cyberloafing was significant. Perceived stress mediated the relationship between a competitive class climate and cyberloafing. Meanwhile, self-esteem moderated the U-shaped relationship between perceived stress and cyberloafing and the linear relationship between a competitive class climate and perceived stress. The results of this study indicate that the influence of a competitive class climate on individual learning behavior may be nonlinear, and proper competition can contribute to reducing individual cyberloafing.

Women's experience of mild to moderate mental health problems during pregnancy, and barriers to receiving support

OBJECTIVE

To explore the experiences of women during pregnancy with mild to moderate mental health problems and describe the barriers to receiving support in relation to their mental health.

RESEARCH DESIGN AND PARTICIPANTS

This paper reports part of a larger project which recruited women and midwives in one hospital in Wales. Participants completed questionnaires in early pregnancy in an antenatal clinic, and the characteristics of women with and without symptoms of anxiety and depression compared. All women were invited to express interest in a follow up interview in late pregnancy. Women identified to have depression and anxiety in early pregnancy, but not under the care of perinatal mental health services, were eligible for interview. Interviews were conducted with 20 women using a visual timeline to aid discussion and were thematically analysed.

FINDINGS

In late pregnancy mental health disorders were reported by nine women, of which five were diagnosed during adulthood. EPDS scores found 15 women had symptoms of mild to moderate depression and GAD-7 scores indicating 15 women with mild to moderate anxiety. Three themes were identified: moods and emotions - past, present and future; expectations and control; knowledge and conversations.

KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE

Due to limited access to specialist perinatal mental health services women relied on support networks and self-care to maintain their mental health. More time and better continuity at antenatal appointments along with improved mental health literacy may increase discussions regarding women's mental health during pregnancy. In addition investment is required to develop strategies and improve access to mental health services for women with mild to moderate mental health problems.

Perceived social support predicts self-reported and objective health and health behaviors among pregnant women

Perinatal health and health behaviors play a crucial role in maternal and neonatal health. Data examining psychosocial factors which predict self-reported health and health behaviors as well as objective indicators downstream of health behaviors among pregnant women are lacking. In this longitudinal study design with 131 pregnant women, perceived social support was examined as a predictor of self-rated health and average levels of sleep quality, health-promoting and health-impairing behaviors, and red blood cell (RBC) polyunsaturated fatty acids across early, mid, and late pregnancy. Participants provided a blood sample and fatty acid methyl esters were analyzed by gas chromatography. Measures included the Multidimensional Scale of Perceived Social Support, Pittsburgh Sleep Quality Index, and Prenatal Health Behavior Scale. Regression models demonstrated that, after adjustment for income, race/ethnicity, age, relationship status, pre-pregnancy body mass index, greater social support was associated with better self-rated health (p = 0.001), greater sleep quality (p = 0.001), fewer health-impairing behaviors (p = 0.02), and higher RBC omega-3 fatty acids (p = 0.003). Associations among social support with health-promoting behaviors, RBC omega-6 fatty acids, or gestational weight gain were not significant. Findings underscore the benefits of perceived social support in the context of pregnancy. Examination of pathways that link social support with these outcomes will be meaningful in determining the ways in which perinatal psychosocial interventions may promote health.

The Impact of Unwanted Pregnancy in Adolescents toward Pregnancy Care: A Systematic Review

BACKGROUND: The unwanted pregnancy in adolescents causes the rejection of pregnancy and fetus itself. AIM: The purpose of this literature review is to determine the impact of unwanted pregnancy on pregnancy care in adolescents. METHODS: The method used a systematic review. The data search using an advanced search techniques on databases and search engines such as CINAHL, PubMed, and Google Scholar. The literature search is based on qualitative study design criteria, national and international articles, published in the past 10 years (2011–2021), and written in Indonesian and English. RESULTS: From the six articles reviewed, it was found that there were 10 impacts of adverse events on pregnancy care in adolescents, namely, not doing ANC, trying to abort the pregnancy, not eating healthy foods with balanced nutrition, not doing physical activity and sports, not taking Fe tablets, getting lack of sleep and rest, ignoring the personal hygiene, being introvert, not doing fetal stimulation, and depression. CONCLUSION: Adolescents, who experience unwanted pregnancy, tend not to do ANC, behave in harming to themselves and their fetus; therefore, the further research can be done regarding the development of a model of care in families with adolescents experiencing unwanted pregnancy.

Self-esteem, job insecurity, and psychological distress among Chinese nurses

BACKGROUND

Many studies investigate the variables relating to psychological distress among nurses, but little is known about the underlying mechanism(s) among job insecurity, self-esteem, and psychological distress.

AIMS

This cross-sectional study examines the prevalence of psychological distress among nurses and the relationships among job insecurity, self-esteem, and psychological distress; it also explores how self-esteem might mediate between job insecurity and psychological distress.

METHODS

Questionnaires that assess job insecurity, self-esteem, and psychological distress were collected from 462 nurses in a tertiary hospital in Shandong Province, China.

RESULTS

Our results show an 83.3 % prevalence rate for psychological distress among nurses. Regression analysis results show that job insecurity positively correlates with psychological distress, explaining 17.5 % of the variance in psychological distress. Mediation analysis results show that self-esteem partially mediates the effect of the two dimensions of job insecurity on psychological distress.

CONCLUSIONS

Psychological distress is prevalent among Chinese nurses. Nursing administrators should take effective measures to improve self-esteem and reduce the negative impacts of job insecurity on nurses, including psychological distress.

Risk factors associated with stress symptoms during pregnancy and postpartum: integrative literature review

Stressful events during prenatal and postpartum have been associated with an increase in the susceptibility to the onset of various diseases, threatening mental and physical health of mother and baby. The aim of this study was to synthesize and analyze the literature related to risk factors associated with stress symptoms during pregnancy and immediate postpartum by means of an integrative review. The search was conducted from January 2013 to July 2020, consulting the following databases: PubMed, PsycINFO, CINAHL, Web of Science and LILACS. In total, 1,677 studies were identified, resulting in 38 articles included in this review. The risk factors most associated with stress in pregnancy and postpartum were related to emotional factors (including mental health, traumatic events and obstetric complications); social and economic factors; mother's health conditions and life style behaviors, and social support and partner related stress. The results are discussed under the light of the biopsychosocial model, which proposes that biological, psychological, and social domains should be considered in order to minimize psychosocial risk conditions. It is concluded that strategies to promote psychological care, education, additional social support and health behaviors should be considered to prevent adverse birth outcomes and to increase maternal well-being.

Obstetric Patients and Healthcare Providers Perspectives to Inform Mobile App Design for Physical Activity and Weight Control During Pregnancy and Postpartum in a Rural Setting

Background

Mobile health technology offers the opportunity for women to engage with physical activity promotion programs without many of the barriers commonly associated with exercise during and after pregnancy (eg, childcare concerns, rigid schedules, fear of doing harm to fetus or self, access to fitness facilities, uncomfortable with body in front of others) which may be particularly useful in under-resourced rural environments. We conducted the first known study on perspectives of pregnant women, postpartum women, and obstetric healthcare providers in a rural setting on needs related to the development of a mobile app designed to increase physical activity during pregnancy and postpartum.

Methods

Focus groups and in-depth face-to-face personal interviews were conducted with 14 pregnant women, 13 postpartum women, and 11 healthcare providers in a rural community. Semi-structured questions utilizing constructs of the Health Belief Model were used to identify barriers, facilitators, and other influences on physical activity during pregnancy and postpartum. Recordings of all in-depth interviews and focus groups were transcribed and standard content analyses for qualitative data were conducted.

Results

Rural women and healthcare providers expressed several key perspectives about and recommendations to promote physical activity during and after pregnancy. Broadly, these perspectives encapsulated two main themes: 1) physical activity as critical for weight control and 2) the need for evidence-based exercise information. Key desired features of this app identified include goal setting/progress tracking, evidence-based exercise guidance tailored to specific time points of pregnancy and postpartum, social support via community-based forum, symptom tracking, time-efficient workouts, and push notifications.

Conclusion

The perspectives identified by participants should be utilized when designing mobile health physical activity mobile apps for pregnant and postpartum women in rural areas.

The relationship between self-esteem and psychological distress in critical care nurses

BACKGROUND

Self-esteem can be described as negative or positive beliefs people have about themselves. It is an important personal source to combat stress and protect health, and related to job satisfaction.

AIMS AND OBJECTIVES

The aim of this study was to examine the relationship between self-esteem and psychological distress in critical care nurses.

DESIGN

A cross-sectional study.

METHODS

The research population of study consisted of 121 critical care nurses working at a university hospital in Edirne, Turkey between January and April 2017. A questionnaire consisting of 26 questions was used to obtain the personal and demographic information. The Symptom Check List-90-R test was used to determine the emotional status and the self-esteem scale was used to determine the self-esteem status of the participants. Participants were divided into two groups according to the self-esteem scale median score (Group 1: below 60, and Group 2: 60 and above).

RESULTS

The general severity index of the nurses was 1.11 (95% confidence interval [CI] 1.00-1.21). The general severity index of those with a self-esteem scale score below 60 was 1.47 (95% CI 1.37-1.57), while for those who with a self-esteem score of 60 and above, it was 0.73 (95% CI 0.59-0.87). The general severity index of the nurses in Group 1 was statistically significantly higher than that for those in Group 2. The number of nurses with a high symptom level in Group 1 was statistically significantly higher than those in Group 2.

CONCLUSIONS

The study showed that the general severity index and poor symptom level ratios associated with mental well-being are high in critical care nurses. However, critical care nurses with high self-esteem had fewer psychological problems than those with lower self-esteem.

RELEVANCE TO CLINICAL PRACTICE

Critical care nurses with low self-esteem should be given assertiveness, resilience, and interpersonal communication skills training, even outside of health care.

Status and related factors of depression, perceived stress, and distress of women at home rest with threatened preterm labor and women with healthy pregnancy in Taiwan

BACKGROUND

Women with threatened preterm labor (TPTL) resting at home face several life challenges, but their psychological well-being has been ignored. This study aimed to explore the status and related factors of the psychological status of women with TPTL resting at home, and to compare the psychological status differences between TPTL and healthy pregnant women.

METHODS

A cross-sectional, multiple time-point study was conducted to repeatedly assess depression, perceived stress, and distress in 49 TPTL women and 62 healthy pregnant women during pregnancy in Taiwan. Mann-Whitney U tests were used to compare the psychological status differences between these women and the generalized estimating equation was used to identify the factors related to their psychological status.

RESULTS

The TPTL women's perceived stress at 24-27 weeks (p=0.047) and 32-35 weeks (p=0.04) and distress at each time point was significantly greater than that of healthy pregnant women (p<0.001). The common distress experienced by TPTL women was the inability to provide self-care and family care, the baby's health and safety, and to request leave from work for bed rest. Positive personalities, gestational age, preterm birth history, follow-up status and employment have been shown to be related to the psychological status of TPTL women.

LIMITATIONS

The major limitation of this study is the small sample size.

CONCLUSION

This study contributed to a better understanding of the emotional burdens of women with TPTL resting at home. Such findings highlight the need for constructing effective interventions to alleviate the psychological burden of these women.

Low Chronic Self-Esteem and Low Situational Self-Esteem: a literature review

OBJECTIVE

to develop a literature review about low self-esteem and components of the nursing diagnoses Low Chronic Self-Esteem and Low Situational Self-Esteem in patients with depressed mood.

METHOD

an integrative literature review carried out in the Pubmed portal and in the Scopus and Web of Science electronic bibliographic databases. Depression and self-esteem descriptors were used, resulting in 32 articles.

RESULTS

literature indicated 7 clinical indicators and 14 etiological factors for low self-esteem.

CONCLUSION

The clinical indicators Suicidal ideation and Ineffective treatment were more prevalent in the study. The etiological factors Stressful events and Stigmatization were the most frequent, both of which were suggested as new related factors for low self-esteem. Nursing diagnosis recognition can contribute to intervention strategy elaboration by the nurse, according to the urgent diagnostic and the individual's particularities.

Work stress, perceived social support, self-efficacy and burnout among Chinese registered nurses

AIMS

To establish a model and identify structural relationships between Chinese nurses' perceived social support, self-efficacy, work stress and burnout.

BACKGROUND

The prevalence of burnout among nurses tends to be high worldwide. A better understanding of relationships between the study variables can help hospital managers apply effective programmes to reduce burnout. However, no studies have identified the structural relationships between these variables in one model, simultaneously.

METHODS

We conducted a cross-sectional survey to complete questionnaires from 444 nurses working in three Chinese general tertiary hospitals. The proposed model was examined by structural equation modelling.

RESULTS

The proposed model was partially supported by empirical data. The total effect of work stress on burnout was large. Both work stress and the perceived social support moderately and directly affected burnout. Work stress also indirectly affected burnout through perceived social support. Work stress directly influenced perceived social support and self-efficacy. Perceived social support directly affected self-efficacy. However, self-efficacy did not directly influence burnout.

CONCLUSIONS

This study validated a model and identified a deep understanding of structural relationships between the selected variables among Chinese nurses.

IMPLICATIONS FOR NURSING MANAGEMENT

Apart from reducing work stressors, hospital managers should utilize more social support strategies when designing intervention programmes to reduce burnout.

Stress Experiences and Mental Health of Pregnant Women: The Mediating Role of Social Support

Stress in pregnancy is an exceedingly common issue that impacts the mother's mental health and the health of her baby. Yet, women with a supportive network of friends and family may experience lower stress and improved mental health. Therefore, the aims of this secondary analysis were to (a) examine relationships between stress experiences (i.e. perceived stress, pregnancy-specific stress) and indicators of mental health (i.e. absence of depressive symptoms and resourcefulness), (b) determine the effects of social support on stress experiences and indicators of mental health, and (c) determine if social support mediates the relationship between stress experiences and indicators of mental health. A convenience sample of 82 women in their second and third trimester of pregnancy participated in the parent study. Findings indicate that stress experiences were moderately correlated with indicators of mental health and social support predicted stress experiences and indicators of mental health. All social support mediation models were not significant with the exception of social support mediating the relationship between pregnancy-specific stress and resourcefulness. This was the first study to investigate the mediating role of social support on the relationship between pregnancy-specific stress and resourcefulness. Pregnant women may benefit from social support interventions to meaningfully reduce their stress and promote mental health. Such interventions may be physical activity, group prenatal care, or even peripartum home visits.

Psychosocial well-being and efforts to quit smoking in pregnant women of South-Central Appalachia

Introduction

Psychosocial well-being variables from the Tennessee Intervention for Pregnant Smokers (TIPS) study, a longitudinal smoking cessation study in South-Central Appalachia, were investigated as potential predictors of smoking status.

Methods

A sample of 1031 pregnant women participated in an expanded 5A's (Ask, Advise, Assess, Assist, Arrange) program, from 2008 to 2011. Measures of stress, self-esteem, depressive symptoms, and disordered eating collected by interview during the first trimester, or during the third trimester in a combined interview if participants began prenatal care late, were hypothesized to differ among three groups of participants: pregnant women who never smoked, pregnant women who smoked but quit prior to birth, and pregnant women who smoked and did not quit prior to birth. Smoking status was measured throughout the study. Whether or not a participant quit smoking was assessed at delivery.

Results

Non-smokers were lowest in stress F(2,1027) = 46.38, p < .001) and depression (F(2,1028) = 39.81, p < .001), and highest in self-esteem (F(2,1018) = 29.81, p < .001). Only self-reported stress and self-reported self-esteem predicted quitting. Higher reported stress levels were related to a slightly lower likelihood of quitting (OR = 0.95, 95% CI 0.92, 0.98, p = .003) and higher reported self-esteem predicted a slightly higher likelihood of quitting (OR = 1.05, 95% CI 1.02, 1.08, p = .001).

Conclusions

Findings may lead to improved intervention programs and reduction of adverse health effects in children attributable to prenatal smoking. More research should be conducted on smoking cessation in rural pregnant women.

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Low stress and high self-esteem predicted smoking cessation in pregnancy.

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Disordered eating did not predict smoking cessation in pregnancy.

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Depressive symptoms were highest in pregnant smokers who did not quit smoking.

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Non-smokers had higher psychosocial well-being scores than smokers and quitters.

What Role Can Community Health Workers Play in Connecting Rural Women with Depression to the "De Facto" Mental Health Care System?

The prevalence of depression among rural women is nearly twice the national average, yet limited mental health services and extensive social barriers restrict access to needed treatment. We conducted key informant interviews with community health workers (CHWs) and diverse health care professionals who provide care to Appalachian women with depression to better understand the potential roles that CHWs may play to improve women's treatment engagement. In the gap created by service disparities and social barriers, CHWs can offer a substantial contribution through improving recognition of depression; deepening rural women's engagement within existing services; and offering sustained, culturally appropriate support.

The relationship between anxiety and social support in male and female students in high schools in the southeast of Iran

INTRODUCTION

Adolescence is associated with physical, social and personality changes. Adolescents usually face some fears during this period, the removal and adjustment of which requires family and teachers' support and the lack of attention to the issues of maturity will have negative effects on their health, awareness and self-esteem. The aim of this study was to investigate the relationship between anxiety and social support among male and femaille students in high schools in the southeast of Iran.

MATERIALS AND METHODS

In this cross-sectional study that was conducted as a descriptive comparison, 452 students who were studying in the first period of high school in Kerman (junior high schools) were selected as the entire population by the cluster sampling method and the data collection instruments were: a demographic questionnaire, Philips Social Support Scale and the Cattle Anxiety Scale. As well as descriptive statistics, to test the hypothesis of this study by SPSS software, and in the case of abnormal distribution of each variable, non-parametric tests were used.

RESULTS

The results showed that anxiety in girls is great than in boys, also data analysis through Pearson's test showed that there is a negative and significant relationship between anxiety and social support in girls (r = -0.428, n = 226, p < 0.001) and boys (r = -0.378, n = 226, p < 0.001).

CONCLUSION

The results of research showed that by increasing perceptions of social support in students, their anxiety decreases. Therefore, paying attention to the social determinants of health such as social support is important and necessary to reduce the anxiety of students.

Moderated Mediation Effect of Self-esteem on the Relationship Between Parenting Stress and Depression According to Employment Status in Married Women: A Longitudinal Study Utilizing Data from Panel Study on Korean Children

PURPOSE

This study was to examined the moderated mediation effect of self-esteem on the relationship between parenting stress and depression among married women with children using longitudinal data from the 3rd to 6th Panel Studies on Korean.

METHODS

The data from the Panel Study of Korean Children (Korea Institute of Child Care and Education) was collected as part of a longitudinal inquiry of babies born in 2008, their parents and their community environments. Only the data collected from the married women over the age of 20 who participated in the maternal survey was used for this study.

RESULTS

The initial level of married women's parenting stress affects the initial level and the rate of change in self-esteem; the initial level of self-esteem, the initial level and rate of change in depression; and the initial level of parenting stress, the initial level of depression. However, the impact of the rate of change in parenting stress on that of self-esteem was significant only in employed women while the impact of the rate of change in self-esteem on that of depression was significant only in unemployed women.

CONCLUSION

It is necessary to manage parenting stress among married women through various programs and education that increase self-esteem in order to reduce their level of depression.

Role of Mediators in Reducing Antepartum Depressive Symptoms in Rural Low-Income Women Receiving a Culturally Tailored Cognitive Behavioral Intervention

Although cognitive behavioral interventions (CBIs) have demonstrated effectiveness for reducing depressive symptoms in the general population, the mechanism for reducing antepartum depressive symptoms (APDS) in rural low-income and minority women is unknown. This study tested the hypothesis that reducing stress and negative thinking, enhancing self-esteem, and increasing social-support will mediate the effect of a CBI on reducing APDS in rural low-income and minority women. Our findings show that CBI may work through reducing stress and negative thinking and enhancing self-esteem, but not social support. The findings also suggest that mental health care providers should emphasize these activities to reduce antepartum depressive symptoms.

Mental health treatment seeking patterns and preferences of Appalachian women with depression

This qualitative study explored social-cultural factors that shape treatment seeking behaviors among depressed rural, low-income women in Appalachia-a region with high rates of depression and a shortage of mental health services. Recent research shows that increasingly rural women are receiving some form of treatment and identifying their symptoms as depression. Using purposive sampling, investigators recruited 28 depressed low-income women living in Appalachian Kentucky and conducted semistructured interviews on participants' perceptions of depression and treatment seeking. Even in this sample of women with diverse treatment behaviors (half reported current treatment), participants expressed ambivalence about treatment and its potential to promote recovery. Participants stressed that poor treatment quality-not merely access-limited their engagement in treatment and at times reinforced their depression. While women acknowledged the stigma of depression, they indicated that their resistance to seek help for their depression was influenced by the expectation of women's self-reliance in the rural setting and the gendered taboo against negative thinking. Ambivalence and stigma led women to try to cope independently, resulting in further isolation. This study's findings reiterate the need for improved quality and increased availability of depression treatment in rural areas. In addition, culturally appropriate depression interventions must acknowledge rural cultural values of self-reliance and barriers to obtaining social support that lead many women to endure depression in isolation. (PsycINFO Database Record

Associations of social support and stress with postpartum maternal mental health symptoms: Main effects, moderation, and mediation

Poor maternal mental health during the postpartum period can have significant effects on the health of mothers, infants, and families. The findings from cross-sectional studies suggest that stress and social support are related to maternal mental health. This study contributes to the literature through the use of longitudinal data, and examines moderation and mediation among these factors. In 2012-2013, mothers completed surveys assessing stress, social support, and depressive and anxiety symptoms following birth (n = 125), and 3 months (n = 110) and 6 months (n = 99) after birth. The authors examined temporal associations, moderation, and mediation of social support on the relationship between stress and postpartum depressive and anxiety symptoms using modified Poisson regression models and the counterfactual approach to mediation. Current levels of stress and social support were associated with depressive and anxiety symptoms, both independently and when considered together at multiple time points. Social support did not strongly moderate or mediate the relationships between stress and maternal mental health. Interventions to reduce current perceptions of stress and increase social support for mothers during the postpartum period may help improve maternal mental health symptoms. Efforts are needed to assess the current needs of mothers continuously.

Prenatal Psychosocial Profile: translation, cross-cultural adaptation and validation to its use in Brazil

OBJECTIVES

To translate the Prenatal Psychosocial Profile (PPP) to be used in Brazil; to perform its cross-cultural adaptation; and to evaluate its reliability and validity.

DESIGN

Methodological study.

SETTING

The study was conducted in 10 prenatal care clinics at the city of Porto Alegre/Brazil.

PARTICIPANTS

241 women pregnant women.

METHODS

The adaptation process consisted in: translation; first version synthesis; expert committee evaluation; back translation; pre-test of the PPP version in Portuguese (PPP-VP); validation; the data with the participants was collected in 2007, by trained student nurses that approached the women while they were waiting for prenatal consultation.

FINDINGS

The mean scores for all subscales were similar to the ones found by the original authors; internal consistency was verified through Cronbach׳s alpha, with values of 0.71 for the stress subscale; 0.96 for support from the partner; 0.96 for support from others; and 0.79 for self-esteem; validity was supported through factorial analysis; construct and criterion validities were also established.

CONCLUSION

PPP-VP should be used as a tool to obtain a psychosocial profile which can lead to nursing interventions that will reduce health risk behaviours during pregnancy.

Performance of a Culturally Tailored Cognitive-Behavioral Intervention Integrated in a Public Health Setting to Reduce Risk of Antepartum Depression: A Randomized Controlled Trial

INTRODUCTION

Cognitive-behavioral group interventions have been shown to improve depressive symptoms in adult populations. This article details the feasibility and efficacy of a 6-week, culturally tailored, cognitive-behavioral intervention offered to rural, minority, low-income women at risk for antepartum depression.

METHODS

A total of 146 pregnant women were stratified by high risk for antepartum depression (Edinburgh Postnatal Depression Scale [EPDS] score of 10 or higher) or by low-moderate risk (EPDS score of 4-9) and randomized to a cognitive-behavioral intervention or treatment as usual. Differences in mean change of EPDS and Beck Depression Inventory (BDI)-II scores for low-moderate and high-risk women in the cognitive-behavioral intervention and treatment as usual for the full sample were assessed from baseline (T1), posttreatment (T2), and one-month follow-up (T3), and for African American women in the subsample.

RESULTS

Both the cognitive-behavioral intervention and treatment-as-usual groups had significant reductions in the EPDS scores from T1 to T2 and T1 to T3. In women at high risk for depression (n = 62), there was no significant treatment effect from T1 to T2 or T3 for the EPDS. However, in low-moderate risk women, there was a significantly greater mean change in the BDI-II scores from significant decrease in the BDI-II scores from T1 to T2 (4.92 vs 0.59, P = .018) and T1 to T3 (5.67 vs 1.51, P = .04). Also, the cognitive-behavioral intervention significantly reduced EPDS scores for African American women at high risk (n = 43) from T1 to T2 (5.59 vs 2.18, P = .02) and from T1 to T3 (6.32 vs 3.14, P = .04).

DISCUSSION

A cognitive-behavioral intervention integrated within prenatal clinics is feasible in this sample, although attrition rates were high. Compared to treatment as usual, the cognitive-behavioral intervention reduced depressive symptoms for African American women at high risk for antepartum depression and for the full sample of women at low-moderate risk for antepartum depression. These promising findings need to be replicated in a larger controlled clinical trial that incorporates methods to maintain greater participant engagement.

Psychosocial risk factors for excessive gestational weight gain: A systematic review

BACKGROUND

Excessive weight gain during pregnancy can have adverse health outcomes for mother and infant throughout pregnancy. However, few studies have identified the psychosocial factors that contribute to women gaining excessive weight during pregnancy.

AIM

To review the existing literature that explores the impact of psychosocial risk factors (psychological distress, body image dissatisfaction, social support, self-efficacy and self-esteem) on excessive gestational weight gain.

METHODS

A systematic review of peer-reviewed English articles using Academic Search Complete, Cumulative Index to Nursing and Allied Health Literature, MEDLINE Complete, PsycINFO, Informit, Web of Science, and Scopus was conducted. Quantitative studies that investigated psychosocial factors of excessive GWG, published between 2000 and 2014 were included. Studies investigating mothers with a low risk of mental health issues and normally-developing foetuses were eligible for inclusion. From the total of 474 articles located, 12 articles were identified as relevant and were subsequently reviewed in full.

FINDINGS

Significant associations were found between depression, body image dissatisfaction, and social support with excessive gestational weight gain. No significant relationships were reported between anxiety, stress, self-efficacy, or self-esteem and excessive gestational weight gain.

CONCLUSION

The relationship between psychosocial factors and weight gain in pregnancy is complex; however depression, body dissatisfaction and social support appear to have a direct relationship with excessive gestational weight gain. Further research is needed to identify how screening for, and responding to, psychosocial risk factors for excessive gestational weight gain can be successfully incorporated into current antenatal care.