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Molina RL, Beecroft A, Pazos Herencia Y, Bazan M, Wade C, DiMeo A, Sprankle J, Sullivan MM. Pregnancy Care Utilization, Experiences, and Outcomes Among Undocumented Immigrants in the United States: A Scoping Review. Womens Health Issues 2024; 34:370-380. [PMID: 38493075 DOI: 10.1016/j.whi.2024.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 02/01/2024] [Accepted: 02/09/2024] [Indexed: 03/18/2024]
Abstract
BACKGROUND Undocumented immigrants face many barriers in accessing pregnancy care, including language differences, implicit and explicit bias, limited or no insurance coverage, and fear about accessing services. With the national spotlight on maternal health inequities, the current literature on undocumented immigrants during pregnancy requires synthesis. OBJECTIVE We aimed to describe the literature on pregnancy care utilization, experiences, and outcomes of undocumented individuals in the United States. METHODS We performed a scoping review of original research studies in the United States that described the undocumented population specifically and examined pregnancy care utilization, experiences, and outcomes. Studies underwent title, abstract, and full-text review by two investigators. Data were extracted and synthesized using descriptive statistics and content analysis. RESULTS A total of 5,940 articles were retrieved and 3,949 remained after de-duplication. After two investigators screened and reviewed the articles, 29 studies met inclusion criteria. The definition of undocumented individuals varied widely across studies. Of the 29 articles, 24 showed that undocumented status and anti-immigrant policies and rhetoric are associated with lower care utilization and worse pregnancy outcomes, while inclusive health care and immigration policies are associated with higher levels of prenatal and postnatal care utilization as well as better pregnancy outcomes. CONCLUSIONS The small, heterogeneous literature on undocumented immigrants and pregnancy care is fraught with inconsistent definitions, precluding comparisons across studies. Despite areas in need of further research, the signal among published studies is that undocumented individuals experience variable access to pregnancy care, heightened fear and stress regarding their status during pregnancy, and worse outcomes compared with other groups, including documented immigrants.
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Affiliation(s)
- Rose L Molina
- Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts.
| | | | | | - Maria Bazan
- Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, Massachusetts; Universidad Científica del Sur, Lima, Peru
| | - Carrie Wade
- Countway Library, Harvard Medical School, Boston, Massachusetts
| | - Amanda DiMeo
- Ariadne Labs at Brigham and Women's Hospital and Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Jeffrey Sprankle
- Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Margaret M Sullivan
- François-Xavier Bagnoud (FXB) Center for Health & Human Rights, Harvard University, Boston, Massachusetts
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Baumgartel K, Saint Fleur A, Prescott S, Fanfan D, Elliott A, Yoo JY, Koerner R, Harringon M, Dutra SO, Duffy A, Ji M, Groer MW. Social Determinants of Health Among Pregnant Hispanic Women and Associated Psychological Outcomes. J Racial Ethn Health Disparities 2023:10.1007/s40615-023-01852-7. [PMID: 37973772 PMCID: PMC11186463 DOI: 10.1007/s40615-023-01852-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 10/17/2023] [Accepted: 10/24/2023] [Indexed: 11/19/2023]
Abstract
BACKGROUND There has been a concerning surge in maternal mortality among Hispanic women in recent years. Compromised mental health is present in nearly half of all maternal deaths, and risk factors include poor social support and depression. OBJECTIVE Among Hispanic women who were born in the USA versus those not born in the USA, we sought to describe and compare social determinants of health and maternal psychological outcomes. METHODS Hispanic pregnant women (n = 579) were recruited from two clinics in Tampa, FL, and completed various questionnaires related to social determinants of health, depression, stress, and social support. STATISTICAL ANALYSIS Descriptive statistics, t-tests, and chi-square analyses were used to compare relationships between maternal nativity and subsequent psychosocial outcomes. Pearson correlations were used to explore associations between variables. RESULTS Hispanic pregnant women who were not born in the USA had lower incomes (χ2 = 5.68, p = 0.018, df = 1), were more likely to be unemployed (χ2 = 8.12, p = 0.004, df = 1), and were more likely to be married (χ2 = 4.79, p = 0.029, df = 1) when compared with those born in the USA. Those not born in the USA reported lower social support (t = 3.92, p<0.001), specifically the tangible (t = 4.18, p < 0.001) and emotional support subscales (t = 4.4, p<0.001). When compared with those born in the USA, foreign-born Hispanic women reported less stress (t = 3.23, p = 0.001) and depression (t = 3.3, p = 0.002). CONCLUSION Pregnant Hispanic women not born in the USA are at increased risk for suboptimal social determinants of health, including less social support. US-born women were more stressed and depressed and had higher BMIs.
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Affiliation(s)
- Kelley Baumgartel
- University of South Florida College of Nursing, 12912 USF Health Dr, Tampa, FL, 33612, USA.
| | - Angeline Saint Fleur
- University of South Florida College of Nursing, 12912 USF Health Dr, Tampa, FL, 33612, USA
| | - Stephanie Prescott
- University of South Florida College of Nursing, 12912 USF Health Dr, Tampa, FL, 33612, USA
| | - Dany Fanfan
- University of Florida College of Nursing, 1225 Center Drive, Gainesville, FL, 32619, USA
| | - Amanda Elliott
- University of Florida College of Medicine Psychiatry and Behavioral Neurosciences, 3515 Ave Tampa, Fletcher, FL, 33613, USA
| | - Ji Youn Yoo
- University of Tennessee Knoxville College of Nursing, 1412 Circle Dr, Knoxville, TN, 37996, USA
| | - Rebecca Koerner
- University of South Florida College of Nursing, 12912 USF Health Dr, Tampa, FL, 33612, USA
| | - Monalisa Harringon
- University of South Florida College of Nursing, 12912 USF Health Dr, Tampa, FL, 33612, USA
| | - Samia Ozorio Dutra
- University of Hawaii at Manoa Nancy Atmospera-Walch School of Nursing, 2528 McCarthy Mall, Webster Hall 440, Honolulu, HI, 96822, USA
| | - Allyson Duffy
- University of South Florida College of Nursing, 12912 USF Health Dr, Tampa, FL, 33612, USA
| | - Ming Ji
- University of New Mexico Health Sciences, 2500 Marble Ave NE, Albuquerque, NM, 87106, USA
| | - Maureen W Groer
- University of Tennessee Knoxville College of Nursing, 1412 Circle Dr, Knoxville, TN, 37996, USA
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Non AL, Clausing ES, Lara-Cinisomo S, D'Anna Hernandez KL. COVID-19-Related Risk, Resilience, and Mental Health Among Mexican American Mothers Across the First Year of the Pandemic. J Racial Ethn Health Disparities 2023:10.1007/s40615-023-01849-2. [PMID: 37940768 DOI: 10.1007/s40615-023-01849-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 10/18/2023] [Accepted: 10/24/2023] [Indexed: 11/10/2023]
Abstract
BACKGROUND Latina mothers have been especially affected by the pandemic and historically exhibit high rates of depression and anxiety. However, few longitudinal studies have assessed the effect of the pandemic on this vulnerable population. We hypothesized that COVID-19-related stressors would associate with psychological distress among Latina mothers across the first year of the pandemic. METHODS We investigated COVID-19-related impact, stigma, and fears across two critical time points and changes in these measures in relation to changes in maternal anxiety and depression among mothers of Mexican descent living in Southern California (n=152). Surveys were administered within 5-16 weeks of the March 19, 2020 stay-at-home COVID-19 order in California and again between June to December 2021. RESULTS High proportions of women reported moderate to severe impacts of COVID-19 early in the pandemic, which reduced modestly a year later, e.g., reduced family incomes (55.9% 2020 Lockdown vs 32.7% 1-year follow-up). Anticipatory stigma was high across the first year, e.g., worrying at least some of the time that a family member will be deported (33.1% 2020 Lockdown vs. 14.1% 1-year follow-up), or they would not be able to care for their children (88.5% 2020 lockdown vs 82.2% 1-year follow-up). COVID-19 stigma, impact, and fears were significantly associated with higher levels of anxiety and depressive symptoms at both time points (p<0.003), and changes in COVID-19 impact were associated with changes in depression (p=0.0004). CONCLUSION Findings emphasize the adverse socioeconomic and psychological effects of the pandemic for Latina mothers.
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Affiliation(s)
- Amy L Non
- Department of Anthropology, University of California San Diego, La Jolla, CA, USA.
| | - Elizabeth S Clausing
- Department of Anthropology, School of Global Integrative Studies, University of Nebraska, Lincoln, NE, USA
- Center for Brain, Biology, and Behavior, University of Nebraska, Lincoln, NE, USA
| | - Sandraluz Lara-Cinisomo
- Department of Kinesiology and Community Health, University of Illinois Urbana-Champaign, Urbana, IL, USA
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Zimmermann M, Julce C, Sarkar P, McNicholas E, Xu L, Carr C, Boudreaux ED, Lemon SC, Byatt N. Can psychological interventions prevent or reduce risk for perinatal anxiety disorders? A systematic review and meta-analysis. Gen Hosp Psychiatry 2023; 84:203-214. [PMID: 37619299 PMCID: PMC10569160 DOI: 10.1016/j.genhosppsych.2023.08.005] [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: 05/17/2023] [Revised: 08/07/2023] [Accepted: 08/14/2023] [Indexed: 08/26/2023]
Abstract
OBJECTIVE Little is known about the extent to which interventions can prevent perinatal anxiety disorders. We conducted a systematic review and meta-analysis to examine whether interventions can decrease the onset and symptoms of perinatal anxiety among individuals without an anxiety disorder diagnosis. METHOD We conducted a comprehensive literature search across five databases related to key concepts: (1) anxiety disorders/anxiety symptom severity (2) perinatal (3) interventions (4) prevention. We included studies that examined a perinatal population without an anxiety disorder diagnosis, included a comparator group, and assessed perinatal anxiety. We included interventions focused on perinatal anxiety as well as interventions to prevent perinatal depression or influence related outcomes (e.g., physical activity). RESULTS Thirty-six studies were included. No study assessing the incidence of perinatal anxiety disorder (n = 4) found a significant effect of an intervention. Among studies assessing anxiety symptom severity and included in the quantitative analysis (n = 30), a meta-analysis suggested a small standardized mean difference of -0.31 (95% CI [-0.46, -0.16], p < .001) for anxiety at post intervention, favoring the intervention group. Both mindfulness (n = 6), and cognitive behavioral therapy approaches (n = 10) were effective. CONCLUSIONS Interventions developed for perinatal anxiety were more effective than interventions to prevent perinatal depression. Psychological interventions show promise for reducing perinatal anxiety symptom severity, though interventions specifically targeting anxiety are needed.
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Affiliation(s)
- Martha Zimmermann
- UMass Chan Medical School, 222 Maple Avenue - Chang Building, Shrewsbury, MA 01545, United States of America.
| | - Clevanne Julce
- UMass Chan Medical School, 222 Maple Avenue - Chang Building, Shrewsbury, MA 01545, United States of America
| | - Pooja Sarkar
- UMass Chan Medical School, 222 Maple Avenue - Chang Building, Shrewsbury, MA 01545, United States of America
| | - Eileen McNicholas
- UMass Chan Medical School, 222 Maple Avenue - Chang Building, Shrewsbury, MA 01545, United States of America
| | - Lulu Xu
- UMass Chan Medical School, 222 Maple Avenue - Chang Building, Shrewsbury, MA 01545, United States of America
| | - Catherine Carr
- UMass Chan Medical School, 222 Maple Avenue - Chang Building, Shrewsbury, MA 01545, United States of America
| | - Edwin D Boudreaux
- UMass Chan Medical School, 222 Maple Avenue - Chang Building, Shrewsbury, MA 01545, United States of America
| | - Stephenie C Lemon
- UMass Chan Medical School, 222 Maple Avenue - Chang Building, Shrewsbury, MA 01545, United States of America
| | - Nancy Byatt
- UMass Chan Medical School, 222 Maple Avenue - Chang Building, Shrewsbury, MA 01545, United States of America
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Wiley KS, Knorr DA, Chua KJ, Garcia S, Fox MM. Sociopolitical stressors are associated with psychological distress in a cohort of Latina women during early pregnancy. JOURNAL OF COMMUNITY PSYCHOLOGY 2023; 51:3044-3059. [PMID: 37209669 PMCID: PMC10524743 DOI: 10.1002/jcop.23065] [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: 11/30/2022] [Revised: 03/02/2023] [Accepted: 05/08/2023] [Indexed: 05/22/2023]
Abstract
Research suggests that the 2016 US election was a potential stressor among Latinos residing in the United States. Sociopolitical stressors targeted toward ethnic minority communities and become embodied through psychosocial distress. The current study investigates if and how sociopolitical stressors related to the 45th President, Donald Trump, and his administration are associated with psychological distress in early pregnancy of Latina women living in Southern California during the second half of his term. This cross-sectional analysis uses data from the Mothers' Cultural Experiences study (n = 90) collected from December 2018 to March 2020. Psychological distress was assessed in three domains: depression, state anxiety, and pregnancy-related anxiety. Sociopolitical stressors were measured through questionnaires about sociopolitical feelings and concerns. Multiple linear regression models examined the relationship between sociopolitical stressors and mental health scores, adjusting for multiple testing. Negative feelings and a greater number of sociopolitical concerns were associated with elevated pregnancy-related anxiety and depressive symptoms. The most frequently endorsed concern was about issues of racism (72.3%) and women's rights (62.4%); women endorsing these particular concerns also had higher scores on depression and pregnancy-related anxiety. No significant associations were detected with state anxiety after correction for multiple testing. This analysis is cross-sectional and cannot assess causality in the associations between sociopolitical stressors and distress. These results are consistent with the hypothesis that the 2016 election, the subsequent political environment, and the anti-immigrant rhetoric and policies of former President Trump and his administration were sources of stress for Latinos residing in the United States.
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Affiliation(s)
- Kyle S Wiley
- Department of Anthropology, University of California Los Angeles, Los Angeles, California, USA
- Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, California, USA
| | - Delaney A Knorr
- Department of Anthropology, University of California Los Angeles, Los Angeles, California, USA
- California Center for Population Research, University of California Los Angeles, Los Angeles, California, USA
| | - Kristine J Chua
- Department of Anthropology, University of California Los Angeles, Los Angeles, California, USA
- California Center for Population Research, University of California Los Angeles, Los Angeles, California, USA
| | - Samantha Garcia
- Department of Anthropology, University of California Los Angeles, Los Angeles, California, USA
| | - Molly M Fox
- Department of Anthropology, University of California Los Angeles, Los Angeles, California, USA
- Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, California, USA
- California Center for Population Research, University of California Los Angeles, Los Angeles, California, USA
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Santiago-Warner S. The Integration of the Resolved Through Sharing Perinatal Bereavement Follow-up Model with Latinx Cultural Values: A Case Illustration. CLINICAL SOCIAL WORK JOURNAL 2023:1-11. [PMID: 37360753 PMCID: PMC10155130 DOI: 10.1007/s10615-023-00873-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/19/2023] [Indexed: 06/28/2023]
Abstract
The Resolved Through Sharing (RTS) Perinatal bereavement model is an approach used for working with birthing people and their families who have experienced a perinatal loss. RTS is designed to help families cope with their grief and integrate the loss in their lives, meet the needs of the families during the initial crisis, and offer comprehensive care to each member of the family affected by the loss. This paper utilizes a case illustration to describe a year-long bereavement follow-up of an undocumented underinsured Latina woman who suffered a stillbirth during the beginning of the COVID-19 pandemic and the hostile anti-immigrant policy during the Trump presidency. The case illustration is based on a composite case of several Latina women who had pregnancy losses with similar outcomes, demonstrating how a perinatal palliative care (PPC) social worker provided ongoing bereavement support to a patient who experienced a stillbirth. The case illustrates how the PPC social worker utilized the RTS model, incorporated the patient’s cultural values, and acknowledged systemic challenges which resulted in the patient receiving comprehensive, holistic support that aided her emotional and spiritual recovery from her stillbirth. The author ends with a call to action for providers in the field of perinatal palliative care to incorporate practices that allow for greater access and equity for all birthing people.
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Ornelas IJ, Rao D, Price C, Chan G, Tran A, Aisenberg G, Perez G, Maurer S, Nelson AK. Promoting mental health in Latina immigrant women: Results from the Amigas Latinas Motivando el Alma intervention trial. Soc Sci Med 2023; 321:115776. [PMID: 36809698 PMCID: PMC9998361 DOI: 10.1016/j.socscimed.2023.115776] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 01/25/2023] [Accepted: 02/12/2023] [Indexed: 02/18/2023]
Abstract
INTRODUCTION Latina immigrants are at increased risk of depression and anxiety and limited access to mental health care. This study evaluated the effectiveness of Amigas Latinas Motivando el Alma (ALMA), a community-based intervention to reduce stress and promote mental health among Latina immigrants. METHODS ALMA was evaluated using a delayed intervention comparison group study design. Latina immigrants (N = 226) were recruited from community organizations in King County, Washington from 2018 to 2021. Although originally developed to be delivered in-person, due to the COVID-19 pandemic the intervention was adapted mid-study to be delivered online. Participants completed surveys to assess changes in depression and anxiety post-intervention and at a two-month follow-up. We estimated generalized estimating equation models to assess differences in outcomes across groups, including stratified models for those receiving the intervention in-person or online. RESULTS In adjusted models, participants in the intervention group had lower levels of depressive symptoms than the comparison group post-intervention (β = -1.82, p = 0.01) and at two-month follow-up (β = -1.52, p = 0.01). Anxiety scores decreased for both groups, and there were no significant differences post-intervention or at follow-up. In stratified models, participants in the online intervention group had lower levels of depressive (β = -2.50, p = 0.007) and anxiety (β = -1.86, p = 0.02) symptoms than those in the comparison group, but there were no significant differences among those that received the intervention in-person. CONCLUSIONS Community-based interventions can be effective in preventing and reducing depressive symptoms among Latina immigrant women, even when delivered online. Further research should evaluate the ALMA intervention among larger more diverse Latina immigrant populations.
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Affiliation(s)
- India J Ornelas
- University of Washington, School of Public Health, Department of Health Systems and Population Health, USA.
| | - Deepa Rao
- University of Washington School of Public Health, Department of Global Health, USA.
| | | | - Gary Chan
- University of Washington, School of Public Health, Department of Health Systems and Population Health, USA; University of Washington, Department of Biostatistics, USA.
| | - Anh Tran
- Duke School of Medicine, Department of Family Medicine and Community Health, USA.
| | | | - Georgina Perez
- University of Washington, School of Public Health, Department of Health Systems and Population Health, USA.
| | - Serena Maurer
- University of Washington, School of Public Health, Department of Health Systems and Population Health, USA.
| | - Adrianne Katrina Nelson
- University of Washington, School of Public Health, Department of Health Systems and Population Health, USA.
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The global burden of perinatal common mental health disorders and substance use among migrant women: a systematic review and meta-analysis. Lancet Public Health 2023; 8:e203-e216. [PMID: 36841561 DOI: 10.1016/s2468-2667(22)00342-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 12/16/2022] [Accepted: 12/20/2022] [Indexed: 02/25/2023]
Abstract
BACKGROUND There are one billion migrants globally, of whom 82 million are forced migrants. Pregnant migrants face pre-migration stressors such as conflict, transit stressors including poverty, and post-migration stressors including navigating the immigration system; these stressors can make them vulnerable to mental illness. We aimed to assess the global prevalence of and risk factors for perinatal mental health disorders or substance use among women who are migrants. METHODS In this systematic review and meta-analysis, we searched OVID MEDLINE, Embase, PsycINFO, CENTRAL, Global Health, Scopus, and Web of Science for studies published from database inception until July 8, 2022. Cohort, cross-sectional, and interventional studies with prevalence data for any mental illness in pregnancy or the postnatal period (ie, up to a year after delivery) or substance use in pregnancy were included. The primary outcome was the prevalence of perinatal common mental health disorders among women who are migrants, globally. Data for study quality and risk factors were also extracted. A random-effects meta-analysis was used to calculate pooled prevalence estimates, when appropriate. Sensitivity analyses were conducted according to study quality, sample representativeness, and method of outcome assessment. Risk factor data were synthesised narratively. This study is registered with PROSPERO, CRD42021226291. FINDINGS 18 650 studies were retrieved, of which 135 studies comprising data from 621 995 participants met the inclusion criteria. 123 (91%) of 135 studies were conducted in high-income host countries. Five (4%) of 135 studies were interventional, 40 (30%) were cohort, and 90 (66%) were cross-sectional. The most common regions of origin of participants were South America, the Middle East, and north Africa. Only 26 studies presented disaggregated data for forced migrants or economic migrants. The pooled prevalence of perinatal depressive disorders was 24·2% (range 0·5-95·5%; I2 98·8%; τ2 0·01) among all women who are migrants, 32·5% (1·5-81·6; 98·7%; 0·01) among forced migrants, and 13·7% (4·7-35·1; 91·5%; 0·01) among economic migrants (p<0·001). The pooled prevalence of perinatal anxiety disorders was 19·6% (range 1·2-53·1; I2 96·8%; τ2 0·01) among all migrants. The pooled prevalence of perinatal post-traumatic stress disorder (PTSD) among all migrant women was 8·9% (range 3·2-33·3; I2 97·4%; τ2 0·18). The pooled prevalence of perinatal PTSD among forced migrants was 17·1% (range 6·5-44·3; I2 96·6%; τ2 0·32). Key risk factors for perinatal depression were being a recently arrived immigrant (ie, approximately within the past year), having poor social support, and having a poor relationship with one's partner. INTERPRETATION One in four women who are migrants and who are pregnant or post partum experience perinatal depression, one in five perinatal anxiety, and one in 11 perinatal PTSD. The burden of perinatal mental illness appears higher among women who are forced migrants compared with women who are economic migrants. To our knowledge, we have provided the first pooled estimate of perinatal depression and PTSD among women who are forced migrants. Interpreting the prevalence estimate should be observed with caution due to the very wide range found within the included studies. Additionally, 66% of studies were cross-sectional representing low quality evidence. These findings highlight the need for community-based routine perinatal mental health screening for migrant communities, and access to interventions that are culturally sensitive, particularly for forced migrants who might experience a higher burden of disease than economic migrants. FUNDING UK National Institute for Health Research (NIHR); March of Dimes European Preterm Birth Research Centre, Imperial College; Imperial College NIHR Biomedical Research Centre; and Nuffield Department of Population Health, University of Oxford.
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Espinoza-Kulick MAV, Cerdeña JP. "We Need Health for All": Mental Health and Barriers to Care among Latinxs in California and Connecticut. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:12817. [PMID: 36232112 PMCID: PMC9565216 DOI: 10.3390/ijerph191912817] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 09/26/2022] [Accepted: 10/03/2022] [Indexed: 06/16/2023]
Abstract
Latinx (im)migrant groups remain underserved by existing mental health resources. Past research has illuminated the complex factors contributing to this problem, including migration-related trauma, discrimination, anti-immigrant policies, and structural vulnerability. This paper uses decolonial-inspired methods to present and analyze results from two studies of Latinx (im)migrant communities in central California and southern Connecticut in the United States. Using mixed quantitative and qualitative analysis, we demonstrate the intersectional complexities to be addressed in formulating effective mental health services. Relevant social and structural factors including knowledge of mental health, access to insurance, and experiencing discrimination were significantly associated with anxiety symptoms, based on linear regression analysis. Ethnographic interviews demonstrate how complex trauma informs mental health needs, especially through the gendered experiences of women. Overlapping aspects of gender, language barriers, fear of authorities, and immigration status contoured the lived experiences of Latinx (im)migrants. Thematic analyses of open-ended survey responses also provide recommendations for solutions based on the experiences of those directly affected by these health disparities, particularly relating to healthcare access, affordability, and capacity. Building from these findings and past research, we recommend the adoption of a comprehensive model of mental health service provision for Latinx (im)migrants that takes into account Indigenous language access, structural competency, expanded health insurance, and resources for community health workers.
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Affiliation(s)
| | - Jessica P. Cerdeña
- Yale School of Medicine, Yale University, New Haven, CT 06520, USA
- Institute for Collaboration on Health, Implementation, and Policy (InCHIP), University of Connecticut, Storrs, CT 06269, USA
- Department of Anthropology, University of Connecticut, Storrs, CT 06269, USA
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Ornelas IJ, Perez G, Maurer S, Gonzalez S, Childs V, Price C, Nelson AK, Perez Solorio SA, Tran A, Rao D. Amigas Latinas Motivando el Alma: In-Person and Online Delivery of an Intervention to Promote Mental Health Among Latina Immigrant Women. JOURNAL OF INTEGRATIVE AND COMPLEMENTARY MEDICINE 2022; 28:821-829. [PMID: 35723668 PMCID: PMC9595613 DOI: 10.1089/jicm.2022.0491] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Objective: A few mindfulness-based interventions have been developed for Latina immigrant populations. We describe the feasibility and acceptability of Amigas Latinas Motivando el Alma (ALMA), a culturally grounded intervention developed to prevent and reduce depression and anxiety among Latina immigrants. We also compare participation in the intervention in-person with an online adaptation developed in response to the COVID-19 pandemic. Methods: ALMA was developed through several years of formative research in collaboration with community organizations serving Latino immigrants. The curriculum integrates mindfulness-based approaches with Latino cultural strengths to reduce stress, enhance coping strategies, and increase social support. Latina immigrant women who spoke Spanish were recruited from Latino serving organizations to participate in an intervention trial. The program consisted of eight sessions offered weekly in person to groups of ∼20 Latina immigrants. After the onset of the pandemic, the program was adapted to be delivered online via zoom. Attendance and fidelity were monitored by intervention staff, and a satisfaction survey was given to participants post-intervention. Results: We enrolled 226 Latina immigrant women with an average age of 40 years and an average of 15.0 years living in the United States. The majority of participants were monolingual Spanish speakers (59%) with a high school degree (66%), although almost half were living on less than $2,200 per month (48%). One hundred and seven (47%) attended the program in-person, and 119 (53%) participated online. Program attendance was similar across modalities, with an average of 58% sessions completed among in-person and 60% among online participants. Participant satisfaction and perceived efficacy of the intervention were high in both in-person and online groups. Discussion: Our findings indicate that the ALMA intervention is acceptable and feasible in this population. Future research should assess the efficacy of mindfulness-based interventions in Latina immigrant populations, including both in-person and online modalities. CTR# NCT03749278.
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Affiliation(s)
- India J. Ornelas
- Department of Health Systems and Population Health, University of Washington School of Public Health, Seattle, WA, USA
| | - Georgina Perez
- Department of Health Systems and Population Health, University of Washington School of Public Health, Seattle, WA, USA
| | - Serena Maurer
- Department of Health Systems and Population Health, University of Washington School of Public Health, Seattle, WA, USA
| | | | - Veronica Childs
- Department of Health Systems and Population Health, University of Washington School of Public Health, Seattle, WA, USA
| | - Cynthia Price
- University of Washington School of Nursing, Seattle, WA, USA
| | - Adrianne Katrina Nelson
- Department of Health Systems and Population Health, University of Washington School of Public Health, Seattle, WA, USA
| | - S. Adriana Perez Solorio
- Department of Health Systems and Population Health, University of Washington School of Public Health, Seattle, WA, USA
| | - Anh Tran
- Department of Family Medicine and Community Health, Duke School of Medicine, Durham, NC, USA
| | - Deepa Rao
- Department of Global Health, University of Washington School of Public Health, Seattle, WA, USA
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Fox M. How demographics and concerns about the Trump administration relate to prenatal mental health among Latina women. Soc Sci Med 2022; 307:115171. [PMID: 35803053 PMCID: PMC9542647 DOI: 10.1016/j.socscimed.2022.115171] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 06/11/2022] [Accepted: 06/24/2022] [Indexed: 10/17/2022]
Abstract
RATIONALE The 2016 U.S. presidential election and its aftermath involved political rhetoric and policies that especially targeted women, Latinos, and immigrants. It is possible that concerns about the political environment could affect mental health of individuals in targeted groups. OBJECTIVE In a cohort of 148 pregnant Latina women, this study investigated how demographics and political concerns related to each other and to maternal anxiety, depression, and perceived stress, which have been associated with adverse birth and child development outcomes. METHODS In this cross-sectional, self-report study, participants in Southern California completed a one-time questionnaire from January 2017 to May 2018. RESULTS The highest rates of endorsement were for concerns regarding President Trump's racism, attitude towards women, and deportation risk for family or friends. From several demographic variables, the only significant predictor of state anxiety was expectant parents' birthplaces. From several political concerns variables, the only significant predictor of state anxiety was President Trump's attitude towards women or women's rights. There were no significant effects on other mental health outcomes. CONCLUSIONS Results suggest that birthplace and women's issues may be particularly salient anxiety risk factors for Latina pregnant women in this context. Because of the cross-sectional study design, it is possible that, conversely, pregnant women with high anxiety levels are particularly sensitive to the issue of birthplace or women's rights. Results imply that the political climate and events in the U.S. could have deleterious consequences that may cascade across generations of Latino Americans via effects on pregnant women.
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Affiliation(s)
- Molly Fox
- Departments of Anthropology and Psychiatry & Biobehavioral Sciences, UCLA, Los Angeles, CA, 90095, USA.
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12
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DeBrabander M, Venta A. Migration experiences of Central American youth: Developing a new measure. Psychiatry Res 2022; 314:114652. [PMID: 35640324 DOI: 10.1016/j.psychres.2022.114652] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 05/20/2022] [Accepted: 05/21/2022] [Indexed: 11/29/2022]
Abstract
In recent years, the number of children and families migrating from Central America to the United States (U.S.) has increased exponentially (Rosenblum, 2015). Likely due to this influx, research on Latinx immigrants has also increased. However, no standard assessment of youth migration experiences currently exists. The present study introduces a new measure and pilot data on the migration experiences of youth from Central America. The Migration Experiences Interview (MEI) is a 25-question semi-structured interview that encompasses youths' experiences before, during, and after migration to the U.S, covering topics such as their control over the decision to migrate, whether they witnessed frightening situations along their journey, and their experiences living in the U.S. thus far. The present study provides pilot data on a sample of 64 recently migrated Central American youths aged 15 to 25 (39.1% female). The MEI provides in-depth characterizations and narrative examples of migration experiences that add important information on a largely understudied population to the literature. The MEI's standard, publicly available format has utility for increased consistency in future research and implications for clinical practice and immigration policy.
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Affiliation(s)
- Megan DeBrabander
- Department of Psychology, Sam Houston State University, Huntsville, TX, United States
| | - Amanda Venta
- Department of Psychology, University of Houston, Houston, TX, United States.
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Hernandez-Castro I, Toledo-Corral CM, Chavez T, Habre R, Grubbs B, Al-Marayati L, Lerner D, Lurvey N, Lagomasino I, Eckel SP, Dunton GF, Farzan SF, Breton CV, Bastain TM. Perceived vulnerability to immigration policies among postpartum Hispanic/Latina women in the MADRES pregnancy cohort before and during the COVID-19 pandemic. WOMEN'S HEALTH (LONDON, ENGLAND) 2022; 18:17455057221125103. [PMID: 36148937 PMCID: PMC9511002 DOI: 10.1177/17455057221125103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 07/22/2022] [Accepted: 08/16/2022] [Indexed: 02/02/2023]
Abstract
INTRODUCTION AND OBJECTIVES Research suggests that perceived immigration policy vulnerability has important health implications. Coupled with the mental and physical stressors accompanying the postpartum period and a growing awareness of the discrimination and structural racism experienced by marginalized communities globally, the coronavirus disease 2019 period may have exacerbated stress among vulnerable populations, specifically postpartum Hispanic/Latina women. This study evaluated perceived immigration policy vulnerability (i.e. discrimination, social isolation, and family threats) in early postpartum Hispanic/Latina women in Los Angeles before and during the coronavirus disease 2019 pandemic. METHODS The Perceived Immigration Policy Effects Scale (PIPES) was administered cross-sectionally at 1 month postpartum to 187 Hispanic/Latina women in the MADRES cohort. Respondents between September 2018 and March 2020 were classified as "pre-pandemic" (N = 128), between March 2020 and July 2020 as "early pandemic" (N = 38), and between August 2020 and November 2021 as "later pandemic" (N = 21). Average PIPES subscale scores were dichotomized into "higher" and "lower" groups (⩽median, >median) and logistic regression models were performed. RESULTS Approximately half of participants had incomes of <$50,000 (50.3%) and were Latin American born (54.6%). After adjusting for age, nativity, education, income, postpartum distress, and employment status, early pandemic respondents had 5.05 times the odds of a higher score on the perceived discrimination subscale (95% CI: 1.81, 14.11), 6.47 times the odds of a higher score on the social isolation subscale (95% CI: 2.23, 18.74), 2.66 times the odds of a higher score on the family threats subscale (95% CI: 0.97, 7.32), and 3.36 times the odds of a higher total score (95% CI: 1.19, 9.51) when compared to pre-pandemic respondents. There were no significant subscale score differences between later pandemic and pre-pandemic periods. CONCLUSION Higher perceived immigration policy vulnerability was reported among postpartum women during the early coronavirus disease 2019 pandemic versus pre-pandemic periods. This suggests greater social inequities during the early pandemic period.
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Affiliation(s)
- Ixel Hernandez-Castro
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Claudia M Toledo-Corral
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
- Department of Health Sciences, California State University Northridge, Northridge, CA, USA
| | - Thomas Chavez
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Rima Habre
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Brendan Grubbs
- Department of Obstetrics and Gynecology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Laila Al-Marayati
- Department of Obstetrics and Gynecology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | | | | | - Isabel Lagomasino
- Department of Psychiatry and Behavioral Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Sandrah P Eckel
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Genevieve F Dunton
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
- Department of Psychology, University of Southern California, Los Angeles, CA, USA
| | - Shohreh F Farzan
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Carrie V Breton
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Theresa M Bastain
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
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Experiences of Discrimination and Depression Trajectories over Pregnancy. Womens Health Issues 2022; 32:147-155. [PMID: 34774402 PMCID: PMC9701536 DOI: 10.1016/j.whi.2021.10.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 09/27/2021] [Accepted: 10/08/2021] [Indexed: 01/19/2023]
Abstract
INTRODUCTION Research on risk factors for prenatal depression is critical to improve the understanding, prevention, and treatment of women's psychopathology. The current study examines the relation between experiences of racial discrimination and trajectories of depression symptoms over the course of pregnancy. METHOD Participants completed standardized measures regarding symptoms of depression at four timepoints during pregnancy and reported on experiences of racial discrimination at one timepoint. Latent growth curve modeling was used to examine the relation between discrimination and initial levels (intercept) and trajectories (slope) of depression symptoms over pregnancy. RESULTS Participants were 129 pregnant individuals recruited from obstetric clinics and oversampled for elevated depression symptoms. Thirty-six percent of the participants were living at or below 200% of the federal poverty line. Fifty-four percent of the sample identified as non-Latinx White, 26% as Latinx, and 13% as non-Latinx Black. An unconditional latent growth curve modeling revealed a negative quadratic trajectory of depression symptoms during pregnancy. When women's report of discrimination was added as a predictor of depression trajectories, discrimination predicted the initial value (intercept) of depression symptoms, but not change over the course of pregnancy (slope). Specifically, higher levels of experiences of discrimination were associated with higher levels of depression symptoms. When sociodemographic and contextual covariates were included in the model, a low family income-to-needs ratio was also related to higher levels of depression symptoms. CONCLUSIONS These findings provide evidence that women's experiences of racial discrimination and family financial strain are risk factors for prenatal depression, with implications for screening, treatment, and policy.
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Osman KM, Lara-Cinisomo S, D’Anna-Hernandez KL. Associations between religiosity and perinatal anxiety symptoms among women of Mexican descent. J Affect Disord 2021; 294:77-84. [PMID: 34274791 PMCID: PMC8860167 DOI: 10.1016/j.jad.2021.06.066] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 06/19/2021] [Accepted: 06/27/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Over half of pregnant women experience anxiety symptoms, however perinatal mental health disparities exist. Women of Mexican descent exhibit higher levels of anxiety symptoms which may be linked to sociocultural stressors. However, little is known about culturally relevant factors that may protect against anxiety in this fast-growing population, such as religiosity, an important facet of Mexican culture. METHODS Pregnant women of Mexican descent (n = 197) were recruited from a local community clinic and followed into the postpartum period. Women completed surveys assessing religiosity, acculturation, acculturative stress, and anxiety symptoms. RESULTS Higher levels of religiosity were associated with lower levels of anxiety symptoms throughout pregnancy, but not postpartum (b = -1.01, p = .002). Additionally, religiosity significantly buffered the relationship between acculturative stress and anxiety symptoms during early (R2 = .13, b = -.12, p = .041), mid- (R2 = .19, b = -.19, p < .001) and late pregnancy (R2 = .14, b = -.13, p = .023), and at six weeks postpartum (R2 = .08, b = -.12, R2 = .08, p = .016). LIMITATIONS The study was limited to women of Mexican descent and it is possible that other immigrant groups may exhibit different patterns of religiosity and anxiety symptoms. CONCLUSIONS These results suggest that religiosity may be protective against maternal anxiety among women of Mexican descent, which has important implications for culturally relevant perinatal interventions and treatments.
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Affiliation(s)
- Kayla M. Osman
- California State University San Marcos, 333 S Twin Oaks Valley Rd, San Marcos, CA 92096; Phone: (562) 852-9503
| | - Sandraluz Lara-Cinisomo
- University of Illinois at Urbana-Champaign, 1206 S. Fourth Street, Champaign, IL 61820, USA.
| | - Kimberly L. D’Anna-Hernandez
- Department of Psychology, California State University San Marcos, 333 S Twin Oaks Valley Rd, San Marcos, CA 92096; Phone: (760) 750-8275
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Lara-Cinisomo S, D'Anna-Hernandez K, Non AL. Recommendations for Clinical Practice, Research, and Policy to Address the Effects of the COVID-19 Pandemic on Anxiety Symptoms in Immigrant and U.S.-Born Latina Mothers. Womens Health Issues 2021; 31:301-305. [PMID: 33893016 DOI: 10.1016/j.whi.2021.03.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 02/25/2021] [Accepted: 03/10/2021] [Indexed: 11/16/2022]
Affiliation(s)
- Sandraluz Lara-Cinisomo
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Champaign, Illinois.
| | | | - Amy L Non
- Department of Anthropology, University of California San Diego, La Jolla, California
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A Systematic Review of Technology-Based Prevention and Treatment Interventions for Perinatal Depression and Anxiety in Latina and African American Women. Matern Child Health J 2021; 25:268-281. [PMID: 33389589 DOI: 10.1007/s10995-020-03028-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/04/2020] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Latina and African American women have elevated risk for perinatal depression and anxiety but have low rates of treatment engagement. Amid significant improvements in narrowing the digital divide, the number of technology-based mental health interventions has increased. A technology-based mode of delivery is important to consider because it can increase patient engagement and should inform program development. This review aimed to assess the mode of technology used for preventing and/or treating perinatal depression and anxiety in Latina and African American women, examine symptom management, and describe participant satisfaction. METHODS We used PubMed, CINAHL, PsycINFO, PsycARTICLES, EBSCO, and Social Services Abstracts to identify studies that used technology (e.g., smartphones) to prevent and/or treat depression and/or anxiety in Latina and/or African American perinatal women. To be eligible for inclusion, studies must have had at least 50% Latina and/or African American samples. The review was conducted between November 2018 and October 2019, with no set publication start date. RESULTS Of 152 studies reviewed, six met the inclusion criteria. Four studies included African American women; two studies had samples that were mostly composed of Latina women. Three studies used telephone/smartphone (e.g., text messaging) and three implemented internet-based interventions. All studies addressed depression; one focused on anxiety. The findings demonstrated participant satisfaction and promise for symptom management. DISCUSSION Despite the limited number of studies that used technology to engage Latina and African American perinatal women, the results suggest that these women were willing to participate in digital interventions to address perinatal depression and anxiety.
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