Trends in depression among low-income mothers in the United States, 2005-2015

Co-occurrence of mental illness and substance use among US pregnant individuals, 2012-2021

AIM

Substance use disorders are increasingly prevalent among pregnant individuals, with evident risks of adverse perinatal outcomes. This study examines substance use (tobacco, alcohol and marijuana) among pregnant individuals with mental illness.

METHODS

A national representative sample of pregnant individuals were derived from 2012 to 2021 National Survey of Drug Use and Health data. Associations of past-year mental illness with past-month polysubstance use and each substance use were analyzed by logistic regression models, with complex sampling weights and survey year.

RESULTS

Among 6801 pregnant individuals, 16.4% reported having any mental illness (AMI) in 2012 and 2013, increasing to 23.8% in 2020-2021; and SMI increased from 3.3% to 9.4%. Polysubstance use increased disproportionately among those with severe mental illness (SMI), from 14.0% to 18.6%. Pregnant individuals with greater severity of mental illness had higher odds of polysubstance use (Adjusted Odds Ratio, 95% CI: AMI but no SMI vs. without AMI: 1.59 [1.04, 2.44]; SMI vs. without AMI: 5.48 [2.77, 10.82]).

CONCLUSIONS

Pregnant individuals with greater severity of mental illness were more likely to engage in substance use. Evidence-based educational, screening and treatment services, and public policy changes are warranted to mitigate the harmful health outcomes of substance use among US pregnant individuals with mental illness.

Factors associated with postpartum depression among high-risk women during the COVID-19 pandemic

The purpose of this study was to investigate the impacts of the COVID-19 pandemic on multi-level factors associated with depression among a high-risk sample of postpartum women using longitudinal data collected at two timepoints. High-risk postpartum participants in the United States were recruited to participate in a parent study focused on mitigating risk of cardiometabolic disease in postpartum women. Individuals completed a baseline survey which included the Edinburgh Postpartum Depression Scale (EPDS) at 6-weeks postpartum between 2017 through 2019. A modified survey with the inclusion of selected questions from the Coronavirus Health Impact Survey (CRISIS) questionnaire was administered again during the first 6-months of the COVID-19 pandemic and individuals who completed both the baseline assessment and the COVID-19 assessment were included for analyses (n = 46). Multivariate models were run to investigate the impacts of individual-, interpersonal-, and structural-level factors on change in EPDS scores across the postpartum period. Findings suggest that losing contact with social supports (β = 4.5, SE = 1.9, p = .02) and individuals who reported a total household income of less than $75,000 (β = 3.4, SE = 1.7, p = .05) were more likely to report significantly worsening postpartum depression scores compared to others. Recommendations to mitigate the stressors that have been amplified by the COVID-19 pandemic and resulting mental health disparities include screening all high-risk postpartum women for depression and anxiety during both postpartum and pediatric healthcare visits, providing informational flyers with tips related to healthy coping behaviors and free/affordable community resources, and linking individuals to peer-led support groups.

Implementation of the "Healthy Moms, Healthy Kids" Program in Head Start: An Application of the RE-AIM QuEST Framework Centering Equity

BACKGROUND

Marginalized mothers are disproportionately impacted by depression and face barriers in accessing mental health treatment. Recent efforts have focused on building capacity to address maternal depression in Head Start; however, it is unclear if mental health inequities can be addressed by two-generation programs in Head Start settings. Therefore, this study examined the implementation outcomes and processes of a two-generation program called "Healthy Moms, Healthy Kids" (HMHK) that provided an evidence-based depression treatment to ethnic minority Head Start mothers.

METHOD

Quantitative and qualitative data were collected and merged in a convergent mixed method design in accordance with the RE-AIM Qualitative Evaluation for Systematic Translation (RE-AIM QuEST) framework. Qualitative data included interviews with 52 key stakeholders, including intervention participants and staff members, and 176 sets of meeting minutes from the implementation period. Quantitative data included intervention study data and administrative data.

RESULTS

It was difficult for HMHK to reach the target population, with only 16.8% of eligible mothers choosing to participate. However, mothers who participated experienced reductions in depressive symptoms and parenting stress and shared a variety of positive impacts in interviews. The program was also more successful in enrolling Latinx mothers who were Spanish-speaking or bilingual rather than English-speaking and Black/African American mothers, limiting its reach.

CONCLUSION

Providing IPT therapy groups was effective in reducing maternal depressive symptoms and stress for those who enrolled, but additional work should focus on reducing barriers to participation, considering other delivery models to meet participants' needs, and identifying culturally relevant ways to meet the needs of Black mothers.

Maternal depression, parental attributions, and adolescent psychopathology: An evaluation using observational and video-mediated recall methods

Parenting styles associated with maternal depression are a risk factor for adolescent psychopathology, and maternal attributional styles may be a key mechanism in this relationship. Mother-adolescent dyads (N = 180; 96 male; ages 10-15) completed in-person interactions and then the mothers participated in a video-mediated recall procedure to assess maternal attributions. Maternal depression was associated with negative attributions. Negative attributions were associated with low parental acceptance, aggressive parenting, and low positive parenting. Positive maternal attributions were associated with less aggressive parenting, and more positive parenting during one interaction task. Adolescent externalizing behaviors were associated with negative attributions. Future research should evaluate whether maternal attributions mediate the association between maternal depression and both parenting behaviors and adolescent mental health.

Maternal depression and adolescent optimism

The life course perspective posits that parents' and children's lives are linked through shared experiences and interdependent contexts such as the household. In this paper, we draw on the life course perspective to examine the relationship between maternal depression and adolescent optimism, an important trait that reflects adolescents' positive expectations for the future, and how features of the family context explain this association. We use data from the Fragile Families and Child Wellbeing Study (N = 3013), taking advantage of the study's longitudinal measures of maternal depression that span a 15-year period. First, we find that current maternal depression is negatively associated with optimism among adolescents. Second, we find that the family environment and parent-child relationships, but not economic wellbeing, explain the association between maternal depression and adolescent optimism. These findings inform our understanding of how parent and adolescent wellbeing are linked and, importantly, how the family environment conditions how adolescents envision their futures.

Mental Health, Material Possessions, and Social Capital During COVID-19: A Study of the United States Urban Working-Age Population

This study evaluates the associations between the urban working-age population's mental health, material possession, and social capital during the COVID-19 pandemic. The specific stressors examined in this empirical analysis are income level, food insecurity, and virtual psychological support. This paper further examines the differences across the employed and unemployed population groups. We obtained data from the COVID-19 Household Impact Survey and constructed four measures of mental health conditions: Nervous, Depressed, Lonely, and Hopeless. Our empirical analyses use an ordinal regression model that takes both time and regional factors into consideration to control for potential time effects and time-invariant confounders that only vary between regions. For the employed group, the main results suggest that lower income and food insecurity is correlated with a higher frequency of mental health symptoms, while virtual psychological support predicts a better mental health status. For the unemployed group, food insecurity is negatively associated with mental health, and virtual psychological might help alleviate nervousness and depression.

Dinámicas sociales en salud materna con énfasis en la Morbilidad Materna Extrema y aportes de la bioética en su comprensión

El propósito del presente artículo es analizar las dinámicas sociales en salud materna y los aportes de la bioética en su comprensión, haciendo énfasis en la Morbilidad Materna Extrema. Para ello, se llevó a cabo una revisión narrativa realizada en las bases de datos Scopus, Pubmed, Web of Science, Lilacs, Scielo y Google Scholar con la estrategia “Maternal Health” AND “Bioethics” OR “Social Justice”; incluyendo artículos en español, inglés y portugués, publicados en los últimos 25 años. En los resultados se incluyeron 79 manuscritos originales y 21 manuscritos de reflexión y revisión, que surtieron el análisis descriptivo al generar las siguientes categorías temáticas: 1. Necesidades de atención en salud y de cuidado; 2. Determinantes sociales, factores de riesgo y protectores; 3. Calidad de la atención, experiencias en el tratamiento y barreras de acceso; y 4. Perspectivas éticas y bioéticas de la salud materna. Como conclusión, se pudo afirmar que el abordaje bioético de la salud materna propone categorías de análisis como la justicia, la equidad, la autonomía y el acceso. Además de las condiciones de vida desde la pluralidad cultural y las consideraciones en cuanto a la comunicación y el lenguaje. Lo anterior, implica que desde los sistemas de salud se deben rediseñar los enfoques de atención en salud materna para abordar las vulnerabilidades y potenciar las capacidades de las mujeres.

The trend and pattern of depression prevalence in the U.S.: Data from National Health and Nutrition Examination Survey (NHANES) 2005 to 2016

BACKGROUND

To assess the trend and pattern of depression prevalence among adult population by demographic characteristics and severity of disease from 2005 to 2016.

METHODS

We used six cycles of National Health and Nutrition Examination Survey. The Patient Health Questionnaire (PHQ-9) was used to measure of depression with the total score ranges 0-27. Socio-demographic variables including age, gender, marital status, race, education, and poverty income ratio (PIR) were used. The weighted prevalence was calculated for each cycle. Logistic regression was used for assessing time-trends in the prevalence of depression.

RESULTS

A total of 31,191 participants aged>20 years were included. The intensity of prevalence trend was different among subgroups of demographic characteristics. Prevalence in females was 1.5-fold more than that in males and increased approximately 2-fold during the study period. The prevalence in "never married" and "other marital status" subgroups was almost 1.5-fold and 2-fold more than that in "married" subgroup, respectively. Prevalence in the never married subgroup increased 2-fold from the first cycle to the latest one. The prevalence of depression was more in the aged<60 years, race group other than white, low education and PIR≤1 subgroups. But, the intensity of the increasing trend was more in the subgroups of aged≥60 years, white race and PIR>1.

LIMITATIONS

the possibility of age-period-cohort (APC) effect that we were unable to assess and control them.

CONCLUSIONS

In sum, there was an overall increasing trend of depression which was different by demographic characteristics based on subtype of depression.

Housing Instability and Depression among US Mothers Following a Nonmarital Birth

Mothers who had a nonmarital birth experience multiple risk factors for depression, including housing instability. Yet, important questions remain about the extent of long-term housing instability and its association with future depression among at-risk mothers. Using the Fragile Families and Child Wellbeing Study data, we examine cumulative housing instability over a 15-year period following nonmarital birth and its association with maternal depression. Based on a sample of 2279 mothers who had a nonmarital birth in 20 major US cities between 1998–2000, we examined their 15-year residential moves and housing arrangements. Then, we tested the associations between the cumulative residential moves and major depressive episodes (MDE) in Year 15 using logistic regression analysis. One in every four mothers had six or more residential moves in 15 years following a nonmarital birth. For each additional move, mothers reported up to 27.9% higher odds of having a past-year MDE in Year 15, translating into the prevalence increases from 6.0% (zero move) to 20.6% (10 moves). Our findings suggest that greater attention should be paid to housing needs among mothers following a nonmarital birth, including temporary housing assistance and more fundamental programs to reduce housing instability as preventive mental health services.

Trends in substance use and prevention education involvement among U.S. adolescents receiving public assistance: new evidence

PURPOSE

The present study aimed to examine the substance use prevention education involvement in different social settings among adolescents receiving public assistance-cash or food voucher-for low household income (heretofore, "PA program enrollees") and preventive effects of each prevention educational setting on current substance use.

METHODS

Using data from a nationally-representative sample of PA program enrollees from the 2002-2017 National Survey on Drug Use and Health, we estimated the prevalence of substance use prevention education involvement in home, school, and neighborhood settings and the associations between involvement in each educational setting and current alcohol/illicit drug use.

RESULTS

Compared to nonenrollees, PA program enrollees reported significantly lower rates of involvement in all prevention education settings, including parent-child conversations (54.6% vs. 60.1%) and neighborhood prevention resources (71.3% vs. 79.3%). All educational setting were associated with lower odds of current substance use, with the largest effects found for parent-child conversations (AOR = 0.821 [P < .001] for alcohol use; AOR = 0.817 [P < .001] for illicit drug use).

CONCLUSIONS

To reduce the elevated risk of illicit drug use among PA program enrollees, special attention needs to be paid to promote parent-child conversation about substance use and increase access to prevention education in regular classes and preventive messages outside schools.

The mediating effect of parenting stress and couple relationship quality on the association between material hardship trajectories and maternal mental health status

BACKGROUND

Household material hardships could have a negative impact on maternal mental health. Understanding mechanisms by which material hardship trajectories affect maternal depression and anxiety could aid health care professionals and researchers to design better interventions to improve mental health outcomes among mothers.

METHODS

The study identified family-level mechanisms by which material hardship trajectories affect maternal depression and anxiety using Fragile Families and Child Wellbeing Study data (n = 1,645). Latent growth mixture modelling was used to identify latent classes of material hardship trajectories at Years-1, -3, and -5. Parenting stress and couple relationship quality was measured at Year-9. The outcome measures included maternal depression and generalized anxiety disorder (GAD) at Year-15 based on the Composite International Diagnostic Interview - Short Form.

RESULTS

Parenting stress mediated the association between low-increasing hardship (b = 0.020, 95% confidence interval (CI):0.003, 0.043) and maternal depression. Parenting stress also mediated the association between high-increasing hardship (b = 0.043, 95% CI:0.004, 0.092), high decreasing hardship (b = 0.034, 95% CI=0.001, 0.072), and low-increasing (b = 0.034, 95% CI:0.007, 0.066) and maternal GAD. In all models, current material hardship was directly related to maternal depression (b = 0.188, 95% CI:0.134, 0.242) and GAD (b = 0.174, 95% CI:0.091, 0.239).

LIMITATIONS

Study results need to be interpreted with caution as the FFCWS oversampled non-marital births as part of the original study design.

CONCLUSIONS

While current material hardship appears to be more related to maternal mental health, prior material hardship experiences contribute to greater parenting stress which places mothers at risk for experiencing depression and GAD later on.

LSD use in the United States: Trends, correlates, and a typology of us

BACKGROUND

Recent years have witnessed an increased interest in LSD. This study investigates current information on the trends and correlates of LSD use from years 2002-2018 and seeks to develop an initial typology of use and misuse.

METHODS

Data is taken from the NSDUH (National Survey on Drug Use and Health) collected between 2002 and 2018 and trends and correlates of LSD use were analyzed with a survey adjusted logistic regression.

RESULTS

Our findings indicate that LSD use has increased 200 % over the study period (.23 % 2002-2005 to .72 % 2015-2018, AOR = 1.10, 95 % CI = 1.08, 1.12). Our findings also indicate several correlates of LSD use including higher levels of education (college degrees: AOR = 1.62, 95 % CI = 1.23, 2.13), not being married (divorced or separated, AOR = 2.31, 95 % CI = 1.44, 3.73, and have never been married, AOR = 5.67, f 95 % CI = 4.09, 7.86), as well as higher levels of antisocial behavior (having been arrested AOR = 3.20, 95 % CI = 2.50, 4.09) and comorbid mental health and substance abuse disorders (serious psychological distress, AOR = 2.39, 95 % CI = 2.05, 2.80). Further, four distinct subclasses were also discovered within LSD users and two of these subtypes of LSD users contained comorbid mental health disturbances and heavy involvement in the criminal justice system.

CONCLUSION

LSD use has been on the rise within the last decades, particularly among those who are well educated. Two subclasses of LSD use (those with severe comorbid mental health disorders and those with criminal justice involvement) may require further interventions.

Effectiveness of an Interpersonal Psychotherapy (IPT) Group Depression Treatment for Head Start Mothers: A Cluster-Randomized Controlled Trial

BACKGROUND

Maternal depression is known to be a serious problem with higher rates among poor and racial/ethnic minority mothers that can have numerous negative impacts on their children. These mothers have less access to effective care and may be wary of traditional mental health care because of the stigma. The purpose of this study was to test whether an adaptation of an Interpersonal Psychotherapy group for perinatal depression could be effective in reducing depressive symptoms of mothers whose children were enrolled in Head Start.

METHODS

Forty-nine mothers, randomized by site, were recruited into the intervention group, 70 into the control group. They were measured on depressive symptoms, parenting stress, parenting behavior, and parent child interaction at intake, at end of the group, and 6 months following.

RESULTS

The intervention group was lower in depressive symptoms at the end of treatment with a further decrease 6 months post intervention. There was no change in the control group. The intervention group also improved in parenting stress.

LIMITATIONS

The sample size for the intervention group was smaller than desired.

CONCLUSIONS

This study supports the effectiveness of this 12 session IPT group which was highly effective for a population of Head Start mothers. It is a strategy that can be adapted to other settings that serve low income mothers.

Trends and correlates of Internet support group participation for mental health problems in the United States, 2004-2018

PURPOSE

This study sought to examine the trends in Internet support group (ISG) participation among U.S. adults and to investigate the sociodemographic and behavioral health profiles of ISG participants.

METHODS

Data was derived from the National Survey on Drug Use and Health (2004-2018, n = 625,883). Logistic regression was used to examine significance of trend year and correlates of ISG participation. Latent class analysis was conducted to identify subtypes of ISG participants.

RESULTS

The proportion of U.S. adults participating in ISG increased significantly from 2.29% (2004-2007) to 3.55% (2016-2018). ISG participants were less likely to be male, 35 or older, be part of an ethnic/racial minority group, or have household incomes between $20,000 and $49,999. Black/African American participants and those classified as "other" race showed the largest percent increases, while Hispanics showed no change. ISG participants were more likely to have experienced a depressive episode and to have used cannabis. Three subtypes of ISG participants were identified, including the Lower Behavioral Health Risk group (62%), the Elevated Behavioral Health Risk group (24%), and the Depression, Cigarettes, and Cannabis group (14%).

CONCLUSION

Overall, we found an increasing trend in seeking mental health care through ISG among US adults since the early 2000s. While disparities among some disadvantaged groups such as Blacks/African Americans and individuals with lower household income were diminishing, continuing efforts to engage men, older adults, and Hispanics in ISG are needed. This investigation also identified distinct subtypes of ISG participants and provides important implications for future research on ISG.

Mental Health Disorders Associated with Sinonasal and Skull Base Malignancies: A Large Cohort Study

Objective  The main purpose of this article is to examine the prevalence, incidence, sociodemographic, and clinical characteristics of mental health disorders (MHDs) among patients with skull base malignancies. Design  Retrospective cohort study. Settings/Participants  Six-thousand seven-hundred sixty sinonasal/skull base cancer patients in the MarketScan database between 2005 and 2014. Main Outcome Measures  Frequency of MHDs pre- and post-diagnosis in patients harboring sinonasal/skull base malignancies. Results  A significant increase in MHDs was noted from pre- to post-cancer diagnosis (22 vs 31%, p  < 0.0001). Despite an increase in the prevalence rate, the demographic profile of patients with MHDs post-diagnosis remained similar to pre-diagnosis. Those patients harboring MHDs were, however, more likely to be women (62.7 vs 47.4%), and carry a history of smoking (40.9 vs 26.3%) than those without MHDs. These comparisons were statistically significant ( p  < 0.0001). Conclusion  The prevalence of MHDs increases following a diagnosis of a sinonasal/skull base malignancy. Patients with MHDs were more likely to be women and smokers.