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Tian G, Rojas NM, Norton JM, Barajas-Gonzalez RG, Montesdeoca J, Kerker BD. The associations between social support and mental health among Chinese immigrant pregnant and parenting women. BMC Pregnancy Childbirth 2024; 24:583. [PMID: 39243011 PMCID: PMC11380345 DOI: 10.1186/s12884-024-06765-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Accepted: 08/19/2024] [Indexed: 09/09/2024] Open
Abstract
BACKGROUND While it is recognized that social support can alleviate mental health symptoms, this relationship is not well-understood among Chinese pregnant and parenting immigrants in the United States. This study aims to bridge this gap by exploring the relationships between different types of social support and women's anxiety and depression, and examining how these associations vary with pregnancy status. METHODS Data were obtained from a cross-sectional survey conducted in Simplified Chinese or Mandarin between March-June 2021 among 526 women who were pregnant and/or parenting a child under five years. The Patient-Reported Outcomes Measurement Information System (PROMIS) Anxiety, Depression, and Social Support scales were used to measure anxiety, depression, and social support levels. Descriptive statistics, t-tests, chi-square tests, and Pearson's correlations were employed for analysis. Hierarchical regression was conducted to investigate the main and interaction effects of social support types and pregnancy status on mental health outcomes. RESULTS Compared to non-pregnant women, pregnant women reported higher mean scores for anxiety (non-pregnant: 55, pregnant: 59, p < 0.01) and depression (non-pregnant: 54, pregnant: 56, p = 0.02). Instrumental support displayed a significant main effect in relation to anxiety (β=-0.13, p = 0.01) and depression (β=-0.16, p < 0.01); emotional support exhibited a significant main effect solely on depression (β=-0.13, p = 0.01). Notably, the interaction effects between pregnancy status and both instrumental (β=-0.28, p = 0.01) and emotional support (β=-0.42, p < 0.01) were significant for anxiety. In contrast, informational support did not exhibit a significant impact on either anxiety or depression. CONCLUSIONS The findings indicate that tailoring support to the cultural context is crucial, especially for pregnant women in this Chinese immigrant community, with instrumental and emotional support being particularly beneficial in mitigating maternal anxiety.
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Affiliation(s)
- Grace Tian
- Center for Early Childhood Health and Development, Population Health, NYU Grossman School of Medicine, New York, NY, USA.
| | - Natalia M Rojas
- Center for Early Childhood Health and Development, Population Health, NYU Grossman School of Medicine, New York, NY, USA
| | - Jennifer M Norton
- Department of Population Health, NYU Grossman School of Medicine, New York, NY, USA
| | - R Gabriela Barajas-Gonzalez
- Center for Early Childhood Health and Development, Population Health, NYU Grossman School of Medicine, New York, NY, USA
| | - Jacqueline Montesdeoca
- Center for Early Childhood Health and Development, Population Health, NYU Grossman School of Medicine, New York, NY, USA
| | - Bonnie D Kerker
- Center for Early Childhood Health and Development, Population Health, NYU Grossman School of Medicine, New York, NY, USA
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2
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Wickramaratne PJ, Yangchen T, Lepow L, Patra BG, Glicksburg B, Talati A, Adekkanattu P, Ryu E, Biernacka JM, Charney A, Mann JJ, Pathak J, Olfson M, Weissman MM. Social connectedness as a determinant of mental health: A scoping review. PLoS One 2022; 17:e0275004. [PMID: 36228007 PMCID: PMC9560615 DOI: 10.1371/journal.pone.0275004] [Citation(s) in RCA: 37] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Accepted: 09/08/2022] [Indexed: 11/29/2022] Open
Abstract
Public health and epidemiologic research have established that social connectedness promotes overall health. Yet there have been no recent reviews of findings from research examining social connectedness as a determinant of mental health. The goal of this review was to evaluate recent longitudinal research probing the effects of social connectedness on depression and anxiety symptoms and diagnoses in the general population. A scoping review was performed of PubMed and PsychInfo databases from January 2015 to December 2021 following PRISMA-ScR guidelines using a defined search strategy. The search yielded 66 unique studies. In research with other than pregnant women, 83% (19 of 23) studies reported that social support benefited symptoms of depression with the remaining 17% (5 of 23) reporting minimal or no evidence that lower levels of social support predict depression at follow-up. In research with pregnant women, 83% (24 of 29 studies) found that low social support increased postpartum depressive symptoms. Among 8 of 9 studies that focused on loneliness, feeling lonely at baseline was related to adverse outcomes at follow-up including higher risks of major depressive disorder, depressive symptom severity, generalized anxiety disorder, and lower levels of physical activity. In 5 of 8 reports, smaller social network size predicted depressive symptoms or disorder at follow-up. In summary, most recent relevant longitudinal studies have demonstrated that social connectedness protects adults in the general population from depressive symptoms and disorders. The results, which were largely consistent across settings, exposure measures, and populations, support efforts to improve clinical detection of high-risk patients, including adults with low social support and elevated loneliness.
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Affiliation(s)
- Priya J. Wickramaratne
- Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, New York, NY, United States of America
- Division of Translational Epidemiology, New York State Psychiatric Institute, New York, NY, United States of America
| | - Tenzin Yangchen
- Division of Translational Epidemiology, New York State Psychiatric Institute, New York, NY, United States of America
| | - Lauren Lepow
- Departments of Psychiatry and Genetics & Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America
| | - Braja G. Patra
- Division of Health Informatics, Department of Population Health Sciences, Weill Cornell Medicine, New York, NY, United States of America
| | - Benjamin Glicksburg
- Departments of Psychiatry and Genetics & Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America
| | - Ardesheer Talati
- Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, New York, NY, United States of America
- Division of Translational Epidemiology, New York State Psychiatric Institute, New York, NY, United States of America
| | - Prakash Adekkanattu
- Department of Information Technologies and Services, Weill Cornell Medicine, New York, NY, United States of America
| | - Euijung Ryu
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, United States of America
| | - Joanna M. Biernacka
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, United States of America
| | - Alexander Charney
- Departments of Psychiatry and Genetics & Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America
| | - J. John Mann
- Division of Molecular Imaging and the Neuropathology, Departments of Psychiatry and Radiology, New York State Psychiatric Institute, Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, New York, NY, United States of America
| | - Jyotishman Pathak
- Division of Health Informatics, Department of Population Health Sciences, Weill Cornell Medicine, New York, NY, United States of America
| | - Mark Olfson
- Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, New York, NY, United States of America
| | - Myrna M. Weissman
- Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, New York, NY, United States of America
- Division of Translational Epidemiology, New York State Psychiatric Institute, New York, NY, United States of America
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3
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Hagaman A, LeMasters K, Zivich PN, Sikander S, Bates LM, Bhalotra S, Chung EO, Zaidi A, Maselko J. Longitudinal effects of perinatal social support on maternal depression: a marginal structural modelling approach. J Epidemiol Community Health 2021; 75:936-943. [PMID: 33712512 PMCID: PMC8434957 DOI: 10.1136/jech-2020-215836] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 02/22/2021] [Accepted: 03/02/2021] [Indexed: 12/18/2022]
Abstract
BACKGROUND Depression in the perinatal period, during pregnancy or within 1 year of childbirth, imposes a high burden on women with rippling effects through her and her child's life course. Social support may be an important protective factor, but the complex bidirectional relationship with depression, alongside a paucity of longitudinal explorations, leaves much unknown about critical windows of social support exposure across the perinatal period and causal impacts on future depressive episodes. METHODS This study leverages marginal structural models to evaluate associations between longitudinal patterns of perinatal social support and subsequent maternal depression at 6 and 12 months postpartum. In a cohort of women in rural Pakistan (n=780), recruited in the third trimester of pregnancy and followed up at 3, 6 and 12 months postpartum, we assessed social support using two well-validated measures: the Multidimensional Scale of Perceived Social Support (MSPSS) and the Maternal Social Support Index (MSSI). Major depressive disorder was assessed with the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders (DSM IV). RESULTS High and sustained scores on the MSPSS through the perinatal period were associated with a decreased risk of depression at 12 months postpartum (0.35, 95% CI: 0.19 to 0.63). Evidence suggests the recency of support also matters, but estimates are imprecise. We did not find evidence of a protective effect for support based on the MSSI. CONCLUSIONS This study highlights the protective effect of sustained social support, particularly emotional support, on perinatal depression. Interventions targeting, leveraging and maintaining this type of support may be particularly important for reducing postpartum depression.
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Affiliation(s)
- Ashley Hagaman
- Social Behavioral Sciences, Yale University School of Public Health, New Haven, Connecticut, USA
- Center for Methods in Implementation and Prevention Science, Yale University, New Haven, Connecticut, USA
| | - Katherine LeMasters
- Department of Epidemiology, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Carolina Population Center, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Paul N Zivich
- Department of Epidemiology, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Carolina Population Center, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Siham Sikander
- Human Development Research Foundation, Islamabad, Pakistan
- Global Health Department, Health Services Academy, Islamabad, Pakistan
| | - Lisa M Bates
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, USA
| | - Sonia Bhalotra
- Department of Economics, University of Warwick, UK, Coventry, Warwickshire, UK
| | - Esther O Chung
- Department of Epidemiology, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Carolina Population Center, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Ahmed Zaidi
- Human Development Research Foundation, Islamabad, Pakistan
| | - Joanna Maselko
- Department of Epidemiology, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Carolina Population Center, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
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Yılmaz M, Değirmenci F, Yılmaz DV. A psychosocial examination of feelings and thoughts about pregnancy: A qualitative study. Midwifery 2021; 103:103106. [PMID: 34352598 DOI: 10.1016/j.midw.2021.103106] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2020] [Revised: 04/15/2021] [Accepted: 05/05/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND during pregnancy, which is a developmental period, there are risks that may cause pathological changes when physical, mental and social adaptation is not achieved. During antenatal appointments, it is possible to provide necessary care for pregnant women at the right time by screening for risks that threaten health. In addition to physical risk factors, psychosocial risk factors that can have significant effects on the health of pregnant women should also be included in antenatal appointments. A woman's inability to meet her needs or difficulties encountered in psychosocial areas, such as mental health, family relations, social life and job status during pregnancy, may result in mental and social problems as well as physical problems. Insufficient social support, job loss and family communication problems can leave pregnant women vulnerable to stress and cause many pregnancy complications, such as preterm labor. When problems in these areas cannot be detected at an early stage, they can threaten the life of the woman and the fetus. As such, knowledge of the specific feelings and thoughts of pregnant women from a psychosocial perspective will be useful in the evaluation of psychosocial risk factors. PURPOSE to determine the feelings and thoughts of pregnant women from a psychosocial perspective. METHOD this study used a qualitative descriptive approach to investigate pregnancy-related feelings and thoughts in a sample of 23 healthy pregnant women. Data were collected using a personal information form and a semi-structured interview form. The interviews, which were conducted using the semi-structured interview form and individual in-depth interviews, were recorded on a voice recorder. A thematic approach was used to analyze the data. RESULTS according to the results, the mean age of the pregnant women was 30.39 (standard deviation 4.03) years, 73.9% were university graduates and 78.3% were multiparous. Three main themes ('Pregnancy perception', 'Emotions in pregnancy' and 'Psychosocial dimension of pregnancy') and eight subthemes emerged from the data analysis. For 'Pregnancy perception', the subtheme was 'Meaning of pregnancy'. For 'Emotions in pregnancy', the subthemes were 'Emotional status (mood) in pregnancy' and 'Fear in pregnancy'. For 'Psychosocial dimension of pregnancy', the subthemes were 'Reflections of pregnancy on social life', 'Reflections of pregnancy on body image', 'Reflections of pregnancy on sexual life', 'Reflections of pregnancy on marital relationship' and 'Reflections of pregnancy on working life'. CONCLUSIONS in order to protect and maintain the health of the mother and fetus during pregnancy, it is recommended that women should be provided with the best physical and psychosocial care within the context of social and cultural structure, not only in this period but in every stage of their lives.
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Affiliation(s)
- Mualla Yılmaz
- Department of Mental Health Nursing, Mersin University Faculty of Nursing, Mersin, Turkey
| | - Filiz Değirmenci
- Department of Obstetrics and Gynaecology Nursing, Mersin University Faculty of Nursing, Mersin 33343, Turkey.
| | - Duygu Vefikuluçay Yılmaz
- Department of Obstetrics and Gynaecology Nursing, Mersin University Faculty of Nursing, Mersin 33343, Turkey
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Hare MM, Kroll-Desrosiers A, Deligiannidis KM. Peripartum depression: Does risk versus diagnostic status impact mother-infant bonding and perceived social support? Depress Anxiety 2021; 38:390-399. [PMID: 33615587 PMCID: PMC8026554 DOI: 10.1002/da.23121] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 09/21/2020] [Accepted: 11/21/2020] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Peripartum depression (PND) impairs mother-infant boding and perceived social support, yet limited research has examined if women at-risk for PND (AR-PND) also experience impairment. We examined if pregnant women AR-PND, women with PND, and healthy comparison women (HCW) differed in their mother-infant bonding and social support. As PND is highly comorbid with anxiety, we also examined if peripartum anxiety impacted postpartum diagnosis of PND. METHODS A total of 144 pregnant women AR-PND or euthymic were assessed twice antepartum and twice postpartum. We utilized regression models to examine the impact of PND risk group status and diagnostic status on mother-infant bonding and perceived social support postpartum. We conducted a sensitivity analysis using a generalized estimating equations model to determine if anxiety (Hamilton Anxiety Rating Scale, HAM-A) across all four time points was associated with the postpartum diagnosis of PND. RESULTS Women AR-PND experienced significantly worse mother-infant bonding compared to HCW (p = .03). Women diagnosed with PND experienced significantly worse mother-infant bonding and social support compared to HCW (p = .001, p = .002, respectively) and to those who were at-risk for but did not develop PND (p = .02, p = .008, respectively). HAM-A severity at each visit was associated with PND diagnosis status, where each increase in HAM-A was associated with 15% increased odds of being diagnosed with PND postpartum. CONCLUSIONS Both women AR-PND and those with PND experience worse mother-infant bonding. Peripartum anxiety should also be assessed as it represents a marker for later PND.
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Affiliation(s)
- Megan M. Hare
- Center for Children and Families, Department of Psychology, Florida International University, Miami, FL 33199
| | - Aimee Kroll-Desrosiers
- VA Central Western Massachusetts Healthcare System, Leeds, MA 01053
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA 01655
| | - Kristina M. Deligiannidis
- Department of Psychiatry, Zucker Hillside Hospital, Northwell Health, Glen Oaks, NY 11004
- Departments of Psychiatry and Obstetrics & Gynecology, Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY 11549
- Feinstein Institutes for Medical Research, Manhasset, NY 11030
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6
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Kazemi A, Ghaedrahmati M, Kheirabadi G. Partner's emotional reaction to pregnancy mediates the relationship between pregnancy planning and prenatal mental health. BMC Pregnancy Childbirth 2021; 21:168. [PMID: 33639876 PMCID: PMC7913387 DOI: 10.1186/s12884-021-03644-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 02/16/2021] [Indexed: 12/13/2022] Open
Abstract
Background An unplanned pregnancy may be followed by increased depression and anxiety. The aim of the present study was to evaluate the mediating role of partner’s emotional reaction to pregnancy (PERP) on the relationship between pregnancy planning and prenatal mental health. Methods This cross-sectional study was conducted on 303 healthy Iranian pregnant women during their third trimester. The levels of depression and anxiety were measured using the Edinburgh Postnatal Depression Scale and the State-Trait Anxiety Inventory. The PERP score was also measured using a researcher-made questionnaire. The data were analyzed using the plug-in application PROCESS macro. Results The results showed that PERP score was reversely related to pregnancy planning and prenatal depression and anxiety. The direct effect of the pregnancy planning on depression (c = −.05) and anxiety levels (c = −.02) were not significant; but the indirect effect of pregnancy planning on depression (Point Estimate = −.379, CI: −.523 to −.250) and anxiety levels (Point Estimate = −.560, CI: −.741 to −.385) with the mediating role of PERP were significant. Conclusions The results indicated that the effect of pregnancy planning on prenatal mental health is mediated by PERP, and in unplanned pregnancy women need to receive positive reaction of their partners toward pregnancy so that they can preserve their mental health.
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Affiliation(s)
- Ashraf Kazemi
- Reproductive Health Department, School of Nursing and Midwifery, Isfahan University of Medical Sciences, Hezarjerib Av., Isfahan, Iran.
| | - Maryam Ghaedrahmati
- Reproductive Health Department, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Gholamreza Kheirabadi
- Behavioral Sciences Research center, Department of psychiatry, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
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Nakano M, Sourander A, Luntamo T, Chudal R, Skokauskas N, Kaneko H. Early risk factors for postpartum depression: A longitudinal Japanese population-based study. J Affect Disord 2020; 269:148-153. [PMID: 32339130 DOI: 10.1016/j.jad.2020.03.026] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Revised: 03/06/2020] [Accepted: 03/09/2020] [Indexed: 12/18/2022]
Abstract
BACKGROUND Postpartum depression (PPD) negatively impacts maternal health, parenting and development of children. Most previous studies on PPD risk factors are based on Western populations. Additionally, little is known about the association between psychosocial factors during early pregnancy period and PPD. We aimed to identify early risk factors for PPD until three months after delivery using a longitudinal population-based sample from Japan. METHODS The data was collected from 1050 mothers at four time points: first trimester, after the birth, and one and three months post-delivery. Mothers who had a Japanese Edinburgh Postnatal Depression Scale (EPDS) cutoff score above 9 at one or 3 months after delivery were recognized as having PPD (n = 91/8.7%). RESULTS Negative feelings about pregnancy, combined breast and bottle feeding, first-time motherhood, motherhood 24 or less years old, perceived maternal mental illness before pregnancy, and lack of social support were all significantly associated with PPD at three months after delivery. LIMITATIONS The data was collected from one city in Japan, which limits the generalization of the findings. Additionally, PPD was assessed by an EPDS questionnaire, and not by a clinical interview. CONCLUSIONS Even after controlling for the perceived mental illness before pregnancy, several risk factors as early as in the first trimester were associated with PPD. These risk factors should be identified and the mothers should be offered a suitable intervention, in order to prevent the development of PPD.
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Affiliation(s)
- Mami Nakano
- Graduate School of Education and Human Development, Nagoya University, Furo-cho, Chikusa-ku, Nagoya 464-8601, Japan.
| | - Andre Sourander
- Research Center for Child Psychiatry, University of Turku, Lemminkäisenkatu 3/Teutori 3rd Floor, Turku 20014, Finland.
| | - Terhi Luntamo
- Research Center for Child Psychiatry, University of Turku, Lemminkäisenkatu 3/Teutori 3rd Floor, Turku 20014, Finland.
| | - Roshan Chudal
- Research Center for Child Psychiatry, University of Turku, Lemminkäisenkatu 3/Teutori 3rd Floor, Turku 20014, Finland.
| | - Norbert Skokauskas
- Centre for Child and Adolescent Mental Health and Child Protection, Faculty of Medicine, NTNU, NO-7491, Trondheim, Norway.
| | - Hitoshi Kaneko
- Psychological Support and Research Center for Human Development, Nagoya University, Furo-cho, Chikusa-ku, Nagoya 464-8601, Japan.
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Mo PKH, Xin M, Lau JTF. Testing the vulnerability and scar model of the relationship between self-concept, social support and anxiety symptoms among children of HIV-infected parents in China: A 3-year longitudinal study. J Affect Disord 2019; 259:441-450. [PMID: 31611002 DOI: 10.1016/j.jad.2019.08.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2018] [Revised: 06/18/2019] [Accepted: 08/17/2019] [Indexed: 11/20/2022]
Abstract
BACKGROUND Mental illness is a great concern among children of HIV-infected parents (COHIP), who are at their crucial stage of psychosocial development. It has been shown that self-concept (SC) and social support (SS) are important correlates of anxiety symptoms (AS), however, nature of the causality remained unclear. METHODS A 3-year longitudinal study was conducted in rural Central China, where many people were infected with HIV through unhygienic blood donation. A total of 195 COHIP (mean age: 12.6 years, 49.2% male) completed the baseline assessment and were followed for three years. Cross-lagged structural equation modeling analyses were used to test competing theoretical models: vulnerability model (low SC/SS contributes to AS), scar model (AS erodes SC/SS) and reciprocity model (low SC/SS and AS predict each other). RESULTS At each wave, 104 (53.3%) and 67 (41.6%) participants presented with anxiety disorders respectively. Nested-model comparison supported the superiority of scar models wherein AS significantly predicted subsequent low SC (β=-0.24, p=0.013) and SS (β=-0.31, p= 0.033), controlling for synchronous and autoregressive effects of all measures. The most parsimonious multivariate model that included significant relations was finally identified with a good model fit. LIMITATIONS Findings might be subject to reporting bias; and could not inform the temporal relationship between SC and SS. CONCLUSION Prevalence of anxiety was high among Chinese COHIP. The present study provides empirical evidence for scarring effects of AS; thus, highlighted the importance of identifying and treating COHIP's anxiety to mitigate long-term negative impacts on their psychosocial development.
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Affiliation(s)
- Phoenix K H Mo
- School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China; The Chinese University of Hong Kong Shenzhen Research Institute, Shenzhen, China
| | - Meiqi Xin
- School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China; The Chinese University of Hong Kong Shenzhen Research Institute, Shenzhen, China
| | - Joseph T F Lau
- School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China; The Chinese University of Hong Kong Shenzhen Research Institute, Shenzhen, China.
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