Depressive symptomatology in three Latino groups

Gender Differences in Stressors Related to Migration and Acculturation in Patients with Psychiatric Disorders and Turkish Migration Background

Migration, acculturation, and psychiatric disorders may cause stress and adaptation processes differently in men and women, but empirical research is scarce. In a retrospective study n = 62 Turkish migrants and n = 62 native German inpatients with depressive or anxiety disorders, matched for age, gender, and diagnoses, were compared using a 10-item instrument for the assessment of migration- and acculturation related stressors (MIGSTR10). Gender differences in the prevalence of stressors and in the total sum of stressors were calculated and compared between migrants and indigenous patients. Results showed a higher global stress level in migrants and in women than in men with migration background. Regarding single stressors, the perceived loss of status was significantly more prevalent and more pronounced in men than in women (P < 0.05) whereas guilt feelings were more severe in women with Turkish migration background compared to men (P < 0.05). Gender differences of perceived stress should be taken into account in migration and acculturation research.

Assessment of Perceived Stress Related to Migration and Acculturation in Patients with Psychiatric Disorders (MIGSTR10)-Development, Reliability, and Dimensionality of a Brief Instrument

Assessment of stressors related to migration and acculturation in patients with psychiatric disorder and migration background could help improve culturally sensitive concepts of psychiatry and psychotherapy for diagnosis and treatment. The present overview delineates development and psychometric properties of an instrument (MIGSTR10) for assessment of stressors related to migration and acculturation, particularly for application in patients with psychiatric disorders. Ten migration-related stressors were derived from a qualitative content analysis of case histories of patients with psychiatric disorder and migration background and put into a suitable interview and questionnaire format (MIGSTR10; 10 questions, answer format: categorical yes/no, and dimensional 0-10) for self-assessment and observer ratings in several languages. Reliability (interrater agreement, internal consistency) and dimensionality (multi-dimensional scaling, MDS) were investigated in n = 235 patients with migration background and n = 612 indigenous German patients. Interrater agreement (ICC) for MIGSTR10 single items and sum scores (categorical and dimensional) was sufficiently high (≥.58); internal consistency (Cronbach's α) reached medium to high values (.56-.73). MDS revealed a two-dimensional solution with two item clusters (A: communication, migration history, forced marriage, homesickness, discrimination, other stressors; B: family conflicts, loss of status, feelings of shame, guilt feelings). The MIGSTR10 is a rationally developed, straightforward 10-item screening instrument with satisfactory psychometric properties for the assessment of individual and specific stressors related to migration and acculturation.

Latino immigrants, depressive symptoms, and cognitive behavioral therapy: A systematic review

BACKGROUND

In order to address the needs of the growing Latino immigrant population, this study aimed to systematically review peer-reviewed articles of intervention studies that used cognitive behavioral therapy to treat depressive symptoms among Latino immigrants in the U.S.

METHODS

We searched PsycINFO, PubMed, and Medline databases from January 1995 through July 2016 as part of a registered review protocol (PROSPERO) following PRISMA guidelines. Inclusion criteria were intervention studies that used cognitive behavioral techniques to treat depressive symptoms among a predominantly U.S. Latino immigrant sample -- or subsample with disaggregated results, and the use of standardized measures of depression. We used the National Heart, Lung, and Blood Institute quality assessment tools for systematic reviews to assess risk of bias.

RESULTS

We identified 11 studies that met inclusion criteria. Nine of the included studies reported a reduction of depressive symptoms. Each study used a least one cultural adaptation to deliver the intervention. Using an existing content model, cultural adaptations were categorized as (a) cognitive-informational adaptations, (b) affective-motivational adaptations, and (c) environmental adaptations.

LIMITATIONS

Heterogeneity of articles in terms of sample size, cultural adaptations, methodological rigor, and setting limited comparability of effectiveness across studies.

CONCLUSIONS

Culturally adapted CBT to address depressive symptoms among Latino immigrants appears promising but further research is needed. The most commonly used cultural adaptations included language, inclusion of migration experience, and adjusting for literacy level. Study design elements and adaptations were often responsive to geographic characteristics and available resources.

Perceived Discrimination in Patients With Psychiatric Disorder and Turkish Migration Background in Germany

Perceived discrimination (PD) has a negative impact on the course of psychiatric disorders. We have investigated PD in inpatients with affective or anxiety disorder and Turkish migration background (TP) or native Germans (GP). Migration-related, clinical, and sociodemographic data of n = 62 TP and n = 62 GP, matched for age, sex, and psychiatric diagnoses, were retrospectively analyzed. PD was assessed as one of 10 questions related to migration and acculturation (yes/no, severity 0-10). PD prevalence rates were compared between TP and GP; relationships of PD with other variables were analyzed using bivariate correlations and multiple regression analyses. A PD prevalence of 26% in TP and 1% in GP was found (odds ratio, 21.2 [2.7-165.8]). Migration background was the strongest predictor of PD in the total group. Within the TP sample, asylum-seeking status and migration-related distress were significantly predictive of PD. In patients with psychiatric disorder in Germany, PD seems to be strongly related to migration-related distress.

Linking Femininity, Weight Concern, and Mental Health Among Latina, Black, and White Women

Studies examining women's appearance ideals and weight concern have predominantly relied on samples of White women. This study addresses this oversight, examining the different relations among embodied femininity, weight concern, and depressive symptomatology that exist for different groups of women. Using a nationally representative sample of women between the ages of 18 and 45, bivariate analyses were conducted using three samples of Latina, Black, and White women. When sample size allowed, a multivariate model was tested (i.e., for Black and White respondents). Results confirm, as hypothesized, different patterns of relations between embodied femininity, weight concern, and depressive symptomatology for each of the samples. At the bivariate level, embodied femininity, weight concern, and depressive symptomatology were positively intercorrelated among Latina respondents. Whereas weight concern fully mediated the relation between embodied femininity and depressive symptomatology for the White respondents, the mediational model was not borne out for the Black respondents. For the latter, although embodied femininity and weight concern were related, weight concern was unrelated to depressive symptoms. Both of these patterns are discussed, as well as the need for greater empirical sensitivity to various constructions of femininity among women of different ethnicities.

Traumatic dissociation as a predictor of posttraumatic stress disorder in South African female rape survivors

Women survivors of rape are at an increased risk for posttraumatic stress disorder (PTSD). Traumatic dissociation has been identified as a precursor of PTSD. This study assessed the predictive potential of traumatic dissociation in PTSD and depression development.The study followed a longitudinal, prospective design. Ninety-seven female rape survivors were recruited from 2 clinics in Cape Town, South Africa. Clinical interviews and symptom status assessments of the participants were completed to measure dissociation, childhood traumas, resilience, depression, and PTSD.Traumatic dissociation was a significant predictor of PTSD and depression. The linear combination of prior dissociation, current dissociation, and resilience significantly explained 20.7% of the variance in PTSD. Dissociation mediated the relationship between resilience and PTSD.As traumatic dissociation significantly predicts PTSD, its early identification and management may reduce the risk of developing PTSD. Interventions focused on promoting resilience may also be successful in reducing the risk of dissociation following rape.

Perinatal depression treatment preferences among Latina mothers

The study described here was designed to determine treatment preferences among Latinas to identify treatment options that meet their needs and increase their engagement. Focus group interviews were conducted with 22 prenatal and postpartum Latinas at risk for depression. The group interviews were conducted in Spanish and English using a standardized interview protocol. Focus group transcripts were analyzed to identify themes regarding perinatal depression coping strategies, preferred approaches to treating perinatal depression, and recommendations for engaging perinatal Latinas in treatment. The results suggest that Latinas' treatment preferences consist of a pathway (i.e., hierarchical) approach that begins with the use of one's own resources, followed by the use of formal support systems (e.g., home-visiting nurse), and supplemented with the use of behavioral therapy. Antidepressant use was judged to be acceptable only in severe cases or after delivery. The data indicate that to increase health-seeking behaviors among perinatal Latinas, practitioners should first build trust.

Is depression associated with contraceptive motivations, intentions, and use among a sample of low-income Latinas?

BACKGROUND

Latinas in the United States experience high rates of unintended pregnancy and low rates of contraception use, yet reasons are not completely understood. Depression is common among pregnant and nonpregnant Latinas; its influence on contraceptive motivations, intentions, and use is understudied.

OBJECTIVES

We sought to 1) describe Latinas' contraceptive motivations, intentions, and use; 2) use structural equation modeling to test associations between depression and contraceptive self-efficacy/motivations/intentions/use; and 3) determine whether associations differ by pregnancy status.

METHODS

This cross-sectional study included Latinas ages 15 to 45 recruited from an urban Federally Qualified Health Center in Baltimore, Maryland. Structured surveys were used to collect data regarding depressive symptoms measured using the PHQ-9. All other constructs were measured with previously validated questions. Constructs included contraceptive self-efficacy, positive and negative contraceptive motivations (perceived advantages and disadvantages of using contraception), contraceptive intentions to begin or continue contraception use, and contraceptive methods currently used.

RESULTS

Among pregnant Latinas, depression was associated with negative motivations (β = 0.16; p < .05), negative motivations were associated with intentions (β = -0.22; p < .01), and contraceptive self-efficacy was associated with intentions (β = 0.43; p < .001). Among nonpregnant Latinas, contraceptive self-efficacy was associated with intentions (β = 0.78; p < .001) and intentions were associated with use (β = 0.40; p < .05).

CONCLUSIONS

Among pregnant Latinas, negative motivations intervene in the association between depression and contraceptive intentions. For nonpregnant Latinas, intentions intervene in the association between self-efficacy and contraceptive use. This study underscores the importance of depression screening during pregnancy and encourages practitioners to target contraceptive motivations to improve contraceptive use.

Maternal post-traumatic stress disorder, depression and alcohol dependence and child behaviour outcomes in mother-child dyads infected with HIV: a longitudinal study

OBJECTIVES

HIV and psychiatric disorders are prevalent and often concurrent. Childbearing women are at an increased risk for both HIV and psychiatric disorders, specifically depression and post-traumatic stress disorder (PTSD). Poor mental health in the peripartum period has adverse effects on infant development and behaviour. Few studies have investigated the relationship between maternal PTSD and child behaviour outcomes in an HIV vertically infected sample. The aim of this study was to investigate whether maternal postpartum trauma exposure and PTSD were risk factors for child behaviour problems. In addition, maternal depression, alcohol abuse and functional disability were explored as cofactors.

SETTING

The study was conducted in Cape Town, South Africa.

PARTICIPANTS

70 mother-child dyads infected with HIV were selected from a group of participants recruited from community health centres.

DESIGN

The study followed a longitudinal design. Five measures were used to assess maternal trauma exposure, PTSD, depression, alcohol abuse and functional disability at 12 months postpartum: Life Events Checklist (LEC), Harvard Trauma Scale (HTS), Alcohol Use Disorders Identification Test (AUDIT), Center for Epidemiological Studies Depression (CESD) Scale and the Sheehan Disability Scale (SDS). Child behaviour was assessed at 42 months with the Child Behaviour Checklist (CBCL).

RESULTS

The rate of maternal disorder was high with 50% scoring above the cut-off for depression, 22.9% for PTSD and 7% for alcohol abuse. Half of the children scored within the clinical range for problematic behaviour. Children of mothers with depression were significantly more likely to display total behaviour problems than children of mothers without depression. Maternal PTSD had the greatest explanatory power for child behaviour problems, although it did not significantly predict child outcomes.

CONCLUSIONS

This study highlights the importance of identifying and managing maternal PTSD and depression in mothers of children infected with HIV. The relationship between maternal PTSD and child behaviour warrants further investigation.

Stressors related to immigration and migration background in Turkish patients with psychiatric disorder: validity of a short questionnaire (MIGSTR10)

The validity of a brief 10-item instrument for the assessment of stressors potentially related to migration and migration background (MIGSTR10) was evaluated in a retrospective analysis. To show convergent and discriminant validity, MIGSTR10 scores and general psychosocial stressors derived from DSM-IV axis IV (DSMSTR9) were compared between a randomly selected group of 30 inpatients with Turkish migration background (MIG) and a native German control group (CON), matched for age, gender, and diagnosis. The differential contribution of MIGSTR10 and DSMSTR9 to global functioning (GAF scores) was calculated. Multivariate analysis showed significantly higher distress in MIG compared to CON with regard to MIGSTR10 (λ = 0.33; P < 0.0005) and DSMSTR9 (λ = 0.703; P = 0.030); significant differences of single stressor severities between MIG and CON were found for "communication problems", "migration history", "loss of status", and "homesickness" (adjusted P < 0.01) of the MIGSTR10, but for none of the DSMSTR9 stressors. Multiple regression analyses revealed a significant independent contribution of MIGSTR10, but not of DSMSTR9 sum scores, to GAF scores (R² = 23%, P = 0.011) in the MIG group whereas no significant overlap between stressor severity and GAF scores was found in CON. The results corroborate the validity of the MIGSTR10 to assess migration-related stressors which can affect global functioning and mental health in patients with migration background.

Assessing Stressors Related to Migration in Patients With Psychiatric Disorders

A 10-item instrument for the assessment of probable migration-related stressors was developed based on previous work (MIGSTR10) and interrater reliability was tested in a chart review study. The MIGSTR10 and nine nonspecific stressors of the DSM-IV Axis IV (DSMSTR9) were put into a questionnaire format with categorical and dimensional response options. Charts of 100 inpatients (50 Turkish migrants [MIG], 50 native German patients [CON]) with affective or anxiety disorder were reviewed by three independent raters and MIGSTR10, DSMSTR9, and Global Assessment of Functioning scale (GAF) scores were obtained. Interrater reliability indices (ICC) of items and sum scores were calculated. The prevalence of single migration-related stressors in MIG ranged from 15% to 100% (CON 0–92%). All items of the MIGSTR10 (ICC 0.58–0.92) and the DSMSTR9 (ICC 0.56–0.96) reached high to very high interrater agreement (p < .0005). The item analysis of the MIGSTR10 revealed sufficient internal consistency (Cronbach’s α = 0.68/0.69) and only one item (“family conflicts”) without substantial correlation with the remaining scale. Correlation analyses showed a significant overlap of dimensional MIGSTR10 scores (r² = 0.25; p < .01) and DSMSTR9 scores (r² = 9%; p < .05) with GAF scores in MIG indicating functional relevance. MIGSTR10 is considered a feasible, economic, and reliable instrument for the assessment of stressors potentially related to migration.

The Diabetes Symptom Self-Care Inventory: development and psychometric testing with Mexican Americans

CONTEXT

Type 2 diabetes is prevalent throughout the world. In previous studies of Mexican Americans with type 2 diabetes, 95%-97% of those sampled reported having symptoms they believe were caused by diabetes and most self-treated their symptoms. To more accurately capture Mexican Americans' symptom prevalence and their self-treatments, the Diabetes Symptom Self-Care Inventory (DSSCI) was adapted from the Diabetes Self-Care Instrument.

OBJECTIVES

This article describes the modification process used to perfect the DSSCI for use in improving self-care among people with type 2 diabetes.

METHODS

This instrumentation study used qualitative and quantitative methods. The study was completed in four phases that used focus groups, cognitive interviews, and survey administration. Four convenience samples were drawn from community-dwelling Mexican American adults, aged 25-75 years, with type 2 diabetes in an urban area and a rural location in Texas.

RESULTS

Phase I: Seven focus groups (n=45) generated data for revising items. Phase II: Cognitive interviews with 16 participants were used to evaluate four revisions of the questionnaire. Phase III: Surveys were administered to 81 participants. Total number of symptoms on the DSSCI correlated with scores on the Centers for Epidemiological Studies-Depression scale (r=0.65, P<0.001), Illness Perception Questionnaire-Revised Diabetes Symptom subscale (r=0.57, P<0.001), and Audit of Diabetes-Dependent Quality of Life scale (r=-0.42, P<0.001). Minor revisions followed. Phase IV: Test-retest stability was demonstrated (n=44).

CONCLUSION

The DSSCI is a culturally relevant, sound measure of Mexican Americans' diabetes symptoms and the actions they take to address them.

Depression and Nigerian-born immigrant women in the United States: a phenomenological study

This phenomenological study, using the Husserlian philosophy, explored the perceptions of Nigerian-born immigrant women in the United States and their portrayal of depression. Through face-to-face, semi-structured, audio-taped interviews incorporating open-ended questions and probes to facilitate discussion, the study examined a purposive sample of 19 Nigerian-born immigrant women's perception of depression. Data were analysed using Colaizzi's seven step method of data analysis. The findings from the study uncovered six themes: (1) craziness and madness; (2) curse and evil spirit possession; (3) denial and secrecy; (4) isolation and rejection; (5) spirituality and religion; and (6) need for education. Findings indicated that Nigerian-born women were not able to differentiate depression from other types of mental illnesses. The women described depression as something that affects others and not them. The women's perception provided insight into why the clergy was preferred for treatment of depression rather than health care professionals. The findings of the study should increase the awareness of nurses and other health care professionals of the need to focus on evidence-based, culturally specific research, and illuminate issues surrounding depression in this population.

Initial Outcomes of a Culturally Adapted Behavioral Activation for Latinas Diagnosed With Depression at a Community Clinic

Latinos demonstrate high rates of depression, often do not seek treatment, and terminate prematurely for a variety of reasons, including lack of sensitivity to contextual and cultural factors in treatment approaches. For decades researchers have suggested a behavioral approach to Latinos diagnosed with depression because such an approach targets the complex environmental stressors experienced by these populations with a simple, pragmatic approach. Recently, behavioral activation has been culturally and linguistically adapted for Latinos/Latinas diagnosed with depression (BA-Latino or BAL). The current study consists of a pilot evaluation of BAL at a bilingual (Spanish—English) community mental health clinic ( N = 10 Latinas). Results provide preliminary support for the feasibility and effectiveness of BAL for Latinas in a community setting in terms of treatment adherence, retention, and outcomes. Implications and future directions are discussed.

Short-term in-home intervention reduces depressive symptoms in Early Head Start Latina mothers of infants and toddlers

Depressive symptoms may compromise the ability of low-income Latina mothers with limited English language proficiency to parent their infants or toddlers. Eighty Early Head Start Latina mothers with limited English language proficiency were randomized to an advanced practice nurse-delivered, culturally tailored, in-home psychotherapy intervention, or to usual care. Repeated measures regression analysis showed a significantly greater decrease in depressive symptoms for intervention mothers compared to the usual care group at 22 and 26 weeks (4 weeks post intervention). Intervention mothers' reports of their child's aggression diminished significantly from T1 to T4 compared to usual care mothers (p = .03). Self-efficacy appeared to only partially mediate the intervention effect, and maternal health moderated the intervention impact. Results indicate that the intervention reduced depressive symptoms and, compared to previous studies in this population, retention of mothers in both intervention and control conditions was improved.

Demands of Immigration, Health Literacy, and Depression in Recent Latino Immigrants

Latino immigrants have unique stressors that can influence mental health. The challenges of adapting to a new society include language barriers, separation from family, and feelings of loss, which can lead to depression. Low health literacy may make it difficult to obtain health care services, and depression may then go untreated. This secondary data analysis examined the relationships of immigration demands, health literacy, and depression in a sample of recent Latino immigrants. Depressive symptoms were a significant problem; 26% of the participants reported symptoms that were suggestive of depression. Furthermore, low health literacy and greater immigration demands predicted higher depression scores. The study suggests that recent Latino immigrants would benefit from health literacy training, education on depressive symptoms, and better access to mental health services. Latinos who do access health care services need to be screened for depression; furthermore, home health care nurses can promote access to support and health care services.

Clinical Trail Outcomes of the Mexican American Problem Solving Program (MAPS)

Depression among Mexican immigrant women and children exceeds national prevalence rates. Given the influence of maternal depression on children, a clinical trial testing the effects of the Mexican American Problem Solving (MAPS) program was designed to address depression symptoms of Mexican immigrant women and their fourth and fifth grade children (302 dyads) through a linked home visiting and after school program compared to peers in a control group. Schools were randomized to intervention and control groups. There were statistically significant improvements in the children's health conceptions and family problem solving communication, factors predictive of mental health. Improvements in children's depression symptoms in the intervention group approached statistical significance. These promising results suggest that refined school based nursing interventions be included in community strategies to address the serious mental health problems that Mexican immigrants face.

Behavioral Activation for Latinos With Depression

Latinos are the fastest-growing ethnic minority group in the United States and face great environmental challenges (e.g., unemployment, loss of social support networks, displacement, and disruption of the family) as well as prejudice and discrimination. These contextual factors are significant risk factors for Latino depression. A behavioral treatment for depression, behavioral activation (BA), may be particularly relevant in treating Latino depression because of its emphasis on contextual factors. This case study presents a cultural modification of BA for Latinos with depression. The treatment of a 25-year-old Latina illustrates a successful application. It suggests that, with some modifications, BA may be a suitable treatment for this population.

Health-related quality of life among Mexican Americans living in colonias at the Texas-Mexico border

Understanding influences on health-related quality of life (HRQL) is critical in order to track and improve the health of poor, vulnerable populations and reduce health disparities. However, studies assessing HRQL of minorities are relatively scarce. The purpose of this study was to document personal and socioenvironmental correlates to HRQL. The study population is Mexican Americans in the Texas-Mexico border region living in colonias - unincorporated, impoverished settlements with substandard living conditions along the U.S.-Mexico border. Mexican Americans living in colonias are one of the most disadvantaged, hard-to-reach minority groups in the United States. We used data from the Integrated Health Outreach System Project collected in 2002 and 2003. Our sample included 386 participants randomly selected and interviewed face-to-face with a structured survey. We measured HRQL and examined personal and socioenvironmental correlates. Unadjusted and adjusted (multivariate) logistic regression models were used for data analyses. We found that border Mexican Americans living in colonias were of similar mental health status compared to the general population of the United States, but worse off in terms of physical health. Poor education and long-term residency in colonias were predictors of lower physical health. Women reported worse mental health than men. Length of time living in a colonia, co-morbidity status, and perceived problems with access to healthcare was associated with poorer mental health status. This study provides information for health professionals and policymakers and underscores the need to provide better preventive and medical services for underserved populations. Major findings indicate the need for additional research centered on further exploration of the impact of economic, cultural, and social influences on HRQL among severely disadvantaged populations.

Un Corazón Saludable: factors influencing outcomes of an exercise program designed to impact cardiac and metabolic risks among urban Latinas

A high prevalence of physical inactivity, metabolic risk factors, and depression place Latinas in peril of developing cardiovascular disease. "Un Corazón Saludable: A Healthy Heart" was developed to engage urban Latinas in physical activity and increase awareness of cardiac and metabolic risk factors. Two hundred and twenty-five Latinas enrolled in the program that included salsa aerobics and culturally sensitive health education modules. Cardiac and metabolic risk factors measured in this study were body mass index (BMI), waist-to-hip ratio, abdominal obesity, and blood pressure. Psychosocial risk factors measured included depressive symptoms and perceived social support. Fifty-two percent of the enrollees completed the program. Results indicated decreases in BMI, abdominal obesity, and symptoms of depression among Latinas who completed the program. Those who did not complete the program were younger, had greater depressive symptomatology, reported poorer social support, and they tended to be caregivers and U.S. born. Focus groups of program participants ascertained that caregiving and family obligations were major barriers to exercise while social support was a major facilitator of exercise. This research indicates that programs developed to recognize and address cultural barriers can impact physical and psychosocial risk factors among urban Latinas who are able to attend. Program retention may improve if future exercise programs conducted through community-base organizations offered support to Latinas regarding issues that interfere with self-care and health promotion. Future programs should consider including mental health and social service case management as part of comprehensive exercise/educational programs.

Supporting the mental health of mothers raising children in poverty: how do we target them for intervention studies?

Poverty increases maternal stress by heightening exposure to negative life events, job loss, chronic strains, poor housing, dangerous neighborhoods, and conflict with partners, culminating in crippling depressive symptoms, the most prevalent mental health threat. Depressive symptoms interfere with the provision of the strong maternal support needed to counter the hardships of poverty, thus placing infants and toddlers at risk for delayed language, social, and emotional development. Initial clinical trials in high-risk mothers have shown promise, and successive tests of interventions will be strengthened if mothers who have mental health risks can be accurately targeted for inclusion. This article reports on a sequential, data-driven process by which high-risk mothers were targeted for intervention in two trials currently in progress to reduce depressive symptoms. An iterative process of using data to identify at-risk mothers and validate the presence of risk factors helped hone the recruitment and design of the intervention trials. This report also offers guidance for further study.

Anthropological and psychological merge: design of a stress measure for Mexican farmworkers

This study implements qualitative and quantitative methodologies in the development of a culturally appropriate instrument of stress for Mexican immigrant farmworkers. Focus groups were used to uncover culturally based perspectives on life stressors, definitions of stress, and stress mediators. Qualitative data were analyzed using QSR NVivo and then used to develop a 23-item stress scale. The scale was tested for reliability and validity in an independent sample and demonstrates excellent reliability (alpha = 0.9123). Test-retest coefficients of the stress scale are also strong (r = 0.8344, p = 0.0000). Qualitative analyses indicated three major sources of stress: work, family, and community. Emotional aspects of stress also emerged, demonstrating a cultural perspective of stress closely related to feelings of despair and not being able to find a way out of despairing situations. This paper reveals themes gathered from the qualitative data and identifies reliability and validity constructs associated with the scale. The stress scale developed as part of this investigation is a reliable and culturally appropriate instrument for assessing stress among Mexican immigrant farmworkers.

The state of nursing science - cultural and lifespan issues in depression: part I: focus on adults

Depression is a devastating disorder, affecting approximately 17 million persons within the United States. The manifestation of depressive phenomena is a complex, dynamic, biopsychosocial process involving lifespan and cultural aspects. Unless appropriately treated, depression persists over time having a significant negative effect on life and increasing the risk of suicide. Psychiatric mental health (PMH) nurses are uniquely positioned to address this epidemic health concern. This manuscript is Part I of the review of current nursing literature on adult depression. This review can be used to enhance PMH nurses' knowledge of current nursing research and their efforts in addressing prevention, early intervention, education and treatment of adults who experience depression.

The Relationship Between Maternal and Child Mental Health in Mexican Immigrant Families

Depression is a leading cause of disability in the United States, with Mexican immigrant women reporting depression rates higher than the national average. The purposes of this study were to describe mental health symptoms in a sample (n = 182) of Mexican immigrant mothers and their relationships to child mental health, family functioning, and acculturation. Over one third of the mothers reported depression and anxiety symptoms above standardized cutoffs while 31% of the children scored in the depressed range. Of those children with high depression scores, 51% also had a mother with high depression and anxiety scores. Boys' depression scores were related to maternal reports of family functioning and stress, while girls' depression scores were related to maternal reports of depression, anxiety, and stress. Maternal mental health symptoms were associated with family functioning but not with acculturation. These data indicate that poorer maternal mental health and family functioning is associated with greater stress in Mexican immigrant children.