Desired mental health resources for urban, ethnically diverse, impoverished women struggling with anxiety and depression

Men's mental health - Conceptualization, effects, and coping

Men are predisposed to suffer with unaddressed depression and anxiety. This study sought to empower men, in three urban, racially/ethnically diverse, underserved, and impoverished neighborhoods, for mental health self-care by capturing their perceptions of depression and anxiety. Using community-based participatory research, in the context of long-term partnerships between a department of nursing and these neighborhoods, the researchers recruited 50 men aged 23-83 years. Data were collected via six homogeneous, zoom-based focus groups composed of Black, Hispanic, and White men, respectively. The men identified themes pertaining to the conceptualization and devastating effects of depression and anxiety as well as coping strategies employed to mitigate the symptoms.

Capturing men's perspectives on prevalence, existing resources, and solutions to depression and anxiety using community-based participatory research and focus groups

OBJECTIVE

Men are predisposed to suffer from unaddressed depression and anxiety. The purpose of this study was to capture the perceptions of men in three urban, racially/ethnically diverse, under-resourced, and impoverished neighborhoods around this health issue. The results were used to design a resident-driven solution to this health disparity.

DESIGN

Design This study utilized a focus group method within the ideological perspective of community-based participatory research (CBPR).

SAMPLE

Sample The researchers recruited 50 Black, Hispanic, and White men aged 23-83 years to participate in this study during the summer of 2021.

MEASUREMENTS

Measurements Data were collected via six homogeneous, Zoom-based focus groups. Five of the focus groups were offered in English and the sixth in Spanish.

RESULTS

The men identified themes and subthemes pertaining to the perception of widespread depression and anxiety in their neighborhoods, existing typical and atypical community resources, and suggested solutions to this health disparity. These results were translated into a solution involving the training of five male, lay mental health ambassadors.

CONCLUSIONS

Policies and solutions to issues of mental health disparity must be informed by the communities that they intend to serve. CBPR is a robust vehicle for empowering communities to address the healthcare issues facing them.

Women Supporting Women: The Use of Art With Anxious/Depressed, Urban, Impoverished, Ethnically Diverse Women

BACKGROUND: Depression and anxiety disproportionately affect urban, ethnically diverse, impoverished women-particularly when access to culturally sensitive care is limited. Using community-based participatory research in the context of long-term, academic/community partnerships, women supporting women, a supportive/educative group intervention piloting an art project, was offered. AIMS: The purpose of this study was to examine the impact of an artist book-making project on diverse women struggling with anxiety and depression. METHODS: A descriptive qualitative approach was used within this mixed-method study. Thirty-one participants, aged 18 to 86 years, were asked: (1) How does this book tell your story? (2) How did creating this book impact you personally? (3) How would you describe the experience of creating your book alongside women from our group? (4) How did this project help you with anxiety and depression? (5) What did you do with the book that you made? The framework method for analysis of qualitative data in multidisciplinary health research was used. RESULTS: Four themes, with corresponding subthemes, were identified: (1) personal story entailed expression of past, present, and future journey and mediums to depict the story; (2) method of coping included relaxation, diversion, and self-care; (3) creative impact encompassed affirmation of identity, empowerment, healing, pride in work, and a vehicle to connect; and (4) creating in community incorporated inspiration, sharing, and solidarity. CONCLUSIONS: These results suggest that an art project provides a culturally sensitive, clinically relevant, and cost-effective self-care intervention for vulnerable women struggling with anxiety and depression.

Factors impacting attrition of vulnerable women from a longitudinal mental health intervention study

OBJECTIVE

This study explored factors associated with attrition of vulnerable women from a community-based, longitudinal mental health intervention study.

DESIGN

The study employed a quasi-experimental, nonequivalent comparison group pretest-posttest design. The intervention consisted of six, 90-min meetings featuring education and support.

SAMPLE

One hundred and eighteen women aged 18-88 years enrolled from four urban neighborhoods.

MEASUREMENTS

The team used the Generalized Anxiety Disorder-7, the Primary Health Questionnaire-9, a self-care knowledge for anxiety and depression instrument, and demographics to measure variables.

INTERVENTION

Sessions occurred at trusted neighborhood sites. The team provided transportation, child care, and reminder calls or texts. Community health workers actively encouraged participants to continue in the study. The researchers did not offer financial incentives. Completion of the intervention involved attending four of six sessions.

RESULTS

The study had a 39% attrition rate. Results, using a Chi-square test for independence, indicated significant associations between attrition, neighborhood/homelessness, and family income. Additionally, there were significant associations between attrition, a past diagnosis of anxiety, and a lack of concurrent therapy for anxiety/depression.

CONCLUSIONS

This study identified social determinants and mental health factors linked to the attrition of urban, ethnically diverse, and impoverished women from longitudinal intervention studies.

A Qualitative Inquiry Addressing the Experience of Depression in Impoverished Ethnically Diverse Women: Implications for Developing a Community-Based Model

BACKGROUND

Literature suggests that a disparity exists relative to the higher prevalence of depression among the population of impoverished ethnically diverse women, the services available, and care received resulting in a significant health issue for women.

OBJECTIVES

An exploratory-descriptive qualitative study explored the experiences of depression among the population and key stakeholders to inform the development of a community-based program to reduce depression and improve the quality of life of ethnically diverse women residing in an urban community.

DESIGN

Data were collected using focus groups and individual interviews with members of the population and key community representatives, transcribed verbatim, reviewed for accuracy, coded, and analyzed for themes.

RESULTS

Compassion, ease, and hope emerged as the three overarching foundational themes.

CONCLUSION

An intentional infrastructure and strategies to create an experience of compassion, ease, and hope appear to be essential core components of a successful community mental health program model for impoverished women experiencing depression.

Women supporting women: Supportive/educative groups for ethnically diverse, urban, impoverished women dealing with depression and anxiety

Depression and anxiety are mental health issues that disproportionately affect urban, ethnically diverse, impoverished women. Using community based participatory research and in the context of long-term partnerships between a nursing department and underserved neighborhoods that are predominately Black, Hispanic, and White respectively, supportive/educative groups were offered. The study employed a quasi-experimental, nonequivalent comparison group pretest-posttest design. Seventy-two women aged 17-88 years participated. Repeated measures ANOVA indicated a significant increase in knowledge for self-care for depression and anxiety and a significant decrease in anxiety and depression symptomatology from before to after the group sessions.

Maternal Mental Health after Custody Loss and Death of a Child: A Retrospective Cohort Study Using Linkable Administrative Data

OBJECTIVE

The objective was to compare mental illness diagnoses and treatment use among mothers who lost custody of their child through involvement with child protection services and those seen in mothers dealing with the death of a child.

METHODS

We studied mental health outcomes of a cohort of women whose first child was born in Manitoba, Canada between 1 April 1997 and 31 March 2015. Of these women, 5,792 had a child taken into care, and 1,143 mothers experienced the death of a child (<18 y old) before 31 March 2015. Adjusted relative rates (ARR) of 3 mental health diagnoses and 3 mental health treatment use outcomes between these 2 groups were examined.

RESULTS

Mothers with a child taken into care had significantly greater ARR of depression (ARR = 1.90; 95% CI, 1.82 to 1.98), anxiety (ARR = 2.51; 95% CI, 2.40 to 2.63), substance use (ARR = 8.54; 95% CI, 7.49 to 9.74), physician visits for mental illness (ARR = 3.01; 95% CI, 2.91 to 3.12), and psychotropic medication use (ARR = 4.95; 95% CI, 4.85 to 5.06) in the years after custody loss compared with mothers who experienced the death of a child.

CONCLUSION

Losing custody of a child to child protection services is associated with significantly worse maternal mental health than experiencing the death of a child. Greater acknowledgement and supportive services should be provided to mothers experiencing the loss of a child through the involvement of child protection services.

Community-based counseling reaches and helps bereaved people living in low-income households

OBJECTIVE

Poverty is related to increased grief-related mental health problems, leading some to suggest bereavement counseling should be tailored to income. However, information about accessibility and effectiveness of such counseling programs serving low-income households is scarce. This longitudinal study therefore investigated the association between poverty and complicated grief (CG), and the effectiveness of a community-based bereavement counseling program in serving low-income households.

METHODS

Two hundred eighty-eight participants (75% female) were enrolled. Loss-related and demographic variables were assessed at baseline. Regression analyses were used to investigate household income as a predictor of CG, and examine bereavement counseling effectiveness by comparing CG symptom change across three household income categories across three time-points: baseline (T1), T1 + 12 months (T2), and T1 + 18 months (T3).

RESULTS

Of all participants, 35.8% reported below poverty-threshold income, twice the general population's rate. Multiple regression analysis indicated poverty-threshold income was a predictor of CG symptoms over and above demographic and loss-related characteristics. Three-way interaction analysis detected a significant treatment effect for study condition across time, but no differences in treatment effects across income.

CONCLUSION

Lower household income was associated with higher CG symptoms. Since income did not predict differential treatment response, community-based bereavement counseling appeared no less efficacious for members of low-income households. Clinical or methodological significance of this article: While previous research has indicated low income may be a risk factor for mental health problems after bereavement, and it has therefore been suggested bereavement counseling should be tailored to income, no study to date has investigated the need for such tailoring. This controlled, longitudinal treatment study fills this gap in knowledge. Main findings are that low income is a key predictor of complicated grief symptoms. The study also shows that the effectiveness of one-to-one bereavement counseling does not appear to differ according to income level.

Social Status, Discrimination, and Minority Individuals' Mental Health: a Secondary Analysis of US National Surveys

OBJECTIVES

Our study measured minority individuals' social status factors and frequency of discrimination experiences, in order to delineate social mechanisms linking race/ethnicity to mental status (specifically, to current mood/anxiety disorder and self-rated mental health).

METHODS

In this nationally representative secondary research, our data analyses drew on the cross-sectional "Collaborative Psychiatric Epidemiology Surveys," dating 2001-2003. The sample for the final model numbered 9368 respondents (2016 Asians, 2676 Latinos, 4676 blacks).

RESULTS

Across races/ethnicities, better mental health was associated with male gender, higher income, marriage, more education, and less-frequent discrimination experiences; discrimination experiences could impair health, especially among blacks. Marriage's strong contribution to Asians' mental health did not hold among blacks; education's contribution to Latinos' mental health did not hold among blacks either. Blacks' mental health was unaffected by immigration status, but Asian and Latino immigrants showed less-robust mental health than native-born counterparts.

CONCLUSIONS

Across the three racial/ethnic groups studied, differences were noted in relationships between self-reported mental health status and the employed social status and discrimination factors.

Teen Mothers' Experience of Intimate Partner Violence: A Metasynthesis

Pregnant and parenting teens suffer higher rates of intimate partner violence (IPV) than older mothers. This qualitative metasynthesis explores teen mothers' experience with IPV during pregnancy and postpartum. Organized by the metaphor of a web, findings highlight how pervasive violence during childhood contributes to teen pregnancy and the risk of IPV as violence is normalized. The web constricts through the partner's control as violence emerges or worsens with pregnancy. Young mothers become increasingly isolated, and live with the physical and psychological consequences of IPV. Trauma-informed nursing practice is needed to support teen mothers in violent intimate relationships to spin a new web.

Impact of Integrating Community-Based Participatory Research Into a Baccalaureate Nursing Curriculum

BACKGROUND

Community-based participatory research (CBPR) is rapidly gaining respect within the health care community as a means to promote public health and address health disparities. It has also recently been named as one of the competencies needed by public health professionals to be effective.

METHOD

This article describes an educational innovation where CBPR is integrated into a baccalaureate nursing curriculum as a strategy to create meaningful learning experiences for nursing students while benefitting the health of the community.

RESULTS

The impact of this approach was analyzed over a period of 12 years. The positive outcomes for the community, students, and faculty are described, along with the unique challenges.

CONCLUSION

Integrating CBPR into a nursing curriculum is an innovation that is worthy of further assessment.

Adverse outcomes in bereaved mothers: The importance of household income and education

Intense and enduring psychological distress has been well-documented in numerous studies on bereaved parents including anxious, depressive, and traumatic stress symptoms. A state of poverty is also known to increase the risk of psychological distress in the general population, yet this variable has not yet been sufficiently evaluated in outcomes specifically for bereaved parents. This study is the first to investigate poverty, education, and parental bereavement while examining the relative risk of other variables as informed by the literature. The findings reveal that poverty was the strongest predictor of psychological distress when compared to others factors which have traditionally been considered significant in parental bereavement. Bereaved parents living in poverty may be less likely to seek support and have fewer available resources. Practice and policy implications are discussed.

•

What is known on the subject:•

Anxious, grief-related depressive and traumatic stress symptoms are common in bereaved parents following the death of their child 90.

•

What this paper adds to existing knowledge:•

People who had lower incomes had higher levels of anxiety, depression and posttraumatic stress.

•

The implications for policy and practice:•

Parents with low incomes and low levels of education may not be able to access support following their loss.

•

Providers and policy makers should aim to identify if other stressors are contributing to distress rather than focus solely on diagnoses related to loss.

•

No cost broader bereavement services may be important to consider for those living in poverty.

Conducting Research With Community Groups

Nurse scientists are increasingly recognizing the necessity of conducting research with community groups to effectively address complex health problems and successfully translate scientific advancements into the community. Although several barriers to conducting research with community groups exist, community-based participatory research (CBPR) has the potential to mitigate these barriers. CBPR has been employed in programs of research that respond in culturally sensitive ways to identify community needs and thereby address current health disparities. This article presents case studies that demonstrate how CBPR principles guided the development of (a) a healthy body weight program for urban, underserved African American women; (b) a reproductive health educational intervention for urban, low-income, underserved, ethnically diverse women; and (c) a pilot anxiety/depression intervention for urban, low-income, underserved, ethnically diverse women. These case studies illustrate the potential of CBPR as an orientation to research that can be employed effectively in non-research-intensive academic environments.

Embedding Research in Undergraduate Learning Opportunities

As a means of promoting scholarship, faculty are increasingly including undergraduate nursing students as team members in faculty-led research projects. Research involvement is a high-impact educational practice that enhances student engagement and retention rates and enables the reflection and integration of learning. The purpose of this article is to describe the benefits and innovative ways of directly involving undergraduate nursing students in faculty-guided research projects. Case examples from four non-research-intensive nursing programs are presented to illustrate the benefits of undergraduate student research involvement to students, faculty, their communities, as well as the nursing profession. Student assistance in all phases of the research process, ranging from research question generation, literature reviews, methods development, and data collection and analysis, to presentations and manuscript publication, motivates and helps faculty progress with their research programs. Benefits also include the creation of effective learning experiences that build nursing knowledge and potentially contribute to community health.

Exploring the relationship between perceptions of neighbourhoodresources, sense of coherence and health for different groups in a norwegian neighbourhood

Background

Health and conditions for health are unevenly distributed across neighbourhoods. Within a salutogenic perspective, neighbourhood-resources can be internalised, and become generalised resistance resources. This paper aims to examine whether the neighbourhood could be a supportive arena for health-promotion, and for whom.

Design and Methods

A cross-sectional study, based on register data from the population-survey in Malvik, Norway, (N=865) was conducted. Using multiple regression analysis, total sample and sub-group analyses (men/women, low/high earners, employed/unemployed) of 5 independent neighbourhood-measures (overall satisfaction, neighbourhood Social Capital, satisfaction with availability and quality of neighbourhood-resources, and neighbourhood participation) on Sense of Coherence (SOC) and health respectively were obtained.

Results

Overall satisfaction (β=0.153) and neighbourhood social capital (β=0.134) emerged as the most consistent partial correlates of SOC across groups. In turn, SOC was the strongest coefficient for health-outcomes (β=0.238). Neighbourhood participation had more consistent correlations with health than SOC across groups. Group-differences became visible in proportions of explained variance in SOC (varying from 7 to 23.7%) and health (varying from 6.7 to 20.6%), and in the relative importance of neighbourhood-variables. Satisfaction with quality of neighbourhood-resources was significantly related to SOC in non-workers (β=0.451) and low-earners (β=0.261), and health-outcomes in women (β=0.143).

Conclusions

Health might be promoted in the neighbourhood mainly through strengthening SOC, and deprived groups, especially non-workers, may benefit most from health-promotion in the neighbourhood. Findings suggest that high satisfaction with quality can contribute to better health-outcomes for groups with weaker average SOC. The proposed theoretical framework is only partly supported.