Social Determinants of Depression Among Hispanic Women

The Relationship Between Quality of Life and Depressive Symptoms Among Jordanian Community-Dwelling Older Adults

OBJECTIVE

The current study aimed to examine the relationship between depressive symptoms and quality of life among Jordanian community-dwelling older adults.

METHODS

A cross-sectional, descriptive correlational design was used. A convenience sample (N = 602) was selected to recruit the participants in the Amman governorate during the period from August to November 2021.

RESULTS

Findings demonstrated that the mean (SD) age of older adults was 67.5 (7.0) years and 51.5% of participants were females. Also, 54.1% of the participants experienced moderate to severe depressive symptoms with a total mean (SD) score was 8.57 on a scale of 0 to 15, while the mean (SD) for the quality of life scale was 12.12 (3.85) on a scale of 4 to 20. Significant differences existed in quality of life and depressive symptoms based on marital status (p < .001), educational level (p < .001), working status (p < .01), income (p < .001), and chronic disease (p < .01). Quality of life and its domains were negatively associated with depressive symptoms (B= - 0.596, p < .001). Also, marital status, working, educational level, income, and chronic disease were associated with depressive symptoms.

CONCLUSION

Strategies to improve quality of life should be promoted to minimize depressive symptoms among older adults and consider significant demographic factors.

Phenome-wide investigation of bidirectional causal relationships between major depressive disorder and common human diseases

The high comorbidity of major depressive disorder (MDD) with other diseases has been well-documented. However, the pairwise causal connections for MDD comorbid networks are poorly characterized. We performed Phenome-wide Mendelian randomization (MR) analyses to explore bidirectional causal associations between MDD (N = 807,553) and 877 common diseases from FinnGen datasets (N = 377,277). The inverse variance weighting method was the primary technique, and other methods (weighted median and MR-Egger) were used for sensitivity analyses. Our MR analyses showed that the genetic liability to MDD is causally associated with the risks of 324 disease phenotypes (average b: 0.339), including 46 psychiatric and behavioral disorders (average b: 0.618), 18 neurological diseases (average b: 0.348), 44 respiratory diseases (average b: 0.345), 40 digestive diseases (average b: 0.281), 18 circulatory diseases (average b: 0.237), 37 genitourinary diseases (average b: 0.271), 66 musculoskeletal and connective diseases (average b: 0.326), 22 endocrine diseases (average b: 0.302), and others. In a reverse analysis, a total of 51 genetic components predisposing to various diseases were causally associated with MDD risk (average b: 0.086), including 5 infectious diseases (average b: 0.056), 11 neurological diseases (average b: 0.106), 14 oncological diseases (average b: 0.108), and 5 psychiatric and behavioral disorders (average b: 0.114). Bidirectional causal associations were identified between MDD and 15 diseases. For most MR analyses, little evidence of heterogeneity and pleiotropy was detected. Our findings confirmed the extensive and significant causal role of genetic predisposition to MDD in contributing to human disease phenotypes, which were more pronounced than those seen in the reverse analysis of the causal influences of other diseases on MDD.

Mothers and Babies Virtual Group (MBVG) for perinatal Latina women: study protocol for a hybrid type-1 effectiveness-implementation randomized controlled trial

BACKGROUND

Immigrant Latinas (who are foreign-born but now reside in the USA) are at greater risk for developing postpartum depression than the general perinatal population, but many face barriers to treatment. To address these barriers, we adapted the Mothers and Babies Course-an evidence-based intervention for postpartum depression prevention-to a virtual group format. Additional adaptations are inclusion of tailored supplemental child health content and nutrition benefit assistance. We are partnering with Early Learning Centers (ELC) across the state of Maryland to deliver and test the adapted intervention.

METHODS

The design is a Hybrid Type I Effectiveness-Implementation Trial. A total of 300 participants will be individually randomized to immediate (N = 150) versus delayed (N = 150) receipt of the intervention, Mothers and Babies Virtual Group (MB-VG). The intervention will be delivered by trained Early Learning Center staff. The primary outcomes are depressive symptoms (measured via the Center for Epidemiologic Studies-Depression Scale), parenting self-efficacy (measured via the Parental Cognition and Conduct Towards the Infant Scale (PACOTIS) Parenting Self-Efficacy subscale), and parenting responsiveness (measured via the Maternal Infant Responsiveness Instrument) at 1-week, 3-month, and 6-month post-intervention. Depressive episodes (Structured Clinical Interview for DSM-V- Disorders Research Version) at 3-month and 6-month post-intervention will also be assessed. Secondary outcomes include social support, mood management, anxiety symptoms, perceived stress, food insecurity, and mental health stigma at 1-week, 3-month, and 6-month post-intervention. Exploratory child outcomes are dysregulation and school readiness at 6-month post-intervention. Intervention fidelity, feasibility, acceptability, and appropriateness will also be assessed guided by the Reach, Effectiveness, Adoption, Implementation, Maintenance (RE-AIM) framework.

DISCUSSION

This study will be one of the first to test the efficacy of a group-based virtual perinatal depression intervention with Latina immigrants, for whom stark disparities exist in access to health services. The hybrid effectiveness-implementation design will allow rigorous examination of barriers and facilitators to delivery of the intervention package (including supplemental components) which will provide important information on factors influencing intervention effectiveness and the scalability of intervention components in Early Learning Centers and other child-serving settings.

REGISTRATION

ClinicalTrials.gov NCT05873569.

Feasibility and acceptability of SEPA+PrEP: An HIV prevention intervention to increase PrEP knowledge, initiation, and persistence among cisgender heterosexual Hispanic women

The HIV epidemic disproportionately affects Hispanics in the U.S., with Hispanic women (HW) accounting for 18% of new HIV diagnoses in 2019 despite comprising only 16% of the female population. The imbalance of power related to cultural values and HW's lack of knowledge and low perception of risk for HIV interferes with prevention efforts (e.g., condom use, HIV testing, and Pre-Exposure Prophylaxis [PrEP]). It is estimated that in 2019, only 10% of women in the U.S. who could benefit from PrEP were given prescriptions for it. This number is estimated to be significantly lower among HW. PrEP is highly effective for preventing HIV, reducing the risk of acquiring HIV from sexual activity by about 99%. To respond to this need, we developed SEPA+PrEP, a biobehavioral HIV prevention intervention that adapted and integrated SEPA (Salud/Health, Educación/Education, Prevención/Prevention, Autocuidado/Self-Care), an empirically validated behavioral HIV prevention intervention, with the evidence-based biomedical strategy of PrEP. This study aimed to investigate the feasibility and acceptability of SEPA+PrEP among cisgender heterosexual Hispanic women (HW). We used a mixed methods approach to gather data from 44 HW living in the City of Homestead and its surrounding communities in Miami-Dade County, Florida. None of the participants knew about PrEP prior to participating in the study, and the majority (70.5%, n = 23) had not used condoms when engaging in vaginal sex during the previous three months. Overall, study results suggest that SEPA+PrEP is an acceptable and feasible intervention to prevent HIV among HW, with a focus on PrEP knowledge, initiation, and maintenance.

A Qualitative Analysis of Latina Migrant Farmworkers' Perception of Mental Health: Voices From Wisconsin

INTRODUCTION

Despite evidence showing Latinos' high prevalence of mental health, little is known about Latina migrant farmworkers' mental health experiences, especially those working in Midwestern states. Considering the multiple vulnerabilities observed among Latina migrant farmworkers, it is necessary to gain insight from own accounts and perceptions of mental health and mental health-seeking experiences.

METHOD

A qualitative descriptive approach, using in-depth semi-structured interviews with open-ended questions, served to retrieve data from 34 Latina migrant farmworkers. This study was informed by Chicana, postcolonial, and Black feminist epistemologies.

RESULTS

Thematic analysis identified themes within the data. These findings pertained to the conceptualization of mental health within the contexts of family, capacities, stigma, denial, and faith.

DISCUSSION

Our results demonstrate the need for health care providers to consider Latina migrant farmworkers' perceptions about mental health and apply those in designing and implementing culturally informed policy and practice.

Causal effects of potential risk factors on postpartum depression: a Mendelian randomization study

Background

Postpartum depression (PPD) is a type of depressive episode related to parents after childbirth, which causes a variety of symptoms not only for parents but also affects the development of children. The causal relationship between potential risk factors and PPD remains comprehensively elucidated.

Methods

Linkage disequilibrium score regression (LDSC) analysis was conducted to screen the heritability of each instrumental variant (IV) and to calculate the genetic correlations between effective causal factors and PPD. To search for the causal effect of multiple potential risk factors on the incidence of PPD, random effects of the inverse variance weighted (IVW) method were applied. Sensitivity analyses, including weighted median, MR-Egger regression, Cochrane's Q test, and MR Pleiotropy Residual Sum and Outlier (MR-PRESSO), were performed to detect potential Mendelian randomization (MR) assumption violations. Multivariable MR (MVMR) was conducted to control potential multicollinearity.

Results

A total of 40 potential risk factors were investigated in this study. LDSC regression analysis reported a significant genetic correlation of potential traits with PPD. MR analysis showed that higher body mass index (BMI) (Benjamini and Hochberg (BH) corrected p = 0.05), major depression (MD) (BH corrected p = 5.04E-19), and schizophrenia (SCZ) (BH corrected p = 1.64E-05) were associated with the increased risk of PPD, whereas increased age at first birth (BH corrected p = 2.11E-04), older age at first sexual intercourse (BH corrected p = 3.02E-15), increased average total household income before tax (BH corrected p = 4.57E-02), and increased years of schooling (BH corrected p = 1.47E-11) led to a decreased probability of PPD. MVMR analysis suggested that MD (p = 3.25E-08) and older age at first birth (p = 8.18E-04) were still associated with an increased risk of PPD.

Conclusion

In our MR study, we found multiple risk factors, including MD and younger age at first birth, to be deleterious causal risk factors for PPD.

Infección de Amor (Infectious Love): Development and Acceptability of a Telenovela/Soap Opera Intervention for HIV Prevention For Latinas

Latinas continue to be disproportionately affected by HIV in the United States. Effective interventions to address HIV-related disparities among Latinas are available; however, they have not achieved widespread dissemination due to implementation challenges for real-world settings. A culturally tailored intervention that increases access to HIV prevention is urgently needed. The objective of this study was to develop a culturally tailored telenovela (i.e., a soap opera) to promote HIV prevention behaviors (condom use; HIV testing; and pre-exposure prophylaxis awareness, access, and use) among Latinas. The study was conducted in community organizations throughout South Florida. A total of 44 Spanish-speaking Latinas, 18-35 years old, and sexually active with a man in the past 6 months participated in the study. The final product was an HIV prevention telenovela that incorporated Latinas' ideas and feedback and was produced as four 10-minute filmed episodes. This study aimed to develop innovative approaches to reduce HIV-related disparities for Latinas.

Biopsychosocial Factors of Depression Among Hispanic Women Aged ≥50 Years

The purpose of the current study was to identify biopsychosocial factors associated with depressive symptoms among Hispanic women aged ≥50 years. Cross-sectional data related to 10 biological, psychological, and social factors were analyzed. Center for Epidemiologic Studies Depression Scale scores suggested that 32% of the sample had depressive symptoms. Self-esteem, self-perception of health status, income, and chronic pain had statistically significant associations with depressive symptoms. A logistic regression analysis showed that increasing self-esteem scores were associated with decreases in the likelihood of having depressive symptoms. Findings underscore that depression is associated with biological, psychological, and social factors. Culturally tailored interventions that aim at targeting these factors may have an impact on Hispanic women's depression and overall well-being. [Journal of Psychosocial Nursing and Mental Health Services, 61(11), 32-42.].

Integrative blood-based characterization of oxidative mitochondrial DNA damage variants implicates Mexican American's metabolic risk for developing Alzheimer's disease

Alzheimer's Disease (AD) continues to be a leading cause of death in the US. As the US aging population (ages 65 +) expands, the impact will disproportionately affect vulnerable populations, e.g., Hispanic/Latino population, due to their AD-related health disparities. Age-related regression in mitochondrial activity and ethnic-specific differences in metabolic burden could potentially explain in part the racial/ethnic distinctions in etiology that exist for AD. Oxidation of guanine (G) to 8-oxo-guanine (8oxoG) is a prevalent lesion and an indicator of oxidative stress and mitochondrial dysfunction. Damaged mtDNA (8oxoG) can serve as an important marker of age-related systemic metabolic dysfunction and upon release into peripheral circulation may exacerbate pathophysiology contributing to AD development and/or progression. Analyzing blood samples from Mexican American (MA) and non-Hispanic White (NHW) participants enrolled in the Texas Alzheimer's Research & Care Consortium, we used blood-based measurements of 8oxoG from both buffy coat PBMCs and plasma to determine associations with population, sex, type-2 diabetes, and AD risk. Our results show that 8oxoG levels in both buffy coat and plasma were significantly associated with population, sex, years of education, and reveal a potential association with AD. Furthermore, MAs are significantly burdened by mtDNA oxidative damage in both blood fractions, which may contribute to their metabolic vulnerability to developing AD.

Advancing family science and health equity through the 2022-2026 National Institute of Nursing Research strategic plan

BACKGROUND

Consistent with the National Institute of Nursing Research's mission of leading nursing research to address current health challenges, the new Strategic Plan identifies five research lenses: health equity, social determinants of health, population and community health, prevention and health promotion, and systems and models of care. Family research, central to nursing research and practice, is the cornerstone of social ecology and represents a critical intersection of social and structural determinants of health.

PURPOSE

We argue why family health is essential to the 2022-2026 Strategic Plan and how the lenses can strengthen family research.

METHODS

Drawing from collective expertise and existing literature in family research, sociology, psychology, and nursing science, the authors present a new conceptual model that integrates structural racism and heteropatriarchy to examine the salience of family structure statuses for family outcomes and discuss approaches to research design, empirical measurement, and interpretation in order to bring this new model into practice.

DISCUSSION

The NINR Strategic Plan has the potential to dismantle structures that perpetuate racism and health inequity within and across family structures. An underaddressed research area under the new Strategic Plan relates to how social determinants of health influence and are influenced by families.

CONCLUSION

We challenge all investigators, not just family scientists, to expand the scope of their research to conceptualize the role of family on health inequities.

Social Needs and Acculturation as Predictors of Emotional Problems and Perceived Stress Among Latinx Mothers with Low Income

Associations between household social needs, acculturation, and emotional health remain understudied, particularly among Latinx mothers. We analyzed baseline survey data from 455 Latinx mothers in a previous study. Using multinomial regression, we examined whether emotional problems and perceived stress were associated with household social needs and acculturation. Almost half the sample reported four or more household social needs. Social needs cumulatively and independently predicted increased odds of frequent emotional problems or perceived stress. Lower acculturation predicted lower odds of frequent emotional problems. There is increased risk for emotional problems and stress in low-income Latinx mothers who experience high social need. Integrated social service and mental health care models may be one way to improve health outcomes. More research is needed to understand how clinical settings can leverage unique cultural protective factors to address the social and emotional health needs of Latinx mothers.

Factors Associated with Depressive Symptoms among Mexican-Origin Adults in a Community Sample at the US Mexico Border Region

Using baseline data from three partnering federally qualified health centers, we examined factors associated with depressive symptoms among Mexican-origin adults at risk of chronic disease living in three counties in Southern Arizona (i.e., Pima, Yuma, and Santa Cruz). Multivariable linear regression models identified correlates of depressive symptoms for this population controlling for sociodemographic characteristics. Among 206 participants, 85.9% were female and 49% were between 45 and 64 years of age. The proportion of depressive symptoms was 26.8%. Low levels of physical pain and high levels of hope and social support were also reported. Physical pain was positively and significantly related to depressive symptoms (β = 0.22; 95% CI = 0.13, 0.30). Conversely, hope was negatively and significantly associated with depressive symptoms (β = -0.53; 95% CI = -0.78, -0.29). A better understanding of factors related to depressive symptoms among Mexican-origin adults is necessary to fulfill their mental health needs, as well as to achieve health equity and to eliminate health disparities in the US-Mexico border region.

Disparities in Resource Availability, Psychological Intimate Partner Violence, and Depression Among Hispanic Women

This study aims to analyze the relationship between the availability of resources, exposure to psychological intimate partner violence (P-IPV), and depression in Hispanic women in South Florida. This secondary data analysis used cross-sectional baseline data from SEPA (Salud, Educación, Prevención y Autocuidado) III. SEPA III was a randomized controlled trial that tested the SEPA intervention with 320 cisgender, sexually active Hispanic women. Descriptive analysis, logistic, and multiple regressions were conducted. Lower sexual relationship power and attending religious services were associated with higher odds of P-IPV. Reporting a history of P-IPV in the last 3 months predicted depression scores and higher depression scores were associated with higher odds of experiencing P-IPV. Participants with higher depressive scores reported less education, increased emergency room utilization, and less sexual relationship power. P-IPV is highly prevalent among Hispanic women living in South Florida. The availability of personal and community resources can buffer the risk of P-IPV and its mental health consequences. Nurses can strengthen women's resources to prevent Hispanic women from exposure to P-IPV.

Integrative Blood-Based Characterization of Oxidative Mitochondrial DNA Damage Variants Implicates Mexican Americans' Metabolic Risk for Developing Alzheimer's Disease

Alzheimer's Disease (AD) continues to be a leading cause of death in the US. As the US aging population (ages 65+) expands, the impact will disproportionately affect vulnerable populations, e.g., Hispanic/Latinx population, due to their AD-related health disparities. Age-related regression in mitochondrial activity and ethnic-specific differences in metabolic burden could potentially explain in part the racial/ethnic distinctions in etiology that exist for AD. Oxidation of guanine (G) to 8-oxo-guanine (8oxoG) is a prevalent lesion and an indicator of oxidative stress and mitochondrial dysfunction. Damaged mtDNA (8oxoG) can serve as an important marker of age-related systemic metabolic dysfunction and upon release into peripheral circulation may exacerbate pathophysiology contributing to AD development and/or progression. Analyzing blood samples from Mexican American (MA) and non-Hispanic White (NHW) participants enrolled in the Texas Alzheimer's Research & Care Consortium, we used blood-based measurements of 8oxoG from both buffy coat PBMCs and plasma to determine associations with population, sex, type-2 diabetes, and AD risk. Our results show that 8oxoG levels in both buffy coat and plasma were significantly associated with population, sex, years of education, and reveal a potential association with AD. Furthermore, MAs are significantly burdened by mtDNA oxidative damage in both blood fractions, which may contribute to their metabolic vulnerability to developing AD.

Gender Differences in Self-Efficacy for Diabetes Self-Management Among Hispanics: The Mediating Role of Perceived Support and Depressive Symptoms

PURPOSE

The purpose of this study is to examine the extent to which perceived support and depressive symptoms might interfere with Hispanic patients' ability to manage their diabetes and whether these effects vary by gender.

METHODS

Data were collected from a cohort of 232 Hispanic men and women with type 2 diabetes mellitus (T2DM). Conditional process analysis was used to test a moderated mediation model of the time-lagged processes associating gender, diabetes support, and depressive symptoms with reported self-efficacy after 3 months.

RESULTS

Increased depressive symptoms were associated with lower self-efficacy, but the conditional effects varied among men and women. The index of moderated mediation was significant, indicating that among women, the indirect effect of depressive symptoms on self-efficacy was contingent on lower levels of perceived support. Among men, increased depressive symptoms were directly associated with declines in self-efficacy and were not conditional on perceived support.

CONCLUSIONS

Results of the study have important implications for gender health equity. Mental health screening and an assessment of support needs may be important for determining appropriate complementary therapies when treating Hispanic women with chronic conditions such as diabetes. Attention to possible differences in gender-specific mental health needs could lead to improved self-management, better glycemic control, and more equitable health outcomes.

Factors Related to Multidimensional Frailty Among Hispanic People Living With HIV Aged 50 Years and Above: A Cross-sectional Study

ABSTRACT

Among Hispanics, frailty has been extensively studied as a physical syndrome associated with an increased risk for adverse outcomes. Because of additional barriers to accessing care, the impact of frailty may be even more significant for people living with HIV (PLWH). Multidimensional frailty among Hispanic PLWH has not been studied. This study aimed to examine the factors related to multidimensional frailty among Hispanic PLWH aged 50 years and above. A cross-sectional design with 120 participants was used. Hypothesized factors related to multidimensional frailty were sociodemographic and psychosocial variables. Multidimensional frailty was measured with the Tilburg Frailty Indicator. We found that 45.83% of the participants were frail ( n = 55), and multidimensional frailty was significantly associated with higher depressive symptoms ( b = .26, p < .001) and a higher number of comorbidities ( b = .71, p < .001). This study identified factors that clinicians should be aware of when caring for Hispanic PLWH to prevent or manage frailty-related complications.

Acceptability of Behavioral Activation for Depression Among Latinas: A Mixed Methods Study

Latinxs represent the largest ethnoracial minority population in the United States. Despite having significant rates of depression, Latinxs underutilize behavioral health services. This, combined with the association between gender and depression (women have higher rates of depression than men), underscores the importance of developing an improved understanding of how Latinas view behavioral activation (BA), an empirically supported treatment for depression. In this mixed methods study, participants consisted of 77 Latinas; participants were provided with a vignette depicting a fictional character that underwent BA for depression. Participants in the quantitative study completed a measure of treatment acceptability of BA (n = 60); participants in the qualitative study completed a semistructured interview assessing their views on BA (n = 17). Latinas had generally positive attitudes about BA, although they also identified some elements that they perceived might act as barriers to treatment success. Because we were interested in the interplay of cultural factors and treatment acceptability, we also examined enculturation and acculturation as predictors of treatment acceptability-enculturation only was a significant predictor treatment acceptability. Our sample was relatively small, social desirability may have influenced our responses, and it is not known to what extent our results generalize to Latinx men. Latina women find BA to be an acceptable treatment for depression, which suggests promise with regard to clinical outcomes for depressed Latinas receiving BA. Addressing potential barriers to treatment engagement may improve outcomes for depressed Latinas receiving BA.

Exploring the Psychosocial Impact of Living With HIV on Minority Older Women

BACKGROUND: Among older adults, minority older women will account for 60% of the new HIV diagnoses. The psychosocial impact of living with HIV among this vulnerable population narrated by their own voices has been understudied. AIMS: The purpose of this study was to explore the psychosocial impact of living with HIV on minority older women. METHODS: In-depth interviews were conducted with 28 minority older women living with HIV at an Ambulatory Care Center HIV Clinic in South Florida. All interviews were audio-recorded and transcribed verbatim. Conventional content analysis was used to identify and define the major themes that emerged from the interviews. Questions included those concerning description of life after the HIV diagnosis, most challenging aspects of life after the diagnosis, and daily activities since the diagnosis. RESULTS: The analysis of the interview data led to five main themes: (I) Social Impact of HIV, (II) Threats to Health and Well-Being, (III) HIV as a Death Sentence, (IV) Spirituality, and (V) HIV Treatment Adherence. In their narratives, women described a myriad of psychosocial issues such as depressed mood, isolation, economic challenges, stigma, anhedonia of interest, fear of death, among others. CONCLUSIONS: There is a compelling empirical need for rapid implementation of a culturally tailored, holistic, low-cost, multistrategy intervention to early screen and reduce the psychosocial impact of HIV among minority older women.

Gender and Racial/Ethnic Disparities in Social Determinants of Health and Subjective Cognitive Decline: The Mediating Role of Depression

Social determinants of health (SDOH) may be associated with subjective cognitive decline (SCD), which is a precursor for Alzheimer's disease. The main aims of the current study were to examine the association between SDOH and SCD; to determine if there is an indirect pathway among SDOH, depression, and SCD; and to examine the related gender and racial/ethnic disparities. Cross-sectional data were obtained from the 2017 Behavioral Risk Factor Surveillance System Survey (N = 6,509; 2,530 men and 3,978 women aged ≥45 years). Path analyses (stratified by gender and race) were used to determine the relationship between a SDOH index, depression, and SCD. After controlling for gender, age, income, education, employment, and other health-related behaviors, SDOH were positively associated with SCD among the overall population, men, and White populations. SDOH were associated with depression, and depression was associated with SCD among men, women, and White and Black populations. After adjustment for confounders, the indirect pathway among SDOH, depression, and SCD was statistically significant for men (β = 0.035, p < 0.001), women (β = 0.040, p < 0.001), White populations (β = 0.034, p < 0.001), and Black populations (β = 0.036, p = 0.026). Gender and racial/ethnic disparities existed in the relationship among SDOH, depression, and SCD. Future research should assess alternative mediational pathways between SDOH and SCD. [Journal of Gerontological Nursing, 48(2), 13-22.].

Discrimination-Based Acculturative Stress, Depression, and Alcohol Use among Latina Emerging Adults During Initial Months in the USA

Background

The present study examined the links between discrimination-based acculturative stress (DAS), depressive symptoms, and alcohol use among recently immigrated Latina young adults and explored potential within-group Latina ethnic differences.

Methods

Structural equation modeling was used to assess these relations among 530 Latina young adults (age 18-23) who had immigrated to the U.S. within approximately 12 months prior to assessment.

Results

Women reporting more DAS indicated more depressive symptoms and alcohol use than counterparts reporting less DAS. Women reporting more time in the U.S. experienced higher levels of DAS. Undocumented participants, and those who had lived in the U.S. for less time, reported more depressive symptoms than their peers.

Discussion

Findings highlight the need for mental health clinicians to attend to their local sociopolitical climate context for discriminatory practices and integrate cultural factors in mental health and alcohol use interventions targeting Latina young adults who recently immigrated to the U.S.

Ethnicity and Self-reported Depression Among Hispanic Immigrants in the U.S

Viewed to be healthier than ethnic Hispanics born in the United States, Hispanic immigrants represent numerous subgroups with clearly heterogeneous geographic, cultural, structural, and social origins. This study asked how the factors length of U.S. residency, social status, lifestyle, and health care might explain self-reported depression within 5 large, discrete subgroups comprising immigrants from, in turn, Mexico, Puerto Rico, Cuba, the Dominican Republic, and other nations in Central and South America. The study also examined ethnicity's potential role moderating self-reported depression's associations. With pooled data from National Health Interview Surveys 1999-2015, it evaluated each ethnic group separately. Self-reported depression was associated generally with lengthening residence in the U.S., with being female, with poverty, with unemployment, with lack of education, and with lifestyle and health-care factors. These associations were not uniform across ethnic groups, however. Where self-reported depression is concerned, descriptive results suggest the proverbial health advantage may largely accrue specifically to Hispanic immigrants of Cuban and of Central/South American origin.

Biological, Psychological, and Social Determinants of Depression: A Review of Recent Literature

Depression is one of the leading causes of disability, and, if left unmanaged, it can increase the risk for suicide. The evidence base on the determinants of depression is fragmented, which makes the interpretation of the results across studies difficult. The objective of this study is to conduct a thorough synthesis of the literature assessing the biological, psychological, and social determinants of depression in order to piece together the puzzle of the key factors that are related to this condition. Titles and abstracts published between 2017 and 2020 were identified in PubMed, as well as Medline, Scopus, and PsycInfo. Key words relating to biological, social, and psychological determinants as well as depression were applied to the databases, and the screening and data charting of the documents took place. We included 470 documents in this literature review. The findings showed that there are a plethora of risk and protective factors (relating to biological, psychological, and social determinants) that are related to depression; these determinants are interlinked and influence depression outcomes through a web of causation. In this paper, we describe and present the vast, fragmented, and complex literature related to this topic. This review may be used to guide practice, public health efforts, policy, and research related to mental health and, specifically, depression.

Depression and anxiety symptoms across pregnancy and the postpartum in low-income Black and Latina women

Underserved women of color experience high rates of perinatal affective disorders, but most research to date on the natural history of these disorders has been conducted on White women. The present study investigated longitudinal changes in anxiety and depression in a sample of perinatal non-Hispanic Black and Latina women. Categorical (yes/no) measures of positive anxiety and depression screens, as well as total symptom scores, were measured longitudinally across the perinatal period in 178 women (115 non-Hispanic Black, 63 Latina) using the CAT-MH™, a computerized adaptive test. Time (up to 4 visits) and race/ethnicity effects were assessed in linear mixed effects models. Rates of positive anxiety screenings were 13.6%, 3.2%, 8.5%, and 0% in Latina women and 2.6%, 4.2%, 6.1%, and 5.8% in non-Hispanic Black women in the 1^st, 2^nd, and 3^rd trimesters, and postpartum, respectively. Rates of positive anxiety screenings overall were highest in the first trimester (OR = 0.20; 95% CI 0.04-0.98), and there was a significant time-by-race/ethnicity interaction for positive anxiety screens (OR = 8.88; 95% CI 1.42-55.51), as positive screens were most frequent in the first trimester and sharply declined for Latina women, while rates were relatively consistent across the perinatal period in non-Hispanic Black women. Rates of positive depression screens did not change over time, but there was a trend (OR = 1.93; 95% CI 0.93-4.03) for a time-by-race/ethnicity interaction in a direction similar to that seen for anxiety. The odds of positive anxiety screens vary by race/ethnicity and trimester, suggesting that anxiety screening and anxiety interventions may be most resourcefully used in the first trimester for Latina women in particular.

Psychosocial Contributors to Depressive Symptoms in Hispanic Patients With Type 2 Diabetes

PURPOSE

The purpose of this study is to identify psychosocial factors associated with depressive symptoms in Hispanic patients with diabetes and explore the extent to which their effects may vary by gender and acculturation.

METHODS

The authors completed a secondary analysis of data from 247 Hispanic adults with type 2 diabetes. Gender and language groups were compared using chi-square and t tests. Hierarchical multiple regression was used to examine associations of depressive symptoms with perceived support, diabetes-related distress, and social and personal factors.

RESULTS

Women reported less support than men. English speakers reported more depressive symptoms than Spanish speakers. When adjusting for age, gender, and acculturation, psychosocial factors significantly associated with depressive symptoms included less support received, greater emotional burden, and less ability to socialize or pursue normal activities because of diabetes.

CONCLUSIONS

Social support provided by family among less acculturated Hispanics may play an important role in reducing emotional burden and lowering the risk of comorbid depression. The quality of interpersonal relationships and the ability to continue normal activities may also be important. More acculturated Hispanic women with diabetes may be at greater risk for comorbid depression and worse health outcomes. Screening for depression and assessment of support needs is warranted for Hispanic women.

Nutritional Factors Associated With Maternal Depression Among Pregnant Women in Urban Low-Income Settlements in Nairobi, Kenya

BACKGROUND

Nutritional deficiencies are common during pregnancy and a year after childbirth. At the same time, maternal depression affects many women during pregnancy up to 1 year after childbirth. The objectives of this study were to determine the associations between nutrition status, dietary intake, and maternal depression among pregnant women.

METHODS

This was a cross-sectional study that included 262 pregnant women aged 15 to 49 years attending the antenatal clinic in 2 public health facilities in urban low-income settlements in Nairobi, Kenya. Maternal depression was assessed using Edinburgh Postnatal Depression Scale (EPDS). Mid-upper arm circumference (MUAC) was used to determine nutritional status. Dietary intake was assessed using the 24-hour recall, and brain essential nutrients were assessed through a questionnaire. Odds ratio was used to test the associations. All maternal characteristics with P < .001 in the univariable analysis were considered in the multivariable logistic regression, variables with P < .05 were considered significant.

RESULTS

Of the 262 pregnant women, 33.6% (95% CI: 27.9-40.7) had depressive illness as indicated by EPDS >13. About 9.9% of pregnant women had MUAC < 23 cm. The study established statistically significant association between poor nutrition by MUAC and maternal depression (P < .001). Maternal depression was statistically significantly associated with inadequate intake of brain food essential (P = .002). Maternal depression was statistically significantly associated with lower income (P < .001). In multivariable regression analysis, the main predictor of maternal depression was poor nutrition (P < .004).

CONCLUSION

These findings reveal an association between poor nutrition and maternal depression. These results suggest that nutritional deficiencies could be a contributing factor for maternal depression. Study recommends dietary interventions as cost-effective way to reduce deficiencies and improve mental health problems for pregnant women. Assessment of maternal depression and dietary intake be integrated as fundamental components of antenatal care.

Treatment-resistant depression: An overview for psychiatric advanced practice nurses

PURPOSE

Treatment-resistant depression (TRD) can require complex management. The purpose of this paper is to provide an update on the hypothesized neurobiology of depression, and to describe treatment options for patients impacted by TRD.

CONCLUSIONS

Recent neurobiological findings support the use of augmenting pharmacological agents, neuromodulation techniques, and esketamine as effective in achieving remission for those with TRD.

PRACTICE IMPLICATIONS

First-line interventions for depression can be safely managed by primary care providers. Psychiatric advanced practice nurses must be well versed and capable of treating more complicated cases, including TRD, that may require second- or third-line approaches.

Ensuring the fit of an evidence-based curriculum for high-risk Latina young mothers using implementation science

Conduct a comprehensive needs assessment to evaluate the fit of a Cognitive Behavioral Theory (CBT) curriculum implemented within a community organization and inform possible adaptations to fit the mental health difficulties of high-risk Latina young mothers. The PRECEDE-PROCEED implementation framework guided the assessment and results. Focus groups were conducted with high-risk Latina young mothers and staff members to assess the priority mental health problems, environmental stressors and factors contributing and maintaining these difficulties, and existing resources that could be leveraged to address them. Latina young mothers experience a variety of mental health needs and immigration and interpersonal-related stressors. The organization's existing CBT curriculum was found to be feasible and a good fit for the target population. Proposed minor adaptations included a focus on parenting. Results support the robust effects of CBT interventions, including when delivered by paraprofessionals to a high-risk population in a low-resource community setting.

Social determinants of peripartum depressive symptoms among Black peripartum women living with HIV

HIV infection during pregnancy, may present risk of developing depression during pregnancy and postpartum. This psychiatric mood disorder, and many others such as anxiety and HIV-related post-traumatic stress disorder (PTSD) have been reported prevalent among pregnant and non-pregnant women living with HIV (WLWH). Multiple studies have found associations between social determinants of health and depressive symptoms in this population. However, despite deleterious effects on mother and child which may include suicidal ideations and infant death, only very few studies have examined this phenomenon for peripartum women, particularly Black women- a population prone to living in poor social and economic environments. Therefore, guided by the socio-ecologic model, this study examined predictors of peripartum depressive symptoms among Black peripartum WLWH. The study was a secondary data analysis of 143 Black women seen at special prenatal and women's health clinics in Miami, South Florida, USA. More than half of the women who experienced peripartum depressive symptoms (PDS) (n = 81, 57%) were of low socio-economic status. Low income was associated with increased odds of experiencing PDS. Women who endorsed intimate partner violence/abuse (IPV/A) were 6.5 times more likely to experience PDS; and compared to women with 1 or no childcare burden, women with 2 children-care burden were 4.6 times more likely to experience PDS. These findings demonstrate the negative impact of social factors on the psychological health of Black peripartum WLWH. Burdensome interpersonal relationships may have deleterious effects and trigger PDS among these women. Implications for nursing practice, education and research are also discussed.

Housing and Adult Health: Evidence from Chinese General Social Survey (CGSS)

Housing is one of the social determinants of health and the most basic survival needs of human beings. Many studies have preliminarily confirmed that housing factors can influence residents’ health. The aims of this study were: to evaluate the housing factors associated with self-rated health and mental health among Chinese residents; to explore the regional heterogeneity of the impact of housing on health; and to assess the effects of housing on health among different age groups. Data was derived from the Chinese General Social Survey (CGSS). Housing factors were analyzed along six dimensions: housing property, living space, number of living people, number of houses, living region and housing price. Self-rated health and mental health were used to measure health outcomes. Multivariate ordered logistic regression was performed to assess the relationship between housing and health. The living space, living region and housing price was significantly associated with self-rated health. The number of living people living region and housing price were related to mental health. The influence of housing factors on health were more pronounced among residents living in eastern and central area and among the middle-aged group (41–65). Present findings support the notion that housing factors were related to health outcomes. Future studies may focus on the impact of interventions that target on these factors, and the impact of housing on health among special groups such as migrant population and low-and-middle income families.

A randomized control trial to test a peer support group approach for reducing social isolation and depression among female Mexican immigrants

BACKGROUND

Female Mexican Immigrants (FMIs) experience high rates of depression compared with other populations. For this population, depression is often exacerbated by social isolation associated with the experience of immigration. Aim 1. To measure whether a culturally situated peer group intervention will reduce depression and stress associated with the experience of immigration. Aim 2. To test whether an intervention using a "women's funds of knowledge" approach results in improved resilience, knowledge and empowerment. Aim 3. To investigate whether a culturally situated peer group intervention using a women's funds of knowledge approach can give participants a sense and experience of social and physical connection ("emplacement") that is lost in the process of immigration.

METHODS

This mixed-methods study will implement "Tertulias" ("conversational gatherings" in Spanish), a peer support group intervention designed to improve health outcomes for FMI participants in Albuquerque, New Mexico. We will document results of the intervention on our primary hypotheses of a decrease in depression, and increases in resilience and social support, as well as on our secondary hypotheses of decreased stress (including testing of hair cortisol as a biomarker for chronic stress), and an increase in social connectedness and positive assessment of knowledge and empowerment.

DISCUSSION

This project will address mental health disparities in an underserved population that experiences high rates of social isolation. Successful completion of this project will demonstrate that health challenges that may appear too complex and too hard to address can be using a multi-level, holistic approach. Our use of hair samples to test for the 3-month average levels of systemic cortisol will contribute to the literature on an emerging biomarker for analyzing chronic stress.

TRIAL REGISTRATION

This study was registered with ClinicalTrials.gov on 2/3/20, Identifier # NCT04254198 .

Prevalence and correlates of depression among rural and urban Rwandan mothers and their daughters 26 years after the 1994 genocide against the Tutsi

BACKGROUND

In the past 26 years since the genocide against the Tutsi, mental illness continues to be the greatest challenges facing the Rwandan population. In the context of the 1994 genocide against Tutsi, there are three different survival status within Rwandan women. Those who were targeted by the genocide referred to as 'survivors', those who were in the country during the genocide but were not targeted referred to as 'non-targeted', and those who were outside the country referred to as '1959 returnees'. All these groups experienced the traumatic events differently. The literature shows that traumatic stress exposure is associated with depression.

OBJECTIVES

To demonstrate differences in trauma exposure in a sample of mothers and daughters according to their genocide survival status. To examine differences in depression prevalence between these three groups of mothers and daughters as a function of their genocide survival status and place of residence. To examine the relationship between major depression, survival status, place of residence, and trauma exposure in sample of mothers and daughters, including the relationship between mothers' depression and daughters' depression.

METHODS

A sample of 309 dyads of mothers and daughters was recruited. Data were collected using the Mini International Neuropsychiatric Interview, Life Events Questionnaire and the Social Demographics Questionnaire. Data were analysed using descriptive statistics, chi-square test, logistic regression, and one-way ANOVA.

RESULTS

There is a significant difference in trauma exposure in three survival categories of mothers and daughters. A 23% of mothers and 18.4% of daughters met criteria for major depression, with urban participants twice as likely to meet criteria as participants from rural areas. Depression was associated with trauma exposure and place of residence in mothers' and daughters' samples. Maternal depression was associated with depression in daughters.

CONCLUSIONS

Family support counselling services and research to identify factors of intergenerational depression are needed.

Risk factors and experiences of prepartum depression in urban- low-income settlement Nairobi Kenya: a mixed-method study

Background: Prepartum depression is common among pregnant women and has not been studied much in low and middle-income countries. Evidence shows that mental illnesses are prevalent in urban than in rural areas. The study objective was to determine the magnitude of prepartum depression, risk factors, and real-life experiences of depression among pregnant women.

Method: A mixed-method cross-sectional study was conducted. It included 262 pregnant women attending antenatal clinics in two public health facilities in urban low-income settlement Nairobi, Kenya. Edinburgh Postnatal Depression Scale (EPDS) with cut-off >13 was used to classify clinical depressive illness. Further, a focus group discussion was conducted with 20 women identified with depression. Univariable analysis with Odd's Ratio was used to test associations. Variables with a p<0.05 in multivariable regression were considered significant.

Result: Out of the 262 women, 33.6% were found to have clinical depression as indicated by EPDS score of >13. Women's gestational age was statistically significantly associated with prepartum depression [OR 4.27 (95% C.I. 2.08 - 8.79),  p<0.001]. Income level ≤ 5000 KES was statistically significantly associated with prepartum depression [OR 3.64 (95% C.I.1.25 -10.60), p=0.018]. Further, thematic analysis of qualitative indicated that poverty, lack of social support, domestic violence, and unfriendly health care were major contributors to prepartum depression.

Conclusion: Significant numbers of pregnant women were found to experience depression. This prevalence rate indicates a high disease burden of women who live with depression, which is not diagnosed because screening of depression is not done in primary health care centers. This study calls for a need and consideration for screening for perinatal depression in primary health care facilities, mainly in resource-poor areas. Interventions targeting means of resolving conflicts in families are highly needed. Such steps would help achieve key sustainable development goals where maternal and child health remains key priority.

The Relationships between Loneliness, Social Support, and Resilience among Latinx Immigrants in the United States

Globally, international migrants are at elevated risk for experiencing loneliness due to separation from social networks in their countries of origin. In the United States, the political rhetoric has been particularly exclusionary against Latinx immigrants, exposing them to discrimination and fear of deportation. Such environments may result in heightened levels of social isolation, which may contribute to greater risk of poor mental and physical health outcomes. Latinx immigrants, however, may access social support in their destination communities that buffers against these negative outcomes. This study sought to examine how social support and loneliness shape Latinx immigrants' abilities to address the challenges related to migration. Multivariate linear regression analyses were conducted with survey data collected from Latinx immigrants in New York City (n=306). Results revealed that Latinx immigrants with greater social support and less feelings of loneliness were more resilient. Specifically, findings suggest that social support may partially protect against the negative impact of isolation on Latinx immigrants' capacity to thrive. Clinical social workers who work with immigrant groups may consider how migration during the life course affects immigrants' social supports and experiences of loneliness. Social work interventions that integrate strategies to increase social support may provide opportunities to address social isolation and other obstacles associated with migration. Such approaches acknowledge loneliness not only as a psychological symptom, but also as a consequence of unfavorable social environments towards immigrant populations. Future research may develop and assess culturally relevant strategies to promote social support and reduce loneliness among marginalized immigrants.

"Can we talk?": A longitudinal analysis of Latino & non-Hispanic parent-child connectedness & adolescent ideation

BACKGROUND

Over 16 million U.S. adults report a major depressive episode each year. Hispanic females comprise the highest number of U.S. births compared to other race/ethnicities and are expected to remain as the Hispanic population grows. Research postulates that depression often co-occurs within families and is passed down to future generations but has yet to determine racial/ethnic disparities for depression and more acute forms including ideation.

METHODS

Using data from the Fragile Families and Child Wellbeing Study, latent class analyses examined the association of primary caregiver's (PCG) depressive symptoms and how their child's perceived level of parent-child closeness is related to their now-adolescent's (age 15) likelihood of ideation (N = 4,898 families).

RESULTS

Hispanic PCG's reported a lower rate of depressive symptoms (37%) than non-Hispanic PCG's (45%). Hispanic PCG's depressive symptoms were more likely to be chronic throughout their adolescent's lifetime (15%). Regardless of race/ethnicity, PCG's chronic depressive symptoms negatively affected parental closeness and increased suicidal risk for adolescents. These associations were found at ages 9 and 15 for non-Hispanic families, and at age 15 for Hispanic families.

LIMITATIONS

While this is an important first step, parental closeness and ideation can wax and wane. Asking teens about ideation before adolescence could have strengthened our study.

CONCLUSIONS

Suicide prevention must be family system focused, and not solely adolescent focused. Impressing upon individuals who serve children (i.e. teachers) and adults (i.e. physicians) to include yearly depression and suicide screens/assessments is crucial given PCG's different wave presentations and how ideation can present as early as middle school.

Social Determinants of Depression Among Older Black Women Living With HIV

BACKGROUND: The prevalence of depression spans age-groups, but it can be particularly destructive for older people with chronic illness. Among older Black women living with HIV (OBWLH), multiple social determinants have been associated with the prevalence and severity of depression. A greater understanding of the impact of the social determinants at the individual, interpersonal, and community levels is needed. AIMS: To explore social determinants of depression among OBWLH at the intrapersonal, interpersonal, and community levels. METHOD: Cross-sectional descriptive design. RESULTS: A total of 118 OBWLH were analyzed in the study. Depression was prevalent among the participants. Approximately 89.8% of the participants had moderate to severe depressive symptoms. Health status, exercise, and social support were significant predictors of depression in the sample. CONCLUSION: Social determinants at multiple levels play a significant role in the occurrence and management of depression among OBWLH. Implications for practice, education, and research can be drawn from these findings.

Evaluating a Culturally Tailored HIV Risk Reduction Intervention Among Hispanic Women Delivered in a Real-World Setting by Community Agency Personnel

PURPOSE

To evaluate the effectiveness of Salud, Educación, Prevención, y Autocuidad/Health, Education, Prevention and Self-care (SEPA) to increase human immunodeficiency virus (HIV)/sexually transmitted infections (STI) prevention behaviors for Hispanic women delivered in a real-world setting.

DESIGN

Randomized controlled trial.

SETTING

Participants were recruited from the Miami Refugee Center, the Florida Department of Health, and public locations in Miami.

PARTICIPANTS

Three hundred twenty Hispanic women.

INTERVENTION

The SEPA is a culturally tailored intervention developed to address HIV/STI risk behaviors among Hispanic women. The SEPA intervention consisted of three 2.5 hour sessions per week conducted with small groups. The SEPA sessions consisted of group discussions, role playing, negotiation skills, partner communication, and skills building as part of the methodology.

MEASURES

Acculturation, HIV/STI risk behaviors, HIV knowledge, partner communication, intimate partner violence, drug/alcohol use, condom use.

ANALYSIS

Differences at baseline by group were assessed using Wilcoxon rank sum test, χ², and a negative-binomial model. Changes in dependent variables, compared to baseline, were analyzed in separate models. Log-binomial models and negative binomial models were used for dichotomous and count/rate-type dependent variables.

RESULTS

Significant outcome improvements were observed in the SEPA group at 6 and 12 months follow-up. The adjusted prevalence of any condom use was 30% and 37% higher at each follow-up. The adjusted prevalence of answering 10/12 HIV knowledge questions correctly rose by 57% and 63% at each follow-up. Intimate partner violence was significantly lower at each subsequent time point (62% and 41% of baseline). Moderate depressive symptoms were reduced to 50% and 42%, getting drunk was reduced to 20% and 30%, and condom use self-efficacy was significantly higher (84% and 96%).

CONCLUSION

The SEPA intervention reduced HIV/STI risk-related behaviors when delivered in a real-world setting. The results suggest that SEPA can be implemented in various settings to reach Hispanic women, and that SEPA could reach large numbers of women in an efficient, cost-effective way.

Social determinants of depression and suicidal behaviour in the Caribbean: a systematic review

BACKGROUND

Depressive disorder is the largest contributor to years lived with disability in the Caribbean, adding 948 per 100,000 in 2013. Depression is also a major risk factor for suicidal behaviour. Social inequalities influence the occurrence of depression, yet little is known about the social inequalities of this condition in the Caribbean. In support of the 2011 Rio Political Declaration on addressing health inequities, this article presents a systematic review of the role of social determinants on depression and its suicidal behaviours in the Caribbean.

METHODS

Eight databases were searched for observational studies reporting associations between social determinants and depression frequency, severity, or outcomes. Based on the PROGRESS-plus checklist, we considered 9 social determinant groups (of 15 endpoints) for 6 depression endpoints, totalling 90 possible ways ('relationship groups') to explore the role of social determinants on depression. Studies with ≥50 participants conducted in Caribbean territories between 2004 and 2014 were eligible. The review was conducted according to STROBE and PRISMA guidelines. Results were planned as a narrative synthesis, with meta-analysis if possible.

RESULTS

From 3951 citations, 55 articles from 45 studies were included. Most were classified as serious risk of bias. Fifty-seven relationship groups were reported by the 55 included articles, leaving 33 relationship groups (37%) without an evidence base. Most associations were reported for gender, age, residence, marital status, and education. Depression, its severity, and its outcomes were more common among females (except suicide which was more common among males), early and middle adolescents (among youth), and those with lower levels of education. Marriage emerged as both a risk and protective factor for depression score and prevalence, while several inequality relationships in Haiti were in contrast to typical trends.

CONCLUSION

The risk of bias and few numbers of studies within relationship groups restricted the synthesis of Caribbean evidence on social inequalities of depression. Along with more research focusing on regional social inequalities, attempts at standardizing reporting guidelines for observational studies of inequality and studies examining depression is necessitated. This review offers as a benchmark to prioritize future research into the social determinants of depression frequency and outcomes in the Caribbean.