Depression: a major public healthproblem facing the Caribbean

Internalization of Western Ideals on Appearance and Self-Esteem in Jamaican Undergraduate Students

Beauty ideals in the Caribbean are shifting with increased exposure to Western and European standards of appearance. Previous research has shown a consistent link between internalization of Western beauty ideals and depressive symptoms and other forms of psychological disturbance among diverse populations including Caribbeans. We examined the association between internalization of Western beauty ideals and depressive symptoms as well as the potential mediating role of self-esteem on this relation in N = 222 students (155 females, 79 males) attending a tertiary institution in Kingston, Jamaica. Internalization of Western ideals was inversely associated with self-esteem (r =- .35, p < .01) and positively associated with depressive symptoms (r =.13, p < .05). In a model adjusted for age and sex, results revealed a significant indirect effect of internalization of Western ideals of appearance on depressive symptoms via self-esteem (estimate= .21, SE = .05, 95% confidence interval [.13, .32]). The potent effects of culture must be better understood as intercontinental travel becomes less important as a mechanism for cultural exposure and exchange, and there is a significant increase of digital and internet access in the Caribbean. The current study suggest that Caribbeans are at significant risk for internalizing Western ideals of beauty, subsequently diminishing their self-esteem, and ultimately increasing depression symptomatology. The benefits and consequences of cultural exchange should continue to be a topic for research studies.

Sociodemographic, psychosocial and physical health correlates of common mental disorder symptoms among mothers in Trinidad and Tobago: Examining ethnic variations

Historical and cultural experiences have shaped the life experiences of cultural communities in Trinidad and Tobago. Using a cultural focus, the goal of this investigation was to examine ethnic variations both in the prevalence of common mental disorder (CMD) symptoms as well as in the associations between sociodemographic, psychosocial, physical health correlates and CMDs among mothers in Trinidad and Tobago. Participants included 1002 mothers (359 African-, 353 Indo- and 290 Mixed-Ethnic Trinidadian). Mean comparisons indicated similarities in the levels of depression, somatisation and anxiety across ethnic groups. The associations between physical ill health, experiences of pain and depression and between physical ill health and somatisation were stronger for Mixed-Ethnic Trinidadian than Indo-Trinidadian mothers. The relationship between early experiences of domestic violence and depression was stronger for Indo-Trinidadian than Mixed-Ethnic Trinidadian mothers. The associations between early experiences of domestic violence and depression and between experiences of pain and somatisation were stronger for African Trinidadian than Mixed-Ethnic Trinidadian mothers. Thus beyond the direct effects, mothers belonging to specific ethnic groups indicated greater or lesser vulnerabilities to CMDs depending on their exposure to specific correlates. Results have applicability for the development of culturally sensitive interventions for mothers experiencing CMDs.

Detecting depression during pregnancy and associated lifestyle practices and concerns among women in a hospital-based obstetric clinic in Jamaica

OBJECTIVE

Antenatal depression, despite its association with increased maternal morbidity risks, is understudied in the developing world. We determined the rate and predictors of depression throughout pregnancy and the use of medication in women attending an obstetric clinic.

METHOD

Prospective longitudinal study of 452 women newly registered at the antenatal clinic at the University Hospital of the West Indies between September 2005 and February 2006. Sociodemographic data, clinical information and self reports of depression using Edinburgh Postnatal Depression Scale (EPDS) were gathered over three trimesters.

RESULTS

On average, 25% of women were identified as having a probable depressive disorder over the three trimesters. Independent demographic predictors were youth and unemployment (P<05). Planned pregnancy, exercising, not smoking, being married and support from physician and family were protective factors (P<.05). Using a multivariable model, prior history of depression was the strongest predictor of depression during pregnancy. Of those taking medication for depression prior to pregnancy, only 1.6% remained on medication during the pregnancy.

CONCLUSIONS

Poverty-related factors and lifestyle are associated with higher EPDS scores during pregnancy in Jamaican women. A protocol of psychosocial management in obstetric care is discussed along with recommendations for future research.