Use of tobacco, alcohol and cannabis in late adolescence: roles of family living arrangement and socioeconomic group

BACKGROUND

France has one of the highest levels in Europe for early use of legal and illegal psychoactive substances. We investigate in this country disparities in adolescent problematic substance use by family living arrangement and parental socioeconomic group.

METHODS

The data used were from the 2017 nationally-representative ESCAPAD survey, conducted among 17-year-olds in metropolitan France (N = 39,115 with 97% response rate). Prevalence ratios (PR) were estimated using modified Poisson regression.

RESULTS

Adolescents living in non-intact families (44%) reported daily smoking, binge drinking and regular cannabis use (respectively ≥3 episodes and ≥ 10 uses in the last 30 days) much more frequently than those living in intact families (for example, the PR estimates for father single parent families were respectively 1.69 (1.55-1.84), 1.29 (1.14-1.45) and 2.31 (1.95-2.74)). Socioeconomic differences across types of families did little to explain the differential use. Distinctive socioeconomic patterns were found: a classical gradient for smoking (PR = 1.34 (1.22-1.47) for the most disadvantaged group relative to the most privileged); an inverse association for binge drinking (PR = 0.72 (0.64-0.81) for the most disadvantaged relative to the most privileged), and no significant variation for cannabis use.

CONCLUSION

Our findings shed light on the consistency of the excess use of adolescents from non-intact families and on the substance-specific nature of the association with parental socioeconomic group. Preventive approaches at the population level should be complemented by more targeted strategies.

Constructive and destructive interparental conflict, parenting, and coparenting alliance

Guided by the spillover hypothesis of family systems theory, we used data from the Building Strong Families project to examine intrafamily relations between destructive and constructive interparental conflict, harsh and supportive parenting behaviors, and coparenting alliance across different family configurations: married, cohabiting, and noncohabiting (never married) parents. Our sample (N = 2,784 couples/parents) was racially diverse, low-income couples/parents who were unmarried at the conception of their child. All variables were measured when children were approximately 36 months of age. Interparental conflict was assessed through an instrument that included both parents' reported conflict in the relationship and the perception of the other parent's conflict behaviors. Parenting behaviors were measured through observational data and coparenting alliance was based on mothers' and fathers' reports. As expected, path analyses revealed that destructive interparental conflict was related to lower levels of coparenting alliance, whereas constructive interparental conflict was related to higher levels of coparenting alliance, for mothers and fathers. For fathers only, destructive interparental conflict related to harsh parenting, suggesting that paternal parenting is vulnerable to the quality of the relationship with the mother. None of the proposed associations differed by family structure. These findings suggest the need for intervention programs to focus on promoting adaptive conflict management behaviors rather than on family structure. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Lesbians' experiences and attitudes towards parenthood in Greece

Same-sex parenthood is controversial subject. In this paper, we provide insights into the attitudes and experiences of self-reported lesbians regarding parenthood or the prospect of becoming a parent in the current Greek social and cultural context. In Greece, lesbians are not allowed access to in vitro fertilisation (IVF), while a solitary ('single') woman is allowed access for medical reasons. Fifty-nine (59) semi-structured in-depth interviews were conducted with women. What emerged from our data was a clear trend for participants to wish to have their own biological children based mostly on the belief that pregnancy would lead to a sense of self-completeness and/or fulfilment. Women also reported the negative impact of prejudice and social oppression on their reproductive autonomy. Interviewees reported that their reproductive choices were negatively influenced by their family and the wider socio-cultural environment. Even within a semi-permissive legal framework, impaired social acceptance of lesbian parenthood prohibits lesbians from becoming mothers. A major reason responsible for the positive attitude of most participants to shared biological motherhood was an altruistic attitude towards their partners.

Childcare Instability and Maternal Depressive Symptoms: Exploring New Avenues for Supporting Maternal Mental Health

OBJECTIVE

We investigated links between childcare experiences-specifically, care instability and mothers' perceptions of care access-and maternal depressive symptoms in an effort to illuminate policy-amenable mechanisms through which childcare experiences can support maternal mental health.

METHODS

Data were taken from the nationally representative Early Childhood Longitudinal Study-Birth Cohort. We used regression models with lagged dependent variables to estimate associations between aspects of childcare instability and perceptions of care availability and maternal depressive symptoms. We did so on the full sample and then on subgroups of mothers for whom childcare instability may be especially distressing: mothers who are low income, working, single, or non-native speakers of English.

RESULTS

Childcare instability-length in months in the longest arrangement and number of arrangements-was not associated with maternal depressive symptoms. However, mothers' perceptions of having good choices for care were associated with a reduced likelihood of clinical depressive symptoms, even after controlling for prior depressive symptoms and concurrent parenting stress; this latter association was observed both in the full sample (adjusted odds ratio [AOR] = 0.77; 95% confidence interval [CI] = 0.63-0.96) and among subgroups of employed mothers (AOR = 0.71; CI = 0.57-0.87) and single mothers (AOR = 0.72; CI = 0.52-0.99).

CONCLUSIONS

Although dimensions of care instability did not associate with maternal depressive symptoms, mothers' perceptions of available care options did. If replicated, findings would highlight a previously unconsidered avenue-increasing care accessibility and awareness of available options-for promoting maternal mental health in a population likely to experience depression but unlikely to be treated.

Impact of economic problems on depression in single mothers: A comparative study with married women

Objective

The purpose of this study was to investigate the risk factors that influence depression among single mothers.

Methods

Participants were 195 single mothers and 357 married mothers living in an urban community in South Korea. All subjects completed self-report questionnaires that included the following self-rating scales: the Global Assessment of Recent Stress, the Center for Epidemiologic Studies-Depression scale, and the Korean version of the Alcohol Use Disorder Identification Test. Multiple logistic regression analysis was performed to examine independent factors affecting single mothers’ depression.

Results

The prevalence of depression differed notably between the single mothers and the control group, at 33% and 8%, respectively. In the single mothers, young age, low income, residential instability, high stress, and high alcohol-related problems were determined to be associated with depression. Furthermore, after adjusting for covariates, living in rental housing (OR = 11.46, 95% CI 1.72–76.46) was found to be an independent risk factor of depression in the single mothers, while stress (OR = 1.16, 95% CI 1.09–1.24) was found to have this effect on the married mothers.

Conclusions

Practical services concerning economic stability and parenting support should be provided for single mothers to reduce depression among this demographic.

Lack of partner impacts newborn health through maternal depression: A pilot study of low-income immigrant Latina women

INTRODUCTION

Latina women have a high burden of depression and other mental health issues, particularly in the perinatal period. Suboptimal maternal mental health can have adverse developmental and physiological impacts on child growth. The present study examines the impact of unplanned pregnancy and pregnancy relationship status on prenatal maternal depression in a sample of low-income Latina women. We hypothesized that the association between these prenatal stressors and newborn health would be mediated through prenatal depression.

METHOD

The present study included a sample 201 Latina mothers and their children recruited from prenatal clinics during their second or third trimesters. Depression symptomology, relationship status were collected prenatally. At birth, several indices of newborn health were examined, including head circumference percentile and birthweight. Finally, planned pregnancy status was retrospectively collected when the child was between 1 and 2 years old.

RESULTS

Structural equation modelling revealed that single women, compared to partnered women, had higher levels of depression. Higher levels of depression, in turn, predicted poorer newborn health. Unplanned pregnancy was not significantly associated with newborn health.

DISCUSSION

These results suggest that relationship status may be an important screening question for medical examiners to ask to pregnant Latina women during prenatal visits. These results are consistent with past research investigating the effects of maternal mental health on adverse birth outcomes that propose that stressful early environments shape developmental trajectories.

Single Mothers' Experiences with Pregnancy and Child Rearing in Korea: Discrepancy between Social Services/Policies and Single Mothers' Needs

This study aims to explore single mothers’ experiences with social services/policies for their independent living and to identify gaps between these experiences and the needs of single mothers. A focus group discussion was performed to collect data. Seven single mothers discussed their experiences in significant periods of their lives: pregnancy, childbirth, and parenting. Findings from the qualitative thematic analysis show discrepancies between the direction of social services/policies and single mothers’ needs, in terms of difficulties in healthcare, childcare, housing, employment, and income security. To the single mothers in this study, the social safety net is not inclusive, compared to that which is available to two-parent families or adoptive families. It is necessary to intervene in current blind spots of services/policies for single mothers, and to provide a social safety net to strengthen single mothers’ self-reliance and their children’s social security in the long term.

The Mental Health Status and Intellectual Ability of Unwed Mothers Dwelling in Korean Shelter Homes

Although many unwed mothers have issues concerning mental health and intellectual ability, little research has focused on their mental and cognitive status. Due to the public stigma attached to unwed mothers in South Korea, they tend to conceal their status and are less likely to seek psychiatric and psychological help. In this context, this study aims to assess the current status of their mental health and intellectual characteristics. A total of 48 unwed mothers from two shelter homes in South Korea agreed to participate in the study. We compared the mental health status of these unwed mothers with that of the general female population. Unwed mothers were more likely than those of the general female population to have mood disorders, post traumatic stress disorder (PTSD), alcohol and nicotine use disorders, and attention-deficit hyperactivity disorder (ADHD). Among the 48 unwed mothers, 20 (41.7%) had an IQ of less than 70, and the mean IQ (78.31) was significantly lower than the normalized mean IQ of the general female population. This study confirmed that unwed mothers dwelling in Korean shelter homes are more likely than the general female population to have mental disorders.

Welfare-to-work interventions and their effects on the mental and physical health of lone parents and their children

BACKGROUND

Lone parents in high-income countries have high rates of poverty (including in-work poverty) and poor health. Employment requirements for these parents are increasingly common. 'Welfare-to-work' (WtW) interventions involving financial sanctions and incentives, training, childcare subsidies and lifetime limits on benefit receipt have been used to support or mandate employment among lone parents. These and other interventions that affect employment and income may also affect people's health, and it is important to understand the available evidence on these effects in lone parents.

OBJECTIVES

To assess the effects of WtW interventions on mental and physical health in lone parents and their children living in high-income countries. The secondary objective is to assess the effects of welfare-to-work interventions on employment and income.

SEARCH METHODS

We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE Ovid, Embase Ovid, PsycINFO EBSCO, ERIC EBSCO, SocINDEX EBSCO, CINAHL EBSCO, Econlit EBSCO, Web of Science ISI, Applied Social Sciences Index and Abstracts (ASSIA) via Proquest, International Bibliography of the Social Sciences (IBSS) via ProQuest, Social Services Abstracts via Proquest, Sociological Abstracts via Proquest, Campbell Library, NHS Economic Evaluation Database (NHS EED) (CRD York), Turning Research into Practice (TRIP), OpenGrey and Planex. We also searched bibliographies of included publications and relevant reviews, in addition to many relevant websites. We identified many included publications by handsearching. We performed the searches in 2011, 2013 and April 2016.

SELECTION CRITERIA

Randomised controlled trials (RCTs) of mandatory or voluntary WtW interventions for lone parents in high-income countries, reporting impacts on parental mental health, parental physical health, child mental health or child physical health.

DATA COLLECTION AND ANALYSIS

One review author extracted data using a standardised extraction form, and another checked them. Two authors independently assessed risk of bias and the quality of the evidence. We contacted study authors to obtain measures of variance and conducted meta-analyses where possible. We synthesised data at three time points: 18 to 24 months (T1), 25 to 48 months (T2) and 49 to 72 months (T3).

MAIN RESULTS

Twelve studies involving 27,482 participants met the inclusion criteria. Interventions were either mandatory or voluntary and included up to 10 discrete components in varying combinations. All but one study took place in North America. Although we searched for parental health outcomes, the vast majority of the sample in all included studies were female. Therefore, we describe adult health outcomes as 'maternal' throughout the results section. We downgraded the quality of all evidence at least one level because outcome assessors were not blinded. Follow-up ranged from 18 months to six years. The effects of welfare-to-work interventions on health were generally positive but of a magnitude unlikely to have any tangible effects.At T1 there was moderate-quality evidence of a very small negative impact on maternal mental health (standardised mean difference (SMD) 0.07, 95% Confidence Interval (CI) 0.00 to 0.14; N = 3352; studies = 2)); at T2, moderate-quality evidence of no effect (SMD 0.00, 95% CI 0.05 to 0.05; N = 7091; studies = 3); and at T3, low-quality evidence of a very small positive effect (SMD -0.07, 95% CI -0.15 to 0.00; N = 8873; studies = 4). There was evidence of very small positive effects on maternal physical health at T1 (risk ratio (RR) 0.85, 95% CI 0.54 to 1.36; N = 311; 1 study, low quality) and T2 (RR 1.06, 95% CI 0.95 to 1.18; N = 2551; 2 studies, moderate quality), and of a very small negative effect at T3 (RR 0.97, 95% CI 0.91 to 1.04; N = 1854; 1 study, low quality).At T1, there was moderate-quality evidence of a very small negative impact on child mental health (SMD 0.01, 95% CI -0.06 to 0.09; N = 2762; studies = 1); at T2, of a very small positive effect (SMD -0.04, 95% CI -0.08 to 0.01; N = 7560; studies = 5), and at T3, there was low-quality evidence of a very small positive effect (SMD -0.05, 95% CI -0.16 to 0.05; N = 3643; studies = 3). Moderate-quality evidence for effects on child physical health showed a very small negative effect at T1 (SMD -0.05, 95% CI -0.12 to 0.03; N = 2762; studies = 1), a very small positive effect at T2 (SMD 0.07, 95% CI 0.01 to 0.12; N = 7195; studies = 3), and a very small positive effect at T3 (SMD 0.01, 95% CI -0.04 to 0.06; N = 8083; studies = 5). There was some evidence of larger negative effects on health, but this was of low or very low quality.There were small positive effects on employment and income at 18 to 48 months (moderate-quality evidence), but these were largely absent at 49 to 72 months (very low to moderate-quality evidence), often due to control group members moving into work independently. Since the majority of the studies were conducted in North America before the year 2000, generalisabilty may be limited. However, all study sites were similar in that they were high-income countries with developed social welfare systems.

AUTHORS' CONCLUSIONS

The effects of WtW on health are largely of a magnitude that is unlikely to have tangible impacts. Since income and employment are hypothesised to mediate effects on health, it is possible that these negligible health impacts result from the small effects on economic outcomes. Even where employment and income were higher for the lone parents in WtW, poverty was still high for the majority of the lone parents in many of the studies. Perhaps because of this, depression also remained very high for lone parents whether they were in WtW or not. There is a lack of robust evidence on the health effects of WtW for lone parents outside North America.

Welfare-to-work interventions and their effects on the mental and physical health of lone parents and their children

BACKGROUND

Lone parents in high-income countries have high rates of poverty (including in-work poverty) and poor health. Employment requirements for these parents are increasingly common. 'Welfare-to-work' (WtW) interventions involving financial sanctions and incentives, training, childcare subsidies and lifetime limits on benefit receipt have been used to support or mandate employment among lone parents. These and other interventions that affect employment and income may also affect people's health, and it is important to understand the available evidence on these effects in lone parents.

OBJECTIVES

To assess the effects of WtW interventions on mental and physical health in lone parents and their children living in high-income countries. The secondary objective is to assess the effects of welfare-to-work interventions on employment and income.

SEARCH METHODS

We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE Ovid, Embase Ovid, PsycINFO EBSCO, ERIC EBSCO, SocINDEX EBSCO, CINAHL EBSCO, Econlit EBSCO, Web of Science ISI, Applied Social Sciences Index and Abstracts (ASSIA) via Proquest, International Bibliography of the Social Sciences (IBSS) via ProQuest, Social Services Abstracts via Proquest, Sociological Abstracts via Proquest, Campbell Library, NHS Economic Evaluation Database (NHS EED) (CRD York), Turning Research into Practice (TRIP), OpenGrey and Planex. We also searched bibliographies of included publications and relevant reviews, in addition to many relevant websites. We identified many included publications by handsearching. We performed the searches in 2011, 2013 and April 2016.

SELECTION CRITERIA

Randomised controlled trials (RCTs) of mandatory or voluntary WtW interventions for lone parents in high-income countries, reporting impacts on parental mental health, parental physical health, child mental health or child physical health.

DATA COLLECTION AND ANALYSIS

One review author extracted data using a standardised extraction form, and another checked them. Two authors independently assessed risk of bias and the quality of the evidence. We contacted study authors to obtain measures of variance and conducted meta-analyses where possible. We synthesised data at three time points: 18 to 24 months (T1), 25 to 48 months (T2) and 49 to 72 months (T3).

MAIN RESULTS

Twelve studies involving 27,482 participants met the inclusion criteria. Interventions were either mandatory or voluntary and included up to 10 discrete components in varying combinations. All but one study took place in North America. Although we searched for parental health outcomes, the vast majority of the sample in all included studies were female. Therefore, we describe adult health outcomes as 'maternal' throughout the results section. We downgraded the quality of all evidence at least one level because outcome assessors were not blinded. Follow-up ranged from 18 months to six years. The effects of welfare-to-work interventions on health were generally positive but of a magnitude unlikely to have any tangible effects.At T1 there was moderate-quality evidence of a very small negative impact on maternal mental health (standardised mean difference (SMD) 0.07, 95% Confidence Interval (CI) 0.00 to 0.14; N = 3352; studies = 2)); at T2, moderate-quality evidence of no effect (SMD 0.00, 95% CI 0.05 to 0.05; N = 7091; studies = 3); and at T3, low-quality evidence of a very small positive effect (SMD -0.07, 95% CI -0.15 to 0.00; N = 8873; studies = 4). There was evidence of very small positive effects on maternal physical health at T1 (risk ratio (RR) 0.85, 95% CI 0.54 to 1.36; N = 311; 1 study, low quality) and T2 (RR 1.06, 95% CI 0.95 to 1.18; N = 2551; 2 studies, moderate quality), and of a very small negative effect at T3 (RR 0.97, 95% CI 0.91 to 1.04; N = 1854; 1 study, low quality).At T1, there was moderate-quality evidence of a very small negative impact on child mental health (SMD 0.01, 95% CI -0.06 to 0.09; N = 2762; studies = 1); at T2, of a very small positive effect (SMD -0.04, 95% CI -0.08 to 0.01; N = 7560; studies = 5), and at T3, there was low-quality evidence of a very small positive effect (SMD -0.05, 95% CI -0.16 to 0.05; N = 3643; studies = 3). Moderate-quality evidence for effects on child physical health showed a very small negative effect at T1 (SMD -0.05, 95% CI -0.12 to 0.03; N = 2762; studies = 1), a very small positive effect at T2 (SMD 0.07, 95% CI 0.01 to 0.12; N = 7195; studies = 3), and a very small positive effect at T3 (SMD 0.01, 95% CI -0.04 to 0.06; N = 8083; studies = 5). There was some evidence of larger negative effects on health, but this was of low or very low quality.There were small positive effects on employment and income at 18 to 48 months (moderate-quality evidence), but these were largely absent at 49 to 72 months (very low to moderate-quality evidence), often due to control group members moving into work independently. Since the majority of the studies were conducted in North America before the year 2000, generalisabilty may be limited. However, all study sites were similar in that they were high-income countries with developed social welfare systems.

AUTHORS' CONCLUSIONS

The effects of WtW on health are largely of a magnitude that is unlikely to have tangible impacts. Since income and employment are hypothesised to mediate effects on health, it is possible that these negligible health impacts result from the small effects on economic outcomes. Even where employment and income were higher for the lone parents in WtW, poverty was still high for the majority of the lone parents in many of the studies. Perhaps because of this, depression also remained very high for lone parents whether they were in WtW or not. There is a lack of robust evidence on the health effects of WtW for lone parents outside North America.

Mental health among single and partnered parents in South Korea

Objective

This study compares the mental health of single parents relative to partnered parents and assesses the contribution of the social and demographic factors to this difference, examining the gender difference in it.

Methods

We analyzed 12,024 single and partnered subjects, aged 30–59 years, living with children, aged 0–19 years, drawn from the 4^th, 5^th, and 6^th Korea National Health and Nutrition Examination Survey (KNHANES) dataset in South Korea conducted from 2007–2013. Mental health was evaluated by self-reported questionnaires including depressive mood for recent two weeks, presence of suicidal ideation, and the Korean version of the Alcohol Use Disorder Identification Test. Covariates included age, physical illness, socioeconomic status (family income, recipient of national basic livelihood guarantees, educational level, house ownership, job, and residential area), family structure, and support (co-residence of another adult). Multiple logistic regression was carried out and the explained fractions of each covariate was calculated.

Results

Single parents had significantly poorer mental health than their partnered counterparts, with odds ratio (OR) of 2.02 (95% confidence interval (CI) 1.56–2.63) for depressive symptoms, 1.69 (95% CI 1.27–2.25) for suicidal ideation, and 1.74 (95% CI 1.38–2.20) for any of the three mental health statuses (suspicious depression, suicidal ideation, and alcohol dependence) after controlling for the covariates. The odds of depressive symptoms (OR = 3.13, 95% CI 2.50–3.93) and suicidal ideation (OR = 2.50, 95% CI 1.97–3.17) among both single fathers and mothers were higher than partnered parents. However, the odds of alcohol dependence were 3.6 times higher among single mothers than partnered mothers (OR = 3.58, 95% CI 1.81–7.08) and were 1.4 times greater among single fathers than partnered fathers (OR = 1.35, 95% CI 0.81–2.25). Socio-economic status explained more than 50% (except for substance use disorders) of the poorer mental health in single parents. These results were more remarkable for single fathers than for single mothers except for alcohol dependence. However, physical illness, family structure, and support made only minor contributions to single parents’ mental health.

Conclusions

This study demonstrates that single parents have poorer mental health than partnered parents. Although lower SES is an important factor explaining poorer mental health in single parents, there are other factors we cannot explain about their poor mental health. Therefore, we should pay proper regard to identifying other factors affecting mental health and to establishing policies to support single parents.

Self-rated health and mental health of lone fathers compared with lone mothers and partnered fathers: a population-based cross-sectional study

BACKGROUND

Lone parenthood is associated with poorer health; however, the vast majority of previous studies have examined lone mothers and only a few have focused on lone fathers. We aimed to examine the self-rated health and mental health status among a large population-based cross-sectional sample of Canadian lone fathers compared with both partnered fathers and lone mothers.

METHODS

We investigated differences in self-rated health and mental health among 1058 lone fathers compared with 20 692 partnered fathers and 5725 lone mothers using the Ontario component of the Canadian Community Health Survey (2001-2013). Multivariable logistic regression was used to compare the odds of poor/fair self-rated health and mental health between the study groups while adjusting for a comprehensive list of sociodemographic factors, stressors and lifestyle factors.

RESULTS

Lone fathers and lone mothers showed similar prevalence of poor/fair self-rated health (11.6% and 12.5%, respectively) and mental health (6.2% and 8.4%, respectively); the odds were similar even after multivariable adjustment. Lone fathers showed higher odds of poor/fair self-rated health (OR 1.53, 95% CI 1.07 to 2.17) and mental health (OR 2.09, 95% CI 1.26 to 3.46) than partnered fathers after adjustment for sociodemographic factors; however, these differences were no longer significant after accounting for stressors, including low income and unemployment.

CONCLUSIONS

In this large population-based study, lone fathers had worse self-rated health and mental health than partnered fathers and similarly poor self-rated health and mental health as lone mothers. Interventions, supports and social policies designed for single parents should also recognise the needs of lone fathers.

Atopic Eczema and Stress among Single Parents and Families: An Empirical Study of 96 Mothers

This study investigated the extent to which single mothers of children with atopic eczema experience disease-related stress. A total of 96 mothers were divided into 4 groups: mothers living with a partner, who had or did not have a child with atopic eczema, and single mothers, who had or did not have a child with atopic eczema. The following questionnaires were used to assess psychological burden: Short Stress Questionnaire (Kurzer Fragebogen zur Erfassung von Belastung; KFB), Satisfaction with Life Questionnaire (Fragebogen zur Lebenszufriedenheit; FLZ), General Depression Scale (Allgemeine Depressions-Skala; ADS), and the Questionnaire for Parents of Children with Atopic Eczema (Fragebogen für Eltern von Neurodermitis kranken Kindern; FEN). Single mothers had higher levels of helplessness and aggression due to their child's scratching behaviour than did mothers living with a partner and a child with atopic eczema. Single mothers of children with atopic eczema had the highest scores regarding experienced stress in the family and the lowest scores concerning general life satisfaction. Special care should be provided for single mothers with higher stress, in order to teach them how to deal with the scratching behaviour of their children.

Social Determinants of Health at Older Ages: The Long Arm of Early and Middle Adulthood

This article discusses the impacts of midlife social exposures on health in later life, especially for women. Of particular interest is the period of early adulthood. Social epidemiology and life course frameworks help reveal how workplace exposures, family dynamics, and public policies related to work and family shape opportunities in midlife that have long-run health consequences. This is especially important for American women, who have experienced health disadvantages over the last decades compared to women in similarly advanced industrialized countries. In most countries, single women are especially at high risk for poor health at older ages, and job strain can elevate future risks particularly for this subpopulation. Public policies such as maternity leave can reduce risks for poor mental health outcomes among working mothers 30 to 40 years after childbirth, suggesting that the period of early and middle adulthood may influence health trajectories well into old age.

Respite Care for Single Mothers of Children with Autism Spectrum Disorders

Single mothers of children with autism spectrum disorders are rarely studied, yet they may experience unique stressors. Researchers asked 122 single mothers to complete questionnaires concerning respite care, daily hassles/uplifts, depression, and caregiver burden. More than half (59.8%) accessed respite care, which was provided for 1 h per day, often by multiple sources (41%), such as grandparents and community agencies; most were satisfied with this care. Most mothers (77%) were at risk for clinical depression. While uplifts were negatively correlated with depression, hassles and caregiver burden were positively correlated with depression. Respite care was positively related to daily uplifts, and uplifts mediated the relationship between respite care and depression. Recommendations for researchers, policymakers, and school personnel are offered.

Social capital and inequality in health between single and couple parents in Sweden

Aims: To study whether social capital is associated with health among parents and if so, whether existing inequalities in health between single and couple parents could be better understood by introducing social capital as a possible mechanism for how health is distributed. Material and methods: At total of 2,500 parents with children in the age range of 4—16 years were randomized from existing national registers and asked to participate in a nationally distributed postal questionnaire; 1,589 parents participated (277 single and 1,312 couple), giving a response rate of 64%. The questionnaire contained questions regarding sociodemographic and socioeconomic characteristics, self-rated health, emotional and instrumental social support, civic and social participation, and trust. Social capital was measured by different levels of civic and social participation and trust. A multivariate analysis was used in order to find possible associations between social capital and health, when adjusted for social support, sociodemographic and socioeconomic characteristics. Results: A low level of social capital (both social participation and trust), when adjusted for social support, socioeconomic and sociodemographic variables, was clearly and positively associated with less than good self-rated health. Social capital was unevenly distributed between single and couple mothers. Conclusions: Social capital is positively associated with self-rated health, at an individual level. The uneven distribution of social capital between single and couple mothers may be of some importance when trying to further understand and possibly alter the inequality in health that exists between single and couple parents.

Health and healthcare utilization among single mothers and single fathers in Sweden

Aims: To analyse self-rated health and healthcare utilization with regard to whether the respondents were single or couple parents, mothers or fathers. Methods: A postal questionnaire was distributed nationwide to 4,000 randomly chosen individuals 20—64 years of age, with a response rate of 66%. A total of 1,041 respondents had legal custody of a child (150 were single parents and 891 were couple parents), and thus met the definition of a parent used for this study. Analyses of self-rated health and health care utilization were performed according to sex, age, sociodemographic, and socioeconomic characteristics. Three different statistical methods were applied: Spearman correlation analyses, chi-square analyses and multivariate logistic regression. Results: Both single fathers and single mothers reported worse health than their couple counterparts. However, single fathers had contact with a physician more frequently (OR 1.84) than couple fathers, whereas single mothers did not. Furthermore, single mothers refrained from seeing a physician despite a medical need much more often (OR 2.07) than couple mothers. Conclusions: An uneven distribution of sociodemographic and socioeconomic characteristics might help us to understand why single parents, both mothers and fathers, have worse health than parents who live together. Previously recognized gender differences with regard to healthcare utilization were present in our study as well, and it is possible that these differences are related to the unequal distribution of sociodemographic and socioeconomic assets between single fathers and single mothers found here.

Physical Activity Experiences and Beliefs Among Single Mothers: A Qualitative Study

PURPOSE

Single motherhood has been associated with negative health consequences such as depression and cardiovascular disease. Physical activity might reduce these consequences, but little is known about physical activity experiences and beliefs that might inform interventions and programs for single mothers. The present study used social-cognitive theory as a framework to explore physical activity beliefs and experiences among single mothers.

METHOD

Single mothers (N = 14) completed a semistructured interview and the International Physical Activity Questionnaire. Participants were categorized into 3 activity levels, and data were analyzed according to these categories.

RESULTS

All participants reported barriers to physical activity. Physically active single mothers seemed to be more confident in their ability to overcome these barriers and more likely to plan physical activity in their daily routine, and they more frequently reported having social support compared with low-active single mothers. Across all activity levels, participants focused on the physical outcomes of physical activity participation such as weight loss.

CONCLUSIONS

These results provide information that is useful for designing and delivering behavioral interventions for increasing physical activity among single mothers.

Living beyond the Unanticipated Sudden Death of a Partner: A Phenomenological Study

This research project explored grief and its impact upon men and women who have experienced the sudden and unanticipated death of his or her partner.

It included what grief meant to them, how it was manifested in his or her everyday lives and how his or her partner's death had impacted upon his or her relationship with themselves, with others and the world. A Husserlian phenomenological approach was used to explore the experiences of the ten women and five men whose partner had died up to five years prior to being interviewed. The need for the surviving partner to continue to participate in everyday life placed great strain upon the internal resources of the surviving partner. The surviving partner needed to reinvent him or herself, in an attempt to become independent and regain functionality, whilst dealing with the sadness and loss that they had experienced. The surviving partner discovered that a new life order emerged that included hope, optimism, planning for the future and perhaps the prospect of a new relationship. The death of a partner left the surviving partner with a loss that would always be a part of them, with the memories of his or her relationship being maintained within them that will never be replaced by somebody else. The results of this research project reinforce the need for ongoing education of the community in grief and bereavement issues in order to increase the awareness of the support needs of the bereaved person. The length of time and amount of energy required to incorporate the experience into the survivor's life, is greatly underestimated by the community, and perhaps by some of the health and caring professionals. Colonial and hospital based bereavement support services need to be established and be proactive using outreach programs, actively offering the suddenly bereaved partner and family support and information.

Single mothers by choice: Mother-child relationships and children's psychological adjustment

Fifty-one solo mother families were compared with 52 two-parent families all with a 4-9-year-old child conceived by donor insemination. Standardized interview, observational and questionnaire measures of maternal wellbeing, mother-child relationships and child adjustment were administered to mothers, children and teachers. There were no differences in parenting quality between family types apart from lower mother-child conflict in solo mother families. Neither were there differences in child adjustment. Perceived financial difficulties, child's gender, and parenting stress were associated with children's adjustment problems in both family types. The findings suggest that solo motherhood, in itself, does not result in psychological problems for children. (PsycINFO Database Record

Mothering Experiences: How Single Parenthood and Employment Structure the Emotional Valence of Parenting

Research studies and popular accounts of parenting have documented the joys and strains of raising children. Much of the literature comparing parents with those without children indicates a happiness advantage for those without children, although recent studies have unpacked this general advantage to reveal differences by the dimension of well-being considered and important features in parents' lives and parenting experiences. We use unique data from the 2010, 2012, and 2013 American Time Use Survey to understand emotions in mothering experiences and how these vary by key demographic factors: employment and partnership status. Assessing mothers' emotions in a broad set of parenting activities while controlling for a rich set of person- and activity-level factors, we find that mothering experiences are generally associated with high levels of emotional well-being, although single parenthood is associated with differences in the emotional valence. Single mothers report less happiness and more sadness, stress, and fatigue in parenting than partnered mothers, and these reports are concentrated among those single mothers who are not employed. Employed single mothers are happier and less sad and stressed when parenting than single mothers who are not employed. Contrary to common assumptions about maternal employment, we find overall few negative associations between employment and mothers' feelings regarding time with children, with the exception that employed mothers report more fatigue in parenting than those who are not employed.

Health Behaviors, Mental Health, and Health Care Utilization Among Single Mothers After Welfare Reforms in the 1990s

We studied the health of low-income US women affected by the largest social policy change in recent US history: the 1996 welfare reforms. Using the Behavioral Risk Factor Surveillance System (1993-2012), we performed 2 types of analysis. First, we used difference-in-difference-in-differences analyses to estimate associations between welfare reforms and health outcomes among the most affected women (single mothers aged 18-64 years in 1997; n = 219,469) compared with less affected women (married mothers, single nonmothers, and married nonmothers of the same age range in 1997; n = 2,422,265). We also used a synthetic control approach in which we constructed a more ideal control group for single mothers by weighting outcomes among the less affected groups to match pre-reform outcomes among single mothers. In both specifications, the group most affected by welfare reforms (single mothers) experienced worse health outcomes than comparison groups less affected by the reforms. For example, the reforms were associated with at least a 4.0-percentage-point increase in binge drinking (95% confidence interval: 0.9, 7.0) and a 2.4-percentage-point decrease in the probability of being able to afford medical care (95% confidence interval: 0.1, 4.8) after controlling for age, educational level, and health care insurance status. Although the reforms were applauded for reducing welfare dependency, they may have adversely affected health.

Invited Commentary: An Interdisciplinary Approach for Policy Evaluation

Evidence-based policymaking is becoming the norm, but how do we acquire the evidence to inform policies? In their article in the present issue of the Journal, Basu et al. (Am J Epidemiol. 2016;183(6):531-538) used difference-in-difference-in-differences models and a synthetic control approach to examine the effects of the 1996 welfare reforms on health outcomes among single mothers. In the present commentary, we discuss the limitations of observational studies for policy evaluation. Difference-in-differences models, from the field of economics, offer a rigorous approach to cope with those limitations.

Coping with Depression in Single Black Mothers

Very little information exists in the literature about what black women do when they experience symptoms of depression. The purpose of this descriptive study was to analyze the responses of 208 community-residing black single mothers, aged 18 to 45, to an open-ended question asking, "What do you do to feel better when you are feeling down in the dumps?" The theoretical bases of the Ways of Coping Checklist, were used to facilitate categorizing their responses into a coping scale and then a particular coping profile. Percentages were used to categorize the frequency of the responses into the respective coping scale and to categorize the frequency of the combined responses of each woman into a respective coping profile. Of the 333 responses that the women provided, 327 were useable. Findings indicated that a majority of responses fell into the Escape-Avoidance category (n = 206; 63%), followed by the Seeking Social Support (n = 60, 18.3%), Positive Reappraisal (n = 40; 12.2%), Planful Problem Solving (n = 12; 3.7%), Distancing (n = 3; 1%), and Self-Controlling (n = 6; 1.8%) categories. No responses fit the Confrontive Coping or Accepting Responsibility categories and none of the responses indicated that the women sought professional help. Of the 176 women who provided answers to the study question, more than half (64.2%; n = 113) gave only emotion-focused responses, 2.8% (n = 5) gave only problem-focused responses, 2.8% (n = 5) gave mixed responses, and 30.2% (n = 53) reported social support seeking. Implications for future research, cultural theory, and nursing practice are addressed.

The Mental Health Status of Single-Parent Community College Students in California

Single-parenting students face unique challenges that may adversely affect their mental health, which have not been explored in community college settings.

OBJECTIVE

The authors conducted secondary analysis of Spring 2013 data from the American College Health Association-National College Health Assessment to examine difficulties facing single-parent community college students and the association between single parenting and negative mental health (depression, self-injury, suicide attempt).

PARTICIPANTS

Participants were 6,832 California community college students, of whom 309 were single parents.

METHODS

Demographic and mental health data were characterized using univariate descriptive analyses. Bivariate analyses determined whether single parents differed from other students regarding negative mental health or traumatic/difficult events.

RESULTS

Finances, family, and relationship difficulties disproportionally affected single parents, who reported nearly twice as many suicide attempts as their counterparts (5.3% vs. 2.7%; p < .0001).

CONCLUSIONS

Single-parenting students face a higher prevalence of mental health stressors than other community college students.

Parenting stress and parent support among mothers with high and low education

Current theorizing and evidence suggest that parenting stress might be greater among parents from both low and high socioeconomic positions (SEP) compared with those from intermediate levels because of material hardship among parents of low SEP and employment demands among parents of high SEP. However, little is known about how this socioeconomic variation in stress relates to the support that parents receive. This study explored whether variation in maternal parenting stress in a population sample was associated with support deficits. To obtain a clearer understanding of support deficits among mothers of high and low education, we distinguished subgroups according to mothers' migrant and single-parent status. Participants were 5,865 mothers from the Growing Up in Scotland Study, who were interviewed when their children were 10 months old. Parenting stress was greater among mothers with either high or low education than among mothers with intermediate education, although it was highest for those with low education. Support deficits accounted for around 50% of higher stress among high- and low-educated groups. Less frequent grandparent contact mediated parenting stress among both high- and low-educated mothers, particularly migrants. Aside from this common feature, different aspects of support were relevant for high- compared with low-educated mothers. For high-educated mothers, reliance on formal childcare and less frequent support from friends mediated higher stress. Among low-educated mothers, smaller grandparent and friend networks and barriers to professional parent support mediated higher stress. Implications of differing support deficits are discussed.

Randomized control trial: Online parent program and waiting period for unmarried parents in Title IV-D court

Despite a lack of research on parent education programs for unmarried parents, many judicial officers mandate participation. We recruited an understudied sample likely at high risk for negative outcomes-182 court cases involving unmarried parents on government assistance in which paternity was contested and then established via genetic testing ordered by the court. This 2 × 2 randomized controlled trial evaluated the impact on initial litigation outcomes of two factors: (a) participation in an online parent education program or not and (b) having a waiting period between the establishment of paternity and the court hearing concerning child-related issues or not. Using an intent-to-treat framework, we found that among cases not assigned to the program, there was no difference in the rate of full agreement on child-related issues (e.g., child support, custody, parenting time) when comparing cases assigned to a waiting period and cases not assigned to a waiting period. In contrast, for cases assigned to the program, cases also assigned a waiting period were less likely to reach a full agreement than cases that had their hearing on the same day. In addition, cases in the "program and waiting period" condition were less likely to return to court for their hearing than cases in the "no program and waiting period" condition. In exploratory analyses of the subsample of cases in which both parents were present at the court hearing, the pattern of results remained the same, although the findings were no longer statistically significant.

Patterns and predictors of coparenting after unmarried parents part

Nonmarital childbearing has increased dramatically during the past several decades, and the majority of unmarried couples will break up while their child is still young. As a result, many children will be raised by their biological parents living apart, ideally working together as effective coparents. In this article, we use data from the Fragile Families and Child Wellbeing Study (N = 1,193) to describe the trajectories of coparenting over 6 years following the end of a nonmarital relationship and to identify individual and interpersonal characteristics associated with better coparenting over time. Results from growth mixture models (GMMs) suggest that there are 4 primary trajectories of coparenting over time, and results from multinomial logit models show that couples' race/ethnicity, maternal health, and parents' relationship and fertility characteristics are the most salient predictors of coparenting trajectories. These results highlight the heterogeneity of parents' interaction vis-à-vis their common child after a nonmarital union dissolves and point to the challenges of supporting families and children amid high instability.

Managing family life while studying: Single mothers’ lived experience of being students in a nursing program

Evidence suggests that single parent families are more likely to be affected by social problems associated with poor health and poverty. Single parent families are growing in number and are overwhelmingly headed by women. Despite their increasing number and their level of vulnerability, the lived experiences of single mothers have attracted little attention in the literature. Still little is known about many aspects of life as experienced by single mothers. Nursing is a profession that is dominated by women, and every year a number of single mothers enroll in undergraduate nurse education programs. Currently, there is little information about the experiences of women who are single mothers, undertaking a nursing degree in a university. This paper reports a study that explored the lived experiences of five single mother undergraduate nursing students. van Manen's phenomenological method informed the design and conduct of the study. Findings were grouped into the following themes: being exhausted all the time; being overwhelmed with worries; and being hopeful of the future. Findings of this study revealed that the single mothers' major health concerns were chronic tiredness and overwhelming worries. However, their being in the university was perceived as being health promoting and restoring to their self-esteem. Implications for educators, health providers and women's health services are drawn from the findings.

Articulations of Health and Poverty Among Women on WIC

With the global financial meltdown, the crisis of poverty has deepened in communities across the United States. This essay reports results from a culture-centered project on fostering spaces for listening to the voices of the poor in CrossRoads County, Indiana. It highlights the intersections of health and poverty as they emerge from the narratives of mothers utilizing the Supplemental Nutrition Program for Women, Infants, and Children (WIC). Depression, humiliation, and inaccessibility to health care and healthy living outline the struggles of women as they negotiate their access to health. The articulations of agency are situated around competing cultural narratives that, on the one hand, draw on the threads of individual responsibility which resonate through mainstream discourses of poverty in the United States and, on the other hand, interrogate the structural erasure of the basic capacities of health.

Keeping it in the family: the self-rated health of lone mothers in different European welfare regimes

This study examines whether health inequalities exist between lone and cohabiting mothers across Europe, and how these may differ by welfare regime. Data from the European Social Survey were used to compare self-rated general health, limiting long-standing illness and depressive feelings by means of a multi-level logistic regression. The 27 countries included in the analyses are classified into six welfare regimes (Anglo-Saxon, Bismarckian, Southern, Nordic, Central East Europe (CEE) (new EU) and CEE (non-EU). Lone motherhood is defined as mothers not cohabiting with a partner, regardless of their legal marital status. The results indicate that lone mothers are more at risk of poor health than cohabiting mothers. This is most pronounced in the Anglo-Saxon regime for self-rated general health and limiting long-standing illness, while for depressive feelings it is most pronounced in the Bismarckian welfare regime. While the risk difference is smallest in the CEE regimes, both lone and cohabiting mothers also reported the highest levels of poor health compared with the other regimes. The results also show that a vulnerable socioeconomic position is associated with ill-health in lone mothers and that welfare regimes differ in the degree to which they moderate this association.

Child care subsidies, maternal health, and child-parent interactions: evidence from three nationally representative datasets

A complete account of the US child care subsidy system requires an understanding of its implications for both parental and child well-being. Although the effects of child care subsidies on maternal employment and child development have been recently studied, many other dimensions of family well-being have received little attention. This paper attempts to fill this gap by examining the impact of child care subsidy receipt on maternal health and the quality of child-parent interactions. The empirical analyses use data from three nationally representative surveys, providing access to numerous measures of family well-being. In addition, we attempt to handle the possibility of non-random selection into subsidy receipt by using several identification strategies both within and across the surveys. Our results consistently indicate that child care subsidies are associated with worse maternal health and poorer interactions between parents and their children. In particular, subsidized mothers report lower levels of overall health and are more likely to show symptoms consistent with anxiety, depression, and parenting stress. Such mothers also reveal more psychological and physical aggression toward their children and are more likely to utilize spanking as a disciplinary tool. Together, these findings suggest that work-based public policies aimed at economically disadvantaged mothers may ultimately undermine family well-being.

Reconciliation of work and care among lone mothers of adults with intellectual disabilities: the role and limits of care capital

In this study, the concept of social capital is applied to an exploration of Guanxi (social networking to create good relationships) among working lone mothers of adults with intellectual disabilities (ID) in Taiwan. Using in-depth interviews, this study explores the role of social capital, here referred to as 'care capital', in making it possible for working lone mothers to combine their roles as family carers and workers. Eleven divorced or widowed mothers combining their paid work with long-term care responsibilities were recruited from a survey or through NGOs and were interviewed at their home between October 2008 and July 2010. An interpretative phenomenological approach was adopted for data analysis. The findings revealed that the mothers' care capital was extremely limited and was lost, gained and lost again during their life-cycles of long-term care-giving. Guanxi, especially in relation to their employers, proved to be the sole source of care capital for these mothers, making reconciliation between work and care responsibilities possible. In the absence of formal or informal support, religion and the mother-child relationship seemed also to become a kind of care capital for these lone mothers, helping them to get by with their life-long care responsibilities. For formal social and healthcare services, not just in Taiwan but in every country, it is important to develop support for lone mothers of adults with ID who have long-term care responsibilities and low levels of care capital and thus face care poverty.

Are all risks equal? Early experiences of poverty-related risk and children's functioning

Using cumulative risk and latent class analysis (LCA) models, we examined how exposure to deep poverty (income-to-needs ratio <0.50) and 4 poverty-related risks (i.e., single-parent household, residential crowding, caregiver depression, and multiple life stressors) in preschool is related to children's future difficulty in school in a longitudinal sample of 602 Head Start-enrolled, low-income families. Results from the LCA revealed 4 risk profiles: low risk, deep poverty and single, single and stressed, and deep poverty and crowded household. Tests of measurement invariance across racial/ethnic groups established that, although patterns of risk are similar across groups (i.e., risks covary in the same way), the prevalence of risk profiles differs. African American families were overrepresented in the "deep poverty and single" profile while Latino and White families were overrepresented in the "deep poverty and crowded" profile. Finally, children's third grade functioning in 3 domains (i.e., academic performance, behavior problems, and self-regulatory skills) was predicted using a cumulative risk index and LCA-identified risk profiles. Both approaches demonstrated that children who experienced higher levels of risk in preschool had worse school performance than children with low levels of risk. However, LCA also revealed that children who experienced "single and stressed" family settings had more behavior problems than low-risk children while children who experienced "deep poverty and crowded" family settings had worse academic performance. The results indicate that all risks are not equal for children's development and highlight the utility of LCA for tailoring intervention efforts to best meet the needs of target populations.

A longitudinal study of paternal mental health during transition to fatherhood as young adults

BACKGROUND AND OBJECTIVE

Rates of paternal depression range from 5% to 10% with a growing body of literature describing the harm to fathers, children, and families. Changes in depression symptoms over the life course, and the role of social factors, are not well known. This study examines associations with changes in depression symptoms during the transition to fatherhood for young fathers and whether this association differed by key social factors.

METHODS

We combined all 4 waves of the National Longitudinal Study of Adolescent Health to support a 23-year longitudinal analysis of 10 623 men and then created a "fatherhood-year" data set, regressing age-adjusted standardized depressive symptoms scores on fatherhood status (nonresidence/residence), fatherhood-years, and covariates to determine associations between Center for Epidemiologic Studies Depression Scale scores and fatherhood life course intervals.

RESULTS

Depressive symptom scores reported at the entry into fatherhood are higher for nonresident fathers than nonfathers, which in turn are higher than those of resident fathers. Resident fathers have a significant decrease in scores during late adolescence (β = -0.035, P = .023), but a significant increase in scores during early fatherhood (β = 0.023, P = .041). From entrance into fatherhood to the end of early fatherhood (+5 years), the depressive symptoms score for resident fathers increases on average by 68%.

CONCLUSIONS

In our longitudinal, population-based study, resident fathers show increasing depressive symptom scores during children's key attachment years of 0-5. Identifying at-risk fathers based on social factors and designing effective interventions may ultimately improve health outcomes for the entire family.

Single mothers have a higher risk of mood disorders

INTRODUCTION

Previous research has shown single mothers to be at greater risk for both physical and mental health disorders as compared to married mothers. Psychiatric disorders, in particular depression, have been shown to be more prevalent in single mothers than married mothers. This study was aimed at comparing the prevalence of depression, other mood, and anxiety disorders in single and married mothers in a multiethnic Asian society.

MATERIALS AND METHODS

The Singapore Mental Health Study (SMHS) was a cross-sectional survey of the representative population of Singapore. The survey targeted Singapore residents aged 18 years and above. Trained interviewers established the diagnoses of mental disorders using the Composite International Diagnostic Interview version 3.0 (CIDI 3.0). Physical illnesses, social support and sociodemographic correlates were established using structured interviews. For the purpose of this study, single mothers were defined as unmarried, divorced/separated/widowed mothers who had children aged 21 years and below.

RESULTS

Face-to-face interviews were completed with 6616 respondents from December 2009 to December 2010. After controlling for sociodemographic correlates in multiple logistic regression model, single mothers had significantly higher odds of having mood disorders (OR = 5.28) as compared to married mothers.

CONCLUSION

Our study found that single mothers in Singapore across ethnicities, experienced a higher risk for mood disorders as elsewhere in the world. Single motherhood was also associated with lower age and education. Our study identifies young, single mothers as a vulnerable group associated with mental illnesses that must be targeted with specific interventions to improve mental health and well-being.

Employment hardships and single mothers' self-rated health: evidence from the panel study of income dynamics

Using a national sample of single mothers from the 2007 and 2009 waves of the Panel Study of Income Dynamics, this study examined the effects of multiple employment statuses on the selfrated health of single mothers during the recent economic recession. Unlike other studies, the current study minimized selection bias by controlling for prior self-rated health, in addition to other predisposing factors, enabling factors, and need factors. We found that underemployment, but not unemployment, is associated with lower levels of self-rated health of single mothers. Results further indicate that the 25-39 age range (compared to the 18-24 age range), lower family income, prior lower self-rated health, more chronic diseases, and binge drinking place single mothers at an increased risk of lower levels of self-rated health. In contrast, strength-building physical activity is significantly associated with higher levels of self-rated health. Implications for health care policy and social work practice are drawn from the results.

Insecure attachment style as a vulnerability factor for depression: recent findings in a community-based study of Malay single and married mothers

The role of marital breakdown in women's mental health is of key concern in Malaysia and internationally. A cross-sectional questionnaire study of married and separated/divorced and widowed women examined insecure attachment style as an associated risk factor for depression among 1002 mothers in an urban community in Malaysia. A previous report replicated a UK-based vulnerability-provoking agent model of depression involving negative evaluation of self (NES) and negative elements in close relationships (NECRs) interacting with severe life events to model depression. This article reports on the additional contribution of insecure attachment style to the model using the Vulnerable Attachment Style Questionnaire (VASQ). The results showed that VASQ scores were highly correlated with NES, NECR and depression. A multiple regression analysis of depression with backward elimination found that VASQ scores had a significant additional effect. Group comparisons showed different risk patterns for single and married mothers. NES was the strongest risk factor for both groups, with the 'anxious style' subset of the VASQ being the best additional predictor for married mothers and the total VASQ score (general attachment insecurity) for single mothers. The findings indicate that attachment insecurity adds to a psychosocial vulnerability model of depression among mothers cross-culturally and is important in understanding and identifying risk.

Who seeks abortions at or after 20 weeks?

CONTEXT

Recent years have seen the introduction of state bills seeking to ban abortions after 20 weeks, but little empirical data exist on who is affected when such bans become law.

METHODS

As part of a larger study, 272 women who received an abortion at or after 20 weeks' gestation and 169 who received first-trimester abortions at 16 facilities across the country in 2008-2010 were interviewed one week after the procedure. Mixed effect logistic regression analyses were used to determine the characteristics associated with later abortion (i.e., at 20 weeks or later). Causes of delay in obtaining abortion were assessed in open- and closed-ended questions; profiles of women who received later abortions were identified through factor analysis.

RESULTS

Women aged 20-24 were more likely than those aged 25-34 to have a later abortion (odds ratio, 2.7), and women who discovered their pregnancy before eight weeks' gestation were less likely than others to do so (0.1). Later abortion recipients experienced logistical delays (e.g., difficulty finding a provider and raising funds for the procedure and travel costs), which compounded other delays in receiving care. Most women seeking later abortion fit at least one of five profiles: They were raising children alone, were depressed or using illicit substances, were in conflict with a male partner or experiencing domestic violence, had trouble deciding and then had access problems, or were young and nulliparous.

CONCLUSION

Bans on abortion after 20 weeks will disproportionately affect young women and women with limited financial resources.

Economic adversity and depressive symptoms in mothers: Do marital status and perceived social support matter?

Over the past decade there has been increasing interest in the idea that marriage and perhaps other forms of interpersonal support can buffer the negative effects of poverty. The current study tests the hypothesis that marital status, perceived social support and neighborhood collective efficacy can moderate the effects of economic adversity on depressive symptoms among parents. Hierarchical Linear Modeling was used to analyze data from the Project on Human Development in Chicago Neighborhoods. Participants were 1,957 mothers of minor children. Analysis of main effects revealed associations between neighborhood SES (β = −0.69, SE (0.15), p < .001), family income (β = −0.11, SE (0.05), p = .02) financial strain (β = 0.51, SE (0.18), p = .004), being single (β = 0.63, SE (0.24), p = .009) and perceived social support (β = −0.22, SE (0.03), p < .001) on depressive symptoms. The hypothesis that interpersonal resources can buffer the effects of economic adversity was not supported. There were no significant interactions between marital status and economic adversity. There was a significant interaction between perceived social support and neighborhood level socioeconomic status (β = −0.07, SE (0.03), p = .04) but the effects of social support were weakest in neighborhoods characterized by low socioeconomic status.

I'll pick forgiving

In this essay, the author gives voice to turning points in her life related to infidelity, mental illness, and forgiveness. By melding poetry, prose, dream journal entries, and medical case notes, she tells the story of how she became a single parent of a young man with mental illness. This narrative constitutes a defining moment in which she reframes an unforgivable relational transgression as an unforgettable opportunity for forgiveness.

Economic components of grief

This article investigates the nature, context, and impact of economic stressors associated with loss, drawing on a mixed-methods study of changes in financial circumstances and economic roles following death of a life partner. Findings show how economic changes, and the practicalities of dealing with such transitions, shaped individual responses to the death. Perceived decline in financial wellbeing was associated with increased risk of poor psychological health following bereavement. The findings underline the theoretical importance of financial risk factors for anticipating the duration, pattern, and timing of bereavement outcomes. A challenge for service providers and professionals is how to bring understanding of economic components within emotional and practical support for people preparing for death and those who are bereaved.

An updated and expanded meta-analysis of nonresident fathering and child well-being

Since Amato and Gilbreth's (1999) meta-analysis of nonresident father involvement and child well-being, nonmarital childbirths and nonresident father involvement both have increased. The unknown implications of such changes motivated the present study, a meta-analytic review of 52 studies of nonresident father involvement and child well-being. Consistent with Amato and Gilbreth, we found that positive forms of involvement were associated with benefits for children, with a small but statistically significant effect size. Amounts of father-child contact and financial provision, however, were not associated with child well-being. Going beyond Amato and Gilbreth, we analyzed the associations between different types of fathering and overall child well-being, and between overall father involvement and different types of child well-being. We found that nonresident father involvement was most strongly associated with children's social well-being and also was associated with children's emotional well-being, academic achievement, and behavioral adjustment. The forms of father involvement most strongly associated with child well-being were involvement in child-related activities, having positive father-child relationships, and engaging in multiple forms of involvement. Moderator analyses demonstrated variation in effect sizes based on both study characteristics and demographic variables. We discuss the implications of these findings for policy and practice.

[Educational competence of parents with children participating in youth welfare measures]

OBJECTIVE

The study examines the influence of specific risks on parenting at the beginning of youth welfare measures.

METHOD

Family risk factors as well as parental behaviour styles of N = 74 parents were assessed with standardized questionnaires.

RESULTS

The results were evaluated cross-sectionally with one-way factor analysis. Three groups were formed according to degree of risk factors. Families with special risks, i.e., material needs, physically ill parents, or single parents, show a significantly lower level of parenting competence. Differences in negative parenting features are not found to be under the influence of specific risks.

CONCLUSIONS

Parents of children in youth welfare measures who are specifically stressed may need special training to increase their parenting skills, especially when pre-post comparisons show lower parenting quality in the group with specific risk factors at the end of an intervention.

[The vulnerability of women Francophone parent at risk of homelessness in a community in Northern Ontario]

OBJECTIVE

This study aimed to examine the vulnerability of Francophone single mothers at risk of homelessness in Northern Ontario. The project also endeavoured to document the quest for autonomy of these women in a minority context.

METHOD

Employing a qualitative approach, eleven life stories were obtained from five women. Although none were homeless at the time of the interviews, in terms of living on the street, two were living with friends and the others were at risk of becoming homeless. All of the participants were between 20 and 59 years old and had completed their secondary education.

RESULTS

Taking into account their economic and social situation, as well as the participants' health and cultural resources, vulnerabilities throughout the life course were analyzed.

CONCLUSION

The life trajectory of these women showed us that their significant vulnerabilities are relative to the amount of autonomy they are able to secure through the services provided by supporting agencies, particularly in a linguistic minority context. In addition, the triple stigmatization (economic, linguistic and gender relations) requires a broader understanding of the resilience of these women in their journey from poverty (economic) to social (and linguistic) exclusion, and vulnerability. Despite these challenges, each of the individuals interviewed in this study, for whom the quest for autonomy is a continual struggle, demonstrated resilience.