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Grote NK, Lohr MJ, Curran MC, Cristofalo M. Change Mechanisms in Brief Interpersonal Psychotherapy for Women With Perinatal Depression: Qualitative Study. Am J Psychother 2021; 74:112-118. [PMID: 33745285 DOI: 10.1176/appi.psychotherapy.20200039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Brief interpersonal psychotherapy (IPT-B) has been shown to be effective in treating perinatal depression and in preventing depressive relapse among socioeconomically disadvantaged women. Yet, it is unclear how IPT-B alleviates depression. Previous research has suggested four possible change mechanisms derived from IPT's interpersonal model: decreasing interpersonal stress, facilitating emotional processing, improving interpersonal skills, and enhancing social support. This study explored how women who received IPT-B or enhanced maternity support services (MSS-Plus) evaluated their respective experiences. METHODS A qualitative study was conducted with 16 women who had been recruited from public health clinics to participate in a larger, randomized controlled trial of women with major depression or dysthymia and who had been assigned to receive IPT-B or MSS-Plus. The sample was 63% non-Hispanic White, had an average age of 31.6 years, and was balanced in intervention group assignment, posttraumatic stress disorder status, and depression improvement. Telephone interviews included semistructured, open-ended questions eliciting participants' experiences with depression treatment. Predetermined, conceptually derived codes were based on the four postulated IPT change mechanisms. RESULTS Thematic coded excerpts were collected and discussed. Excerpts lent support to the role of IPT-B in helping women decrease their interpersonal stress; identify, reflect on, and regulate their emotions; and improve their social skills. Evidence for increasing social support was mixed but highlighted the importance of the therapeutic relationship. CONCLUSIONS Including qualitative findings into training in public health and other clinical settings will help illuminate the role of the provider in facilitating the change mechanisms that may lead to improved mental health among clients.
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Affiliation(s)
- Nancy K Grote
- School of Social Work (Grote, Lohr, Curran), Department of Child, Family, and Population Health Nursing (Lohr), and Department of Rehabilitation Medicine (Curran), University of Washington, Seattle; Department of Social Work, Seattle University, Seattle (Cristofalo)
| | - Mary Jane Lohr
- School of Social Work (Grote, Lohr, Curran), Department of Child, Family, and Population Health Nursing (Lohr), and Department of Rehabilitation Medicine (Curran), University of Washington, Seattle; Department of Social Work, Seattle University, Seattle (Cristofalo)
| | - Mary C Curran
- School of Social Work (Grote, Lohr, Curran), Department of Child, Family, and Population Health Nursing (Lohr), and Department of Rehabilitation Medicine (Curran), University of Washington, Seattle; Department of Social Work, Seattle University, Seattle (Cristofalo)
| | - Meg Cristofalo
- School of Social Work (Grote, Lohr, Curran), Department of Child, Family, and Population Health Nursing (Lohr), and Department of Rehabilitation Medicine (Curran), University of Washington, Seattle; Department of Social Work, Seattle University, Seattle (Cristofalo)
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Grigoroglou C, van der Feltz-Cornelis C, Hodkinson A, Coventry PA, Zghebi SS, Kontopantelis E, Bower P, Lovell K, Gilbody S, Waheed W, Dickens C, Archer J, Blakemore A, Adler DA, Aragones E, Björkelund C, Bruce ML, Buszewicz M, Carney RM, Cole MG, Davidson KW, Gensichen J, Grote NK, Russo J, Huijbregts K, Huffman JC, Menchetti M, Patel V, Richards DA, Rollman B, Smit A, Zijlstra-Vlasveld MC, Wells KB, Zimmermann T, Unutzer J, Panagioti M. Effectiveness of collaborative care in reducing suicidal ideation: An individual participant data meta-analysis. Gen Hosp Psychiatry 2021; 71:27-35. [PMID: 33915444 DOI: 10.1016/j.genhosppsych.2021.04.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 04/15/2021] [Accepted: 04/18/2021] [Indexed: 10/21/2022]
Abstract
UNLABELLED To assess whether CC is more effective at reducing suicidal ideation in people with depression compared with usual care, and whether study and patient factors moderate treatment effects. METHOD We searched Medline, Embase, PubMed, PsycINFO, CINAHL, CENTRAL from inception to March 2020 for Randomised Controlled Trials (RCTs) that compared the effectiveness of CC with usual care in depressed adults, and reported changes in suicidal ideation at 4 to 6 months post-randomisation. Mixed-effects models accounted for clustering of participants within trials and heterogeneity across trials. This study is registered with PROSPERO, CRD42020201747. RESULTS We extracted data from 28 RCTs (11,165 patients) of 83 eligible studies. We observed a small significant clinical improvement of CC on suicidal ideation, compared with usual care (SMD, -0.11 [95%CI, -0.15 to -0.08]; I2, 0·47% [95%CI 0.04% to 4.90%]). CC interventions with a recognised psychological treatment were associated with small reductions in suicidal ideation (SMD, -0.15 [95%CI -0.19 to -0.11]). CC was more effective for reducing suicidal ideation among patients aged over 65 years (SMD, - 0.18 [95%CI -0.25 to -0.11]). CONCLUSION Primary care based CC with an embedded psychological intervention is the most effective CC framework for reducing suicidal ideation and older patients may benefit the most.
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Affiliation(s)
- Christos Grigoroglou
- Division of Population Health, Health Services Research & Primary Care, University of Manchester, Manchester, England.
| | | | - Alexander Hodkinson
- National Institute of Health Research School for Primary Care Research, Division of Population Health, Health Services Research & Primary Care, University of Manchester, Manchester, England
| | - Peter A Coventry
- Department of Health Sciences, University of York, York, England
| | - Salwa S Zghebi
- National Institute of Health Research School for Primary Care Research, Division of Population Health, Health Services Research & Primary Care, University of Manchester, Manchester, England
| | - Evangelos Kontopantelis
- Faculty of Biology, Medicine and Health, Division of Informatics, Imaging and Data Sciences, University of Manchester, Manchester, England
| | - Peter Bower
- National Institute of Health Research School for Primary Care Research, Division of Population Health, Health Services Research & Primary Care, University of Manchester, Manchester, England
| | - Karina Lovell
- Division of Nursing, Midwifery and Social Work, School of Health Sciences, University of Manchester, Manchester, England; Greater Manchester Mental Health NHS Foundation Trust, Manchester, England
| | - Simon Gilbody
- Department of Health Sciences, Hull York Medical School, HYMS, University of York, York, England
| | - Waquas Waheed
- National Institute of Health Research School for Primary Care Research, Division of Population Health, Health Services Research & Primary Care, University of Manchester, Manchester, England
| | | | - Janine Archer
- School of Health and Society, School of Health and Society, University of Salford, England
| | - Amy Blakemore
- Division of Nursing, Midwifery and Social Work, School of Health Sciences, University of Manchester, Manchester, England
| | - David A Adler
- Departments of Psychiatry and Medicine, Tufts Medical Center and Tufts University School of Medicine, England
| | - Enric Aragones
- Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAPJGol), Barcelona, Spain
| | - Cecilia Björkelund
- Primary Health Care School of Public Health and Community Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Martha L Bruce
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA
| | - Marta Buszewicz
- Institute of Epidemiology and Health, Faculty of Population and Health Sciences, University College London, London, England
| | - Robert M Carney
- Department of Psychiatry, Washington University in St. Louis (WUSTL), St. Louis, Missouri, USA
| | - Martin G Cole
- Department of Psychiatry, St. Mary's Hospital Center, McGill University, Montreal, Quebec, Canada
| | - Karina W Davidson
- Institute of Health Innovations and Outcomes Research, Feinstein Institutes for Medical Research, Northwell Health, Manhasset, New York, USA
| | - Jochen Gensichen
- Institute of General Practice and Family Medicine, LMU Klinikum, Ludwig-Maximilians, University Munich Pettenkoferstr. 10, 80336 Munich, Germany
| | - Nancy K Grote
- School of Social Work, University of Washington, Seattle, USA
| | - Joan Russo
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, USA
| | - Klaas Huijbregts
- Department of Psychiatry and Amsterdam Public Health Research Institute, Amsterdam, Netherlands
| | - Jeff C Huffman
- Harvard Medical School, Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts
| | - Marco Menchetti
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Vikram Patel
- The Pershing Square Professor of Global Health, Harvard Medical School, Boston, MA, USA
| | - David A Richards
- Institute of Health Research, University of Exeter College of Medicine and Health, Exeter, England; Western University of Norway, Bergen, Norway
| | - Bruce Rollman
- Center for Behavioral Health, Media and Technology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Annet Smit
- HAN University of Applied Sciences, Nijmegen, Netherlands
| | | | - Kenneth B Wells
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, USA; Jane and Terry Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, USA
| | - Thomas Zimmermann
- Department of General Practice / Primary Care, Centre for Psychosocial Medicine, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Jurgen Unutzer
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, USA
| | - Maria Panagioti
- National Institute of Health Research School for Primary Care Research, Division of Population Health, Health Services Research & Primary Care, University of Manchester, Manchester, England
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Perzow SED, Hennessey EMP, Hoffman MC, Grote NK, Davis EP, Hankin BL. Mental health of pregnant and postpartum women in response to the COVID-19 pandemic. J Affect Disord Rep 2021; 4:100123. [PMID: 33649750 PMCID: PMC7904453 DOI: 10.1016/j.jadr.2021.100123] [Citation(s) in RCA: 66] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 02/19/2021] [Accepted: 02/20/2021] [Indexed: 12/21/2022] Open
Abstract
Background The COVID-19 pandemic has been uniquely challenging for pregnant and postpartum women. Uncontrollable stress amplifies risk for maternal depression and anxiety, which are linked to adverse mother and child outcomes. This study examined change in internalizing symptoms from before to during the COVID-19 pandemic among pregnant and postpartum women longitudinally, and investigated moderation by loneliness and other contextual risk factors. Methods 135 women (Mage = 31.81; 26% Latina, 55% non-Hispanic White, 11% Black; 39% low-income) enrolled in an existing prospective study completed self-report questionnaires including the EPDS and STAI-short form during early pregnancy, prior to COVID-19, and during COVID-19. Results Depressive symptoms were higher during COVID-19 compared to pre-COVID-19 and just as high as during early pregnancy. Anxiety symptoms were higher during COVID-19 compared to both pre-COVID-19 and early pregnancy. Higher loneliness was associated with increased depressive symptoms during COVID-19. Greater COVID-19 specific adversity was linked to greater increases in internalizing symptoms during COVID-19. Lower income-to-needs-ratio most strongly predicted symptoms during early pregnancy. Limitations The present study is longitudinal, but the correlational nature of the data precludes causal conclusions regarding the effect of the pandemic on mental health. Conclusion Longitudinal analyses suggest the COVID-19 pandemic resulted in increased internalizing symptoms among diverse pregnant and postpartum women. Interpersonal and contextual factors exacerbate risk and the impact of the pandemic on women's mental health. Identifying mothers at-risk for depression and anxiety may increase treatment utilization, mitigate fetal and infant exposure to maternal depression and anxiety, and help prevent adverse child outcomes.
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Affiliation(s)
| | | | - M Camille Hoffman
- University of Colorado School of Medicine, Department of Obstetrics and Gynecology, USA
| | - Nancy K Grote
- University of Washington, School of Social Work, USA
| | - Elysia Poggi Davis
- University of Denver, Department of Psychology, USA.,University of California, Irvine Department of Psychiatry and Human Behavior, USA
| | - Benjamin L Hankin
- The University of Illinois at Urbana-Champaign, Department of Psychology, USA
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Grote NK, Simon GE, Russo J, Lohr MJ, Carson K, Katon W. Incremental Benefit-Cost of MOMCare: Collaborative Care for Perinatal Depression Among Economically Disadvantaged Women. Psychiatr Serv 2017; 68:1164-1171. [PMID: 28669288 DOI: 10.1176/appi.ps.201600411] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Effectiveness of collaborative care for perinatal depression has been demonstrated for MOMCare, from early pregnancy up to 15 months postpartum, for Medicaid enrollees in a public health system. MOMCare had a greater impact on reducing depression and improving functioning for women with comorbid posttraumatic stress disorder (PTSD) than for those without PTSD. This study estimated the incremental benefit and cost and the net benefit of MOMCare for women with major depression and PTSD. METHODS A randomized trial (September 2009 to December 2014) compared the MOMCare collaborative care depression intervention (choice of brief interpersonal psychotherapy or pharmacotherapy or both) with enhanced maternity support services (MSS-Plus) in the public health system of Seattle-King County. Among pregnant women with a probable diagnosis of major depression or dysthymia (N=164), two-thirds (N=106) met criteria for probable PTSD. Blinded assessments at three, six, 12, and 18 months postbaseline included the Symptom Checklist-20 depression scale and the Cornell Services Index. Analyses of covariance estimated gain in depression free days (DFDs) by intervention and PTSD status. RESULTS When the analysis controlled for baseline depression severity, women with probable depression and PTSD in MOMCare had 68 more depression-free days over 18 months than those in MSS-Plus (p<.05). The additional depression care cost per MOMCare participant with comorbid PTSD was $1,312. The incremental net benefit of MOMCare was positive if a DFD was valued at ≥$20. CONCLUSIONS For women with probable major depression and PTSD, MOMCare had significant clinical benefit over MSS-Plus, with only a moderate increase in health services cost.
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Affiliation(s)
- Nancy K Grote
- Dr. Grote and Ms. Lohr are with the School of Social Work, University of Washington, Seattle. Dr. Simon is with Kaiser Permanente Washington Health Research Institute, Seattle. Dr. Russo is with the Department of Psychiatry and Behavioral Sciences, University of Washington Medical Center, Seattle, where the late Dr. Katon was affiliated. Ms. Carson, who is retired, was with Maternity Support Services, Seattle-King County Department of Public Health, Seattle, at the time of this study
| | - Gregory E Simon
- Dr. Grote and Ms. Lohr are with the School of Social Work, University of Washington, Seattle. Dr. Simon is with Kaiser Permanente Washington Health Research Institute, Seattle. Dr. Russo is with the Department of Psychiatry and Behavioral Sciences, University of Washington Medical Center, Seattle, where the late Dr. Katon was affiliated. Ms. Carson, who is retired, was with Maternity Support Services, Seattle-King County Department of Public Health, Seattle, at the time of this study
| | - Joan Russo
- Dr. Grote and Ms. Lohr are with the School of Social Work, University of Washington, Seattle. Dr. Simon is with Kaiser Permanente Washington Health Research Institute, Seattle. Dr. Russo is with the Department of Psychiatry and Behavioral Sciences, University of Washington Medical Center, Seattle, where the late Dr. Katon was affiliated. Ms. Carson, who is retired, was with Maternity Support Services, Seattle-King County Department of Public Health, Seattle, at the time of this study
| | - Mary Jane Lohr
- Dr. Grote and Ms. Lohr are with the School of Social Work, University of Washington, Seattle. Dr. Simon is with Kaiser Permanente Washington Health Research Institute, Seattle. Dr. Russo is with the Department of Psychiatry and Behavioral Sciences, University of Washington Medical Center, Seattle, where the late Dr. Katon was affiliated. Ms. Carson, who is retired, was with Maternity Support Services, Seattle-King County Department of Public Health, Seattle, at the time of this study
| | - Kathy Carson
- Dr. Grote and Ms. Lohr are with the School of Social Work, University of Washington, Seattle. Dr. Simon is with Kaiser Permanente Washington Health Research Institute, Seattle. Dr. Russo is with the Department of Psychiatry and Behavioral Sciences, University of Washington Medical Center, Seattle, where the late Dr. Katon was affiliated. Ms. Carson, who is retired, was with Maternity Support Services, Seattle-King County Department of Public Health, Seattle, at the time of this study
| | - Wayne Katon
- Dr. Grote and Ms. Lohr are with the School of Social Work, University of Washington, Seattle. Dr. Simon is with Kaiser Permanente Washington Health Research Institute, Seattle. Dr. Russo is with the Department of Psychiatry and Behavioral Sciences, University of Washington Medical Center, Seattle, where the late Dr. Katon was affiliated. Ms. Carson, who is retired, was with Maternity Support Services, Seattle-King County Department of Public Health, Seattle, at the time of this study
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Bhat A, Grote NK, Russo J, Lohr MJ, Jung H, Rouse CE, Howell EC, Melville JL, Carson K, Katon W. Collaborative Care for Perinatal Depression Among Socioeconomically Disadvantaged Women: Adverse Neonatal Birth Events and Treatment Response. Psychiatr Serv 2017; 68:17-24. [PMID: 27691376 DOI: 10.1176/appi.ps.201600002] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The study examined the effectiveness of a perinatal collaborative care intervention in moderating the effects of adverse neonatal birth events on risks of postpartum depressive symptoms and impaired functioning among women of lower socioeconomic status with antenatal depression. METHODS A randomized controlled trial with blinded outcome assessments was conducted in ten public health centers, comparing MOMCare (choice of brief interpersonal psychotherapy, pharmacotherapy, or both) with intensive maternity support services (MSS-Plus). Participants had probable diagnoses of major depressive disorder or dysthymia during pregnancy. Generalized estimating equations estimated differences in depression and functioning measures between groups with and without adverse birth events within the treatment arms. A total of 160 women, 43% of whom experienced at least one adverse birth event, were included in the analyses. RESULTS For women who received MOMCare, postpartum depression scores (measured with the Symptom Checklist-20) did not differ by whether or not they experienced an adverse birth event (mean±SD scores of .86±.51 for mothers with an adverse birth event and .83±.56 for mothers with no event; p=.78). For women who received MSS-Plus, having an adverse birth event was associated with persisting depression in the postpartum period (mean scores of 1.20±.0.61 for mothers with an adverse birth event and .93±.52 for mothers without adverse birth event; p=.04). Similar results were seen for depression response rates and functioning. CONCLUSIONS MOMCare mitigated the risk of postpartum depressive symptoms and impaired functioning among women of low socioeconomic status who had antenatal depression and who experienced adverse birth events.
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Affiliation(s)
- Amritha Bhat
- Dr. Bhat and Dr. Russo are with the Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, where the late Dr. Katon was affiliated (e-mail: ). Dr. Grote, Ms. Lohr, Dr. Jung, and Ms. Howell are with the School of Social Work, University of Washington, Seattle. Dr. Rouse is with the Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Boston. Dr. Melville is with Northwest Women's HealthCare, Swedish Medical Center, Seattle. Ms. Carson is with the Seattle-King County Department of Public Health, Seattle
| | - Nancy K Grote
- Dr. Bhat and Dr. Russo are with the Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, where the late Dr. Katon was affiliated (e-mail: ). Dr. Grote, Ms. Lohr, Dr. Jung, and Ms. Howell are with the School of Social Work, University of Washington, Seattle. Dr. Rouse is with the Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Boston. Dr. Melville is with Northwest Women's HealthCare, Swedish Medical Center, Seattle. Ms. Carson is with the Seattle-King County Department of Public Health, Seattle
| | - Joan Russo
- Dr. Bhat and Dr. Russo are with the Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, where the late Dr. Katon was affiliated (e-mail: ). Dr. Grote, Ms. Lohr, Dr. Jung, and Ms. Howell are with the School of Social Work, University of Washington, Seattle. Dr. Rouse is with the Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Boston. Dr. Melville is with Northwest Women's HealthCare, Swedish Medical Center, Seattle. Ms. Carson is with the Seattle-King County Department of Public Health, Seattle
| | - Mary Jane Lohr
- Dr. Bhat and Dr. Russo are with the Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, where the late Dr. Katon was affiliated (e-mail: ). Dr. Grote, Ms. Lohr, Dr. Jung, and Ms. Howell are with the School of Social Work, University of Washington, Seattle. Dr. Rouse is with the Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Boston. Dr. Melville is with Northwest Women's HealthCare, Swedish Medical Center, Seattle. Ms. Carson is with the Seattle-King County Department of Public Health, Seattle
| | - Hyunzee Jung
- Dr. Bhat and Dr. Russo are with the Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, where the late Dr. Katon was affiliated (e-mail: ). Dr. Grote, Ms. Lohr, Dr. Jung, and Ms. Howell are with the School of Social Work, University of Washington, Seattle. Dr. Rouse is with the Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Boston. Dr. Melville is with Northwest Women's HealthCare, Swedish Medical Center, Seattle. Ms. Carson is with the Seattle-King County Department of Public Health, Seattle
| | - Caroline E Rouse
- Dr. Bhat and Dr. Russo are with the Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, where the late Dr. Katon was affiliated (e-mail: ). Dr. Grote, Ms. Lohr, Dr. Jung, and Ms. Howell are with the School of Social Work, University of Washington, Seattle. Dr. Rouse is with the Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Boston. Dr. Melville is with Northwest Women's HealthCare, Swedish Medical Center, Seattle. Ms. Carson is with the Seattle-King County Department of Public Health, Seattle
| | - Elaine C Howell
- Dr. Bhat and Dr. Russo are with the Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, where the late Dr. Katon was affiliated (e-mail: ). Dr. Grote, Ms. Lohr, Dr. Jung, and Ms. Howell are with the School of Social Work, University of Washington, Seattle. Dr. Rouse is with the Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Boston. Dr. Melville is with Northwest Women's HealthCare, Swedish Medical Center, Seattle. Ms. Carson is with the Seattle-King County Department of Public Health, Seattle
| | - Jennifer L Melville
- Dr. Bhat and Dr. Russo are with the Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, where the late Dr. Katon was affiliated (e-mail: ). Dr. Grote, Ms. Lohr, Dr. Jung, and Ms. Howell are with the School of Social Work, University of Washington, Seattle. Dr. Rouse is with the Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Boston. Dr. Melville is with Northwest Women's HealthCare, Swedish Medical Center, Seattle. Ms. Carson is with the Seattle-King County Department of Public Health, Seattle
| | - Kathy Carson
- Dr. Bhat and Dr. Russo are with the Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, where the late Dr. Katon was affiliated (e-mail: ). Dr. Grote, Ms. Lohr, Dr. Jung, and Ms. Howell are with the School of Social Work, University of Washington, Seattle. Dr. Rouse is with the Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Boston. Dr. Melville is with Northwest Women's HealthCare, Swedish Medical Center, Seattle. Ms. Carson is with the Seattle-King County Department of Public Health, Seattle
| | - Wayne Katon
- Dr. Bhat and Dr. Russo are with the Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, where the late Dr. Katon was affiliated (e-mail: ). Dr. Grote, Ms. Lohr, Dr. Jung, and Ms. Howell are with the School of Social Work, University of Washington, Seattle. Dr. Rouse is with the Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Boston. Dr. Melville is with Northwest Women's HealthCare, Swedish Medical Center, Seattle. Ms. Carson is with the Seattle-King County Department of Public Health, Seattle
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Abstract
Many researchers have made the seemingly straightforward predictions that relationship rewards will be positively, and relationship costs will be negatively, associated with indices of relationship quality. Existing literature supports the hypothesis for rewards, but evidence regarding costs is mixed. Depending on the study, indices of costs have been observed to be negatively associated, unassociated, and even positively associated with relationship quality. We argue that the mixed results may have been due in part to past cost measures tapping three separate constructs: (a) a partner's intentional poor behavior directed at the participant, (b) negative things associated with the relationship (but not caused by the partner's intentional behavior), and (c) behaving in such a manner as to meet a partner's needs—something which often may involve performing undesirable activities, foregoing desired opportunities, or giving up money, time, or goods. We believe the first two types of costs should be negatively associated with relationship quality. However, we argue that the last type, because it involves adhering to communal norms (Clark & Mills, 1979, 1993) will often tend to be either negligibly or even positively associated with relationship quality. In two studies the occurrence of these three categories of events in close relationships as well as the quality of those relationships were measured. The overall pattern of results supports our specific hypotheses as well as the general idea that a lack of conceptual clarity regarding “costs” has contributed to the current mixed nature of our literature on links between relationship costs and relationship quality.
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Affiliation(s)
- M S Clark
- Department of Psychology, Carnegie Mellon University, Pittsburgh, PA, USA. mc0z+@andrew.cmu.edu
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7
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Grote NK, Katon WJ, Russo JE, Lohr MJ, Curran M, Galvin E, Carson K. A Randomized Trial of Collaborative Care for Perinatal Depression in Socioeconomically Disadvantaged Women: The Impact of Comorbid Posttraumatic Stress Disorder. J Clin Psychiatry 2016; 77:1527-1537. [PMID: 28076671 DOI: 10.4088/jcp.15m10477] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2015] [Accepted: 03/08/2016] [Indexed: 10/20/2022]
Abstract
OBJECTIVE The comorbidity of posttraumatic stress disorder (PTSD) with antenatal depression poses increased risks for postpartum depression and may delay or diminish response to evidence-based depression care. In a secondary analysis of an 18-month study of collaborative care for perinatal depression, the authors hypothesized that pregnant, depressed, socioeconomically disadvantaged women with comorbid PTSD would show more improvement in the MOMCare intervention providing Brief Interpersonal Psychotherapy and/or antidepressants, compared to intensive public health Maternity Support Services (MSS-Plus). METHODS A multisite randomized controlled trial with blinded outcome assessment was conducted in the Seattle-King County Public Health System, July 2009-January 2014. Pregnant women were recruited who met criteria for a probable diagnosis of major depressive disorder (MDD) on the Patient Health Questionnaire-9 and/or dysthymia on the MINI-International Neuropsychiatric Interview (5.0.0). The primary outcome was depression severity at 3-, 6-, 12-and 18-month follow-ups; secondary outcomes included functional improvement, PTSD severity, depression response and remission, and quality of depression care. RESULTS Sixty-five percent of the sample of 164 met criteria for probable comorbid PTSD. The treatment effect was significantly associated with PTSD status in a group-by-PTSD severity interaction, controlling for baseline depression severity (Wald χ²₁ = 4.52, P = .03). Over the 18-month follow-up, those with comorbid PTSD in MOMCare (n = 48), versus MSS-Plus (n = 58), showed greater improvement in depression severity (Wald χ²₁ = 8.51, P < .004), PTSD severity (Wald χ²₁ = 5.55, P < .02), and functioning (Wald χ²₁ = 4.40, P < .04); higher rates of depression response (Wald χ²₁ = 4.13, P < .04) and remission (Wald χ²₁ = 5.17, P < .02); and increased use of mental health services (Wald χ²₁ = 39.87, P < .0001) and antidepressant medication (Wald χ²₁ = 8.07, P < .005). Participants without comorbid PTSD in MOMCare (n = 33) and MSS-Plus (n = 25) showed equivalent improvement on these outcomes. CONCLUSIONS Collaborative depression care had a greater impact on perinatal depressive outcomes for socioeconomically disadvantaged women with comorbid PTSD than for those without PTSD. Findings suggest that a stepped care treatment model for high-risk pregnant women with both MDD and PTSD could be integrated into public health systems in the United States. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT01045655.
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Affiliation(s)
- Nancy K Grote
- Research Associate Professor, School of Social Work, University of Washington, Campus Box 354900, 4101 15th Ave NE, Seattle, WA 98105. .,School of Social Work, University of Washington, Seattle, Washington, USA
| | - Wayne J Katon
- Department of Psychiatry and Behavioral Sciences, University of Washington Medical School, Seattle, Washington, USA
| | - Joan E Russo
- Department of Psychiatry and Behavioral Sciences, University of Washington Medical School, Seattle, Washington, USA
| | - Mary Jane Lohr
- School of Social Work, University of Washington, Seattle, Washington, USA
| | - Mary Curran
- School of Social Work, University of Washington, Seattle, Washington, USA
| | - Erin Galvin
- School of Social Work, University of Washington, Seattle, Washington, USA
| | - Kathy Carson
- Public Health Seattle and King County (PHSKC), Seattle, Washington, USA
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Grote NK. “What's Been Left Out” of Personality Theory: The Contribution of Women Creating Lives. Psychology of Women Quarterly 2016. [DOI: 10.1177/036168439501900302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Nancy K. Grote
- Visiting Assistant Professor in Psychology at Carnegie Mellon University and a NIMH Postdoctoral Fellow in psychiatric epidemiology at the University of Pittsburgh. She has had a private practice in individual, marital, and family therapy and is currently conducting longitudinal research on the issues of love, justice, and psychological well-being in the marital lives of couples before and after the birth of their first child
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Grote NK. Equality and the Family: Putting Theory Into Practice. Psychology of Women Quarterly 2016. [DOI: 10.1177/036168439802200403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Nancy K. Grote
- Nancy K. Grote is a social and clinical psychologist interested in love and justice in the family. Currently, she is a Visiting Assistant Professor at Reed College in Portland, Oregon
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Grote NK, Katon WJ, Russo JE, Lohr MJ, Curran M, Galvin E, Carson K. COLLABORATIVE CARE FOR PERINATAL DEPRESSION IN SOCIOECONOMICALLY DISADVANTAGED WOMEN: A RANDOMIZED TRIAL. Depress Anxiety 2015; 32:821-34. [PMID: 26345179 PMCID: PMC4630126 DOI: 10.1002/da.22405] [Citation(s) in RCA: 91] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2015] [Revised: 06/05/2015] [Accepted: 07/30/2015] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Both antenatal and postpartum depression have adverse, lasting effects on maternal and child well-being. Socioeconomically disadvantaged women are at increased risk for perinatal depression and have experienced difficulty accessing evidence-based depression care. The authors evaluated whether "MOMCare,"a culturally relevant, collaborative care intervention, providing a choice of brief interpersonal psychotherapy and/or antidepressants, is associated with improved quality of care and depressive outcomes compared to intensive public health Maternity Support Services (MSS-Plus). METHODS A randomized multisite controlled trial with blinded outcome assessment was conducted in the Seattle-King County Public Health System. From January 2010 to July 2012, pregnant women were recruited who met criteria for probable major depression and/or dysthymia, English-speaking, had telephone access, and ≥18 years old. The primary outcome was depression severity at 3-, 6-, 12-, 18-month postbaseline assessments; secondary outcomes included functional improvement, PTSD severity, depression response and remission, and quality of depression care. RESULTS All participants were on Medicaid and 27 years old on average; 58% were non-White; 71% were unmarried; and 65% had probable PTSD. From before birth to 18 months postbaseline, MOMCare (n = 83) compared to MSS-Plus participants (n = 85) attained significantly lower levels of depression severity (Wald's χ(2) = 6.09, df = 1, P = .01) and PTSD severity (Wald's χ(2) = 4.61, df = 1, P = .04), higher rates of depression remission (Wald's χ(2) = 3.67, df = 1, P = .05), and had a greater likelihood of receiving ≥4 mental health visits (Wald's χ(2) = 58.23, df = 1, P < .0001) and of adhering to antidepressants in the prior month (Wald's χ(2) = 10.00, df = 1, P < .01). CONCLUSION Compared to MSS-Plus, MOMCare showed significant improvement in quality of care, depression severity, and remission rates from before birth to 18 months postbaseline for socioeconomically disadvantaged women. Findings suggest that evidence-based perinatal depression care can be integrated into the services of a county public health system in the United States. CLINICAL TRIAL REGISTRATION ClinicalTrials.govNCT01045655.
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Affiliation(s)
- Nancy K. Grote
- School of Social Work, University of Washington, Seattle, WA, USA
| | - Wayne J. Katon
- Department of Psychiatry and Behavioral Sciences, University of Washington Medical School, Seattle, WA, USA
| | - Joan E. Russo
- Department of Psychiatry and Behavioral Sciences, University of Washington Medical School, Seattle, WA, USA
| | - Mary Jane Lohr
- School of Social Work, University of Washington, Seattle, WA, USA
| | - Mary Curran
- School of Social Work, University of Washington, Seattle, WA, USA
| | - Erin Galvin
- School of Social Work, University of Washington, Seattle, WA, USA
| | - Kathy Carson
- Public Health Seattle and King County (PHSKC), Seattle, WA, USA
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Abstract
Brief Interpersonal Psychotherapy (IPT-B) is an eight-session adaption of Interpersonal Psychotherapy (IPT), an evidence-based psychotherapy for depression. The rationale for developing a briefer form of IPT rests on the paucity of empirical evidence linking increased therapy "dose" to enhanced therapeutic effects. The goal of IPT-B is to allow individuals who are unlikely to attend 16 sessions of psychotherapy-because of external or internal constraints-to receive the full benefits of IPT in fewer sessions. We provide an overview of IPT-B and describe the modifications made to standard IPT to adjust for the truncated time course. We then review the empirical evidence supporting this briefer model of IPT, including four open studies, one matched case-control study, and three randomized controlled trials. We conclude that IPT-B offers the dual advantages of rapid relief from suffering and decreased resource utilization.
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Affiliation(s)
- Holly A Swartz
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
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Grote NK, Katon WJ, Lohr MJ, Carson K, Curran M, Galvin E, Russo JE, Gregory M. Culturally relevant treatment services for perinatal depression in socio-economically disadvantaged women: the design of the MOMCare study. Contemp Clin Trials 2014; 39:34-49. [PMID: 25016216 DOI: 10.1016/j.cct.2014.07.001] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2014] [Revised: 06/28/2014] [Accepted: 07/01/2014] [Indexed: 01/30/2023]
Abstract
BACKGROUND Depression during pregnancy has been demonstrated to be predictive of low birthweight, prematurity, and postpartum depression. These adverse outcomes potentially have lasting effects on maternal and child well-being. Socio-economically disadvantaged women are twice as likely as middle-class women to meet diagnostic criteria for antenatal major depression (MDD), but have proven difficult to engage and retain in treatment. Collaborative care treatment models for depression have not been evaluated for racially/ethnically diverse, pregnant women on Medicaid receiving care in a public health system. This paper describes the design, methodology, culturally relevant enhancements, and implementation of a randomized controlled trial of depression care management compared to public health Maternity Support Services (MSS). METHODS Pregnant, public health patients, >18 years with a likely diagnosis of MDD or dysthymia, measured respectively by the Patient Health Questionnaire-9 (PHQ-9) or the Mini-International Neuropsychiatric Interview (MINI), were randomized to the intervention or to public health MSS. The primary outcome was reduction in depression severity from baseline during pregnancy to 18-months post-baseline (one-year postpartum). BASELINE RESULTS 168 women with likely MDD (96.4%) and/or dysthymia (24.4%) were randomized. Average age was 27.6 years and gestational age was 22.4 weeks; 58.3% racial/ethnic minority; 71.4% unmarried; 22% no high school degree/GED; 65.3% unemployed; 42.1% making <$10,000 annually; 80.4% having recurrent depression; 64.6% PTSD, and 72% unplanned pregnancy. CONCLUSIONS A collaborative care team, including a psychiatrist, psychologist, project manager, and 3 social workers, met weekly, collaborated with the patients' obstetrics providers, and monitored depression severity using an electronic tracking system. Potential sustainability of the intervention within a public health system requires further study.
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Affiliation(s)
- Nancy K Grote
- School of Social Work, University of Washington, Seattle, WA, USA.
| | - Wayne J Katon
- Department of Psychiatry and Behavioral Sciences, University of Washington Medical School, Seattle, WA, USA
| | - Mary Jane Lohr
- School of Social Work, University of Washington, Seattle, WA, USA
| | - Kathy Carson
- Public Health Seattle and King County (PHSKC), Seattle, WA, USA
| | - Mary Curran
- School of Social Work, University of Washington, Seattle, WA, USA
| | - Erin Galvin
- School of Social Work, University of Washington, Seattle, WA, USA
| | - Joan E Russo
- Department of Psychiatry and Behavioral Sciences, University of Washington Medical School, Seattle, WA, USA
| | - Marilyn Gregory
- School of Social Work, University of Washington, Seattle, WA, USA
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Grote NK, Spieker SJ, Lohr MJ, Geibel SL, Swartz HA, Frank E, Houck PR, Katon W. Impact of childhood trauma on the outcomes of a perinatal depression trial. Depress Anxiety 2012; 29:563-73. [PMID: 22447637 PMCID: PMC3554235 DOI: 10.1002/da.21929] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2011] [Revised: 02/01/2012] [Accepted: 02/02/2012] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Childhood abuse and neglect have been linked with increased risks of adverse mental health outcomes in adulthood and may moderate or predict response to depression treatment. In a small randomized controlled trial treating depression in a diverse sample of nontreatment-seeking, pregnant, low-income women, we hypothesized that childhood trauma exposure would moderate changes in symptoms and functioning over time for women assigned to usual care (UC), but not to brief interpersonal psychotherapy (IPT-B) followed by maintenance IPT. Second, we predicted that trauma exposure would be negatively associated with treatment response over time and at the two follow-up time points for women within UC, but not for those within IPT-B who were expected to show remission in depression severity and other outcomes, regardless of trauma exposure. METHODS Fifty-three pregnant low-income women were randomly assigned to IPT-B (n = 25) or UC (n = 28). Inclusion criteria included ≥ 18 years, >12 on the Edinburgh Postnatal Depression Scale, 10-32 weeks gestation, English speaking, and access to a phone. Participants were evaluated for childhood trauma, depressive symptoms/diagnoses, anxiety symptoms, social functioning, and interpersonal problems. RESULTS Regression and mixed effects repeated measures analyses revealed that trauma exposure did not moderate changes in symptoms and functioning over time for women in UC versus IPT-B. Analyses of covariance showed that within the IPT-B group, women with more versus less trauma exposure had greater depression severity and poorer outcomes at 3-month postbaseline. At 6-month postpartum, they had outcomes indicating remission in depression and functioning, but also had more residual depressive symptoms than those with less trauma exposure. CONCLUSIONS Childhood trauma did not predict poorer outcomes in the IPT-B group at 6-month postpartum, as it did at 3-month postbaseline, suggesting that IPT including maintenance sessions is a reasonable approach to treating depression in this population. Since women with more trauma exposure had more residual depressive symptoms at 6-month postpartum, they might require longer maintenance treatment to prevent depressive relapse.
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Affiliation(s)
- Nancy K. Grote
- School of Social Work, University of Washington, Seattle, WA,Correspondence to: Nancy K. Grote, School of Social Work, University of Washington, Campus Box 354900, 4101 15th Ave. East, Seattle, WA 98105.
| | | | - Mary Jane Lohr
- School of Social Work, University of Washington, Seattle, WA
| | - Sharon L. Geibel
- Office of Child Development, University of Pittsburgh, Pittsburgh, PA
| | - Holly A. Swartz
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Ellen Frank
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Patricia R. Houck
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Wayne Katon
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA
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Conner KO, Copeland VC, Grote NK, Rosen D, Albert S, McMurray ML, Reynolds CF, Brown C, Koeske G. Barriers to treatment and culturally endorsed coping strategies among depressed African-American older adults. Aging Ment Health 2010; 14:971-83. [PMID: 21069603 PMCID: PMC3060025 DOI: 10.1080/13607863.2010.501061] [Citation(s) in RCA: 79] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE Older adults are particularly vulnerable to the effects of depression, however, they are less likely to seek and engage in mental health treatment. African-American older adults are even less likely than their White counterparts to seek and engage in mental health treatment. This qualitative study examined the experience of being depressed among African-American elders and their perceptions of barriers confronted when contemplating seeking mental health services. In addition, we examined how coping strategies are utilized by African-American elders who choose not to seek professional mental health services. METHOD A total of 37 interviews were conducted with African-American elders endorsing at least mild symptoms of depression. Interviews were audiotaped and subsequently transcribed. Content analysis was utilized to analyze the qualitative data. RESULTS Thematic analysis of the interviews with African-American older adults is presented within three areas: (1) Beliefs about Depression Among Older African-Americans; (2) Barriers to Seeking Treatment for Older African-Americans; and (3) Cultural Coping Strategies for Depressed African-American Older Adults. CONCLUSION Older African-Americans in this study identified a number of experiences living in the Black community that impacted their treatment seeking attitudes and behaviors, which led to identification and utilization of more culturally endorsed coping strategies to deal with their depression. Findings from this study provide a greater understanding of the stigma associated with having a mental illness and its influence on attitudes toward mental health services.
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Affiliation(s)
- Kyaien O. Conner
- Department of Psychiatry, School of Medicine, Western Psychiatric Institute and Clinic, University of Pittsburgh, Pittsburgh, PA 15213, USA, Corresponding author.
| | | | - Nancy K. Grote
- Department of Psychiatry and School of Social Work, University of Washington, Seattle, WA, USA
| | - Daniel Rosen
- School of Social Work, University of Pittsburgh, Pittsburgh, PA, USA
| | - Steve Albert
- Department of Behavioral and Community Health Sciences, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Michelle L. McMurray
- Department of Psychiatry, School of Medicine, Western Psychiatric Institute and Clinic, University of Pittsburgh, Pittsburgh, PA 15213, USA
| | - Charles F. Reynolds
- Department of Psychiatry, School of Medicine, Western Psychiatric Institute and Clinic, University of Pittsburgh, Pittsburgh, PA 15213, USA
| | - Charlotte Brown
- Department of Psychiatry, School of Medicine, Western Psychiatric Institute and Clinic, University of Pittsburgh, Pittsburgh, PA 15213, USA
| | - Gary Koeske
- School of Social Work, University of Pittsburgh, Pittsburgh, PA, USA
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Grote NK, Bridge JA, Gavin AR, Melville JL, Iyengar S, Katon WJ. A meta-analysis of depression during pregnancy and the risk of preterm birth, low birth weight, and intrauterine growth restriction. Arch Gen Psychiatry 2010; 67:1012-24. [PMID: 20921117 PMCID: PMC3025772 DOI: 10.1001/archgenpsychiatry.2010.111] [Citation(s) in RCA: 1164] [Impact Index Per Article: 83.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
CONTEXT Maternal depressive symptoms during pregnancy have been reported in some, but not all, studies to be associated with an increased risk of preterm birth (PTB), low birth weight (LBW), and intrauterine growth restriction (IUGR). OBJECTIVE To estimate the risk of PTB, LBW, and IUGR associated with antenatal depression. DATA SOURCES AND STUDY SELECTION We searched for English-language and non-English-language articles via the MEDLINE, PsycINFO, CINAHL, Social Work Abstracts, Social Services Abstracts, and Dissertation Abstracts International databases (January 1980 through December 2009). We aimed to include prospective studies reporting data on antenatal depression and at least 1 adverse birth outcome: PTB (<37 weeks' gestation), LBW (<2500 g), or IUGR (<10th percentile for gestational age). Of 862 reviewed studies, 29 US-published and non-US-published studies met the selection criteria. DATA EXTRACTION Information was extracted on study characteristics, antenatal depression measurement, and other biopsychosocial risk factors and was reviewed twice to minimize error. DATA SYNTHESIS Pooled relative risks (RRs) for the effect of antenatal depression on each birth outcome were calculated using random-effects methods. In studies of PTB, LBW, and IUGR that used a categorical depression measure, pooled effect sizes were significantly larger (pooled RR [95% confidence interval] = 1.39 [1.19-1.61], 1.49 [1.25-1.77], and 1.45 [1.05-2.02], respectively) compared with studies that used a continuous depression measure (1.03 [1.00-1.06], 1.04 [0.99-1.09], and 1.02 [1.00-1.04], respectively). The estimates of risk for categorically defined antenatal depression and PTB and LBW remained significant when the trim-and-fill procedure was used to correct for publication bias. The risk of LBW associated with antenatal depression was significantly larger in developing countries (RR = 2.05; 95% confidence interval, 1.43-2.93) compared with the United States (RR = 1.10; 95% confidence interval, 1.01-1.21) or European social democracies (RR = 1.16; 95% confidence interval, 0.92-1.47). Categorically defined antenatal depression tended to be associated with an increased risk of PTB among women of lower socioeconomic status in the United States. CONCLUSIONS Women with depression during pregnancy are at increased risk for PTB and LBW, although the magnitude of the effect varies as a function of depression measurement, country location, and US socioeconomic status. An important implication of these findings is that antenatal depression should be identified through universal screening and treated.
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Conner KO, Copeland VC, Grote NK, Koeske G, Rosen D, Reynolds CF, Brown C. Mental health treatment seeking among older adults with depression: the impact of stigma and race. Am J Geriatr Psychiatry 2010; 18:531-43. [PMID: 20220602 PMCID: PMC2875324 DOI: 10.1097/jgp.0b013e3181cc0366] [Citation(s) in RCA: 288] [Impact Index Per Article: 20.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Stigma associated with mental illness continues to be a significant barrier to help seeking, leading to negative attitudes about mental health treatment and deterring individuals who need services from seeking care. This study examined the impact of public stigma (negative attitudes held by the public) and internalized stigma (negative attitudes held by stigmatized individuals about themselves) on racial differences in treatment-seeking attitudes and behaviors among older adults with depression. METHOD Random digit dialing was utilized to identify a representative sample of 248 African American and white older adults (older than 60 years) with depression (symptoms assessed by the Patient Health Questionnaire-9). Telephone-based surveys were conducted to assess their treatment-seeking attitudes and behaviors and the factors that impacted these behaviors. RESULTS Depressed older adult participants endorsed a high level of public stigma and were not likely to be currently engaged in or did they intend to seek mental health treatment. Results also suggested that African American older adults were more likely to internalize stigma and endorsed less positive attitudes toward seeking mental health treatment than their white counterparts. Multiple regression analysis indicated that internalized stigma partially mediated the relationship between race and attitudes toward treatment. CONCLUSION Stigma associated with having a mental illness has a negative influence on attitudes and intentions toward seeking mental health services among older adults with depression, particularly African American elders. Interventions to target internalized stigma are needed to help engage this population in psychosocial mental health treatments.
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Affiliation(s)
- Kyaien O Conner
- Department of Psychiatry, School of Medicine, University of Pittsburgh, PA, USA.
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Grote NK, Swartz HA, Geibel SL, Zuckoff A, Houck PR, Frank E. A randomized controlled trial of culturally relevant, brief interpersonal psychotherapy for perinatal depression. Psychiatr Serv 2009. [PMID: 19252043 DOI: 10.1176/appi.ps.60.3.313] [Citation(s) in RCA: 92] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Depression during pregnancy is one of the strongest predictors of postpartum depression, which, in turn, has deleterious, lasting effects on infant and child well-being and on the mother's and father's mental health. The primary question guiding this randomized controlled trial was, Does culturally relevant, enhanced brief interpersonal psychotherapy (IPT-B) confer greater advantages to low-income, pregnant women than those that accrue from enhanced usual care in treating depression in this population? Enhanced IPT-B is a multicomponent model of care designed to treat antenatal depression and consists of an engagement session, followed by eight acute IPT-B sessions before the birth and maintenance IPT up to six months postpartum. IPT-B was specifically enhanced to make it culturally relevant to socioeconomically disadvantaged women. METHODS Fifty-three non-treatment-seeking, pregnant African-American and white patients receiving prenatal services in a large, urban obstetrics and gynecology clinic and meeting criteria for depression on the Edinburgh Postnatal Depression Scale (score >12 on a scale of 0 to 30) were randomly assigned to receive either enhanced IPT-B (N=25) or enhanced usual care (N=28), both of which were delivered in the clinic. Participants were assessed before and after treatment on depression diagnoses, depressive symptoms, and social functioning. RESULTS Intent-to-treat analyses showed that participants in enhanced IPT-B, compared with those in enhanced usual care, displayed significant reductions in depression diagnoses and depressive symptoms before childbirth (three months postbaseline) and at six months postpartum and showed significant improvements in social functioning at six months postpartum. CONCLUSIONS Findings suggest that enhanced IPT-B ameliorates depression during pregnancy and prevents depressive relapse and improves social functioning up to six months postpartum.
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Affiliation(s)
- Nancy K Grote
- School of Social Work, University of Washington, Seattle, WA 98105, USA.
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Grote NK, Swartz HA, Geibel SL, Zuckoff A, Houck PR, Frank E. A randomized controlled trial of culturally relevant, brief interpersonal psychotherapy for perinatal depression. Psychiatr Serv 2009; 60:313-21. [PMID: 19252043 PMCID: PMC3032494 DOI: 10.1176/ps.2009.60.3.313] [Citation(s) in RCA: 124] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Depression during pregnancy is one of the strongest predictors of postpartum depression, which, in turn, has deleterious, lasting effects on infant and child well-being and on the mother's and father's mental health. The primary question guiding this randomized controlled trial was, Does culturally relevant, enhanced brief interpersonal psychotherapy (IPT-B) confer greater advantages to low-income, pregnant women than those that accrue from enhanced usual care in treating depression in this population? Enhanced IPT-B is a multicomponent model of care designed to treat antenatal depression and consists of an engagement session, followed by eight acute IPT-B sessions before the birth and maintenance IPT up to six months postpartum. IPT-B was specifically enhanced to make it culturally relevant to socioeconomically disadvantaged women. METHODS Fifty-three non-treatment-seeking, pregnant African-American and white patients receiving prenatal services in a large, urban obstetrics and gynecology clinic and meeting criteria for depression on the Edinburgh Postnatal Depression Scale (score >12 on a scale of 0 to 30) were randomly assigned to receive either enhanced IPT-B (N=25) or enhanced usual care (N=28), both of which were delivered in the clinic. Participants were assessed before and after treatment on depression diagnoses, depressive symptoms, and social functioning. RESULTS Intent-to-treat analyses showed that participants in enhanced IPT-B, compared with those in enhanced usual care, displayed significant reductions in depression diagnoses and depressive symptoms before childbirth (three months postbaseline) and at six months postpartum and showed significant improvements in social functioning at six months postpartum. CONCLUSIONS Findings suggest that enhanced IPT-B ameliorates depression during pregnancy and prevents depressive relapse and improves social functioning up to six months postpartum.
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Affiliation(s)
- Nancy K Grote
- School of Social Work, University of Washington, Seattle, WA 98105, USA.
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Abstract
Evidence-based practice (EBP) has become a hot topic in clinical social work and other mental health disciplines. Mental health professionals have called attention to the need for clinical decision-making to be based on the best available empirically supported treatments integrated with client preferences, values, and circumstances. This movement has greatly stimulated mental health professionals to develop, test, and adopt efficacious treatments for clients with psychological problems, but what is missing in the literature is the cultural context in which these treatments must be implemented to be effective with racial/ethnic minority populations. Herein, we utilize the culturally centered framework of Bernal, Bonilla and Bellido (1995) to examine its utility in assessing to what extent empirically supported mental health treatments incorporate culturally relevant components.
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Affiliation(s)
- Kyaien O Conner
- Post-doctoral scholar at the University of Pittsburgh, School of Medicine in the Department of Geriatric Psychiatry
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Swartz HA, Frank E, Zuckoff A, Cyranowski JM, Houck PR, Cheng Y, Fleming MD, Grote NK, Brent DA, Shear MK. Brief interpersonal psychotherapy for depressed mothers whose children are receiving psychiatric treatment. Am J Psychiatry 2008; 165:1155-62. [PMID: 18558645 PMCID: PMC2757752 DOI: 10.1176/appi.ajp.2008.07081339] [Citation(s) in RCA: 117] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Depressed mothers of children with psychiatric illness struggle with both their own psychiatric disorder and the demands of caring for ill children. When maternal depression remains untreated, mothers suffer, and psychiatric illness in their offspring is less likely to improve. This randomized, controlled trial compared the interpersonal psychotherapy for depressed mothers (IPT-MOMS), a nine-session intervention based on standard interpersonal psychotherapy, to treatment as usual for depressed mothers with psychiatrically ill offspring. METHOD Forty-seven mothers meeting DSM-IV criteria for major depression were recruited from a pediatric mental health clinic where their school-age children were receiving psychiatric treatment and randomly assigned to IPT-MOMS (N=26) or treatment as usual (N=21). Mother-child pairs were assessed at three time points: baseline, 3-month follow-up, and 9-month follow-up. Child treatment was not determined by the study. RESULTS Compared to subjects assigned to treatment as usual, subjects assigned to IPT-MOMS showed significantly lower levels of depression symptoms, as measured by the Hamilton Depression Rating Scale, and higher levels of functioning, as measured by the Global Assessment of Functioning, at 3-month and 9-month follow-ups. Compared to the offspring of mothers receiving treatment as usual, the offspring of mothers assigned to IPT-MOMS showed significantly lower levels of depression as measured by the Children's Depressive Inventory at the 9-month follow-up. CONCLUSIONS Assignment to IPT-MOMS was associated with reduced levels of maternal symptoms and improved functioning at the 3- and 9-month follow-ups compared to treatment as usual. Maternal improvement preceded improvement in offspring, suggesting that maternal changes may mediate child outcomes.
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Grote NK, Zuckoff A, Swartz H, Bledsoe SE, Geibel S. Engaging women who are depressed and economically disadvantaged in mental health treatment. Soc Work 2007; 52:295-308. [PMID: 18232240 PMCID: PMC3025777 DOI: 10.1093/sw/52.4.295] [Citation(s) in RCA: 76] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
Women disadvantaged by poverty, as well as racial or ethnic minority status, are more likely to experience depression than the rest of the U.S. population. At the same time, they are less likely to seek or remain in treatment for depression in traditional mental health settings. This article explores a therapeutic, psychosocial engagement strategy developed to address the barriers to treatment engagement and the application of this strategy to a special population--women of color and white women who are depressed and living on low incomes. The conceptual foundations of this intervention-ethnographic and motivational interviewing--as well as its key techniques and structure are reviewed. Finally, a case example description and promising pilot data demonstrate the usefulness of this strategy.
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Affiliation(s)
- Nancy K Grote
- School of Social Work, University of Pittsburgh, PA 15260, USA.
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Grote NK, Bledsoe SE. Predicting postpartum depressive symptoms in new mothers: the role of optimism and stress frequency during pregnancy. Health Soc Work 2007; 32:107-18. [PMID: 17571644 DOI: 10.1093/hsw/32.2.107] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
During the transition to motherhood, women typically show favorable psychological adjustment after the first child is born, whereas 10 percent to 26 percent of women are at risk of developing clinically significant postpartum depressive symptoms. Little is known about which individuals are especially protected against the emergence of postpartum depressive symptoms during this time. Using a "risk and resilience" theoretical framework, we expected that optimism during pregnancy would be associated with less postpartum depression severity, controlling for antenatal depressive symptoms. We also predicted that optimism would buffer the relations between four dimensions of stress frequency during pregnancy (financial, spousal, physical, and occupational) and the development of postpartum depressive symptoms. Using data from three panels of a longitudinal study of married couples across the transition to first parenthood, we found that optimism of expectant mothers during pregnancy was associated with decreased depression severity at six months and 12 months postpartum. The data also showed that when women experienced high frequencies of financial, spousal, and physical stress during pregnancy, those who were optimistic were much less at risk of developing clinically significant depressive symptoms at six months and 12 months postpartum compared with those who were pessimistic. Implications for enhancing optimism across the transition to motherhood through culturally relevant social work practice are discussed.
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Affiliation(s)
- Nancy K Grote
- School of Social Work, University of Pittsburgh, PA 15260, USA.
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Grote NK, Bledsoe SE, Wellman J, Brown C. Depression in African American and White women with low incomes: the role of chronic stress. Soc Work Public Health 2007; 23:59-88. [PMID: 19306588 DOI: 10.1080/19371910802148511] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
The current study examined the links between frequency and severity of acute and chronic stress, on the one hand, and depressive symptoms, on the other hand, in a racially balanced sample of African American and White women with low incomes. We predicted and found that severity of chronic stress accounted for more of the variance in depressive symptoms than did severity of acute stress and that severity of chronic stress amplified the effects of the severity of acute stress on depressive symptoms. Results also showed that African American women tended to have a greater number of depressive symptoms than White women, controlling for income, possibly because they experienced a greater number of chronic stressors than did White women, a condition that rendered them more vulnerable to psychological distress.
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Affiliation(s)
- Nancy K Grote
- School of Social Work, University of Washington, 4101 15th Avenue NE, 354900, Seattle, WA 98105-6299, USA.
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Swartz HA, Zuckoff A, Grote NK, Spielvogle HN, Bledsoe SE, Shear MK, Frank E. Engaging depressed patients in psychotherapy: Integrating techniques from motivational interviewing and ethnographic interviewing to improve treatment participation. ACTA ACUST UNITED AC 2007. [DOI: 10.1037/0735-7028.38.4.430] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Abstract
During the transition to parenthood, perceived imbalances in family work typically increase. Little is known, however, about which individuals are especially prone to perceive unfairness in the division of family work during this time. Using data from a longitudinal study of married couples expecting their first child and controlling for marital distress and other relevant variables, we observed that when husbands were psychologically distressed, both they and their wives were subsequently more likely to perceive unfairness to wives in the division of family work. No analogous significant and prospective effects of wives' levels of distress on their own or their husbands' perceptions of unfairness were found. We also found that once wives perceived the amount of child care they did as unfair, both they and their husbands were later more likely to experience psychological distress, controlling for marital distress and other relevant variables.
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Affiliation(s)
- Nancy K Grote
- School of Social Work, University of Pittsburgh, Pittsburgh, PA 15260, USA.
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Abstract
In this review, we examine several special psychosocial contexts, including pregnancy and motherhood, that may seriously interfere with depressed patients' ability or willingness to engage and remain in treatment for their depression. We also explore the kinds of often-unrecognized subsyndromal comorbidities, such as panic-agoraphobic spectrum, that may complicate conventional treatments for depression or prevent depressed patients from remaining engaged long enough to fully benefit from treatment. We argue that psychotherapy can play a crucial role in addressing the special psychosocial contexts and the kinds of comorbidities experienced by the patient with difficult-to-treat depression. For difficult-to-treat depression during pregnancy and motherhood, preliminary data from several studies suggest that 8-24 sessions of weekly interpersonal psychotherapy (IPT), often followed by monthly maintenance IPT, is a promising long-term treatment for both middle- and low-income women. For difficult-to-treat depression with panic-agoraphobic subsyndromal features, preliminary results suggest that an integrated treatment approach, combining IPT for depression and cognitive-behavioral treatment for coexisting symptoms of panic, leads to higher depression response rates. These data imply that tailoring treatments to patients' specific needs and circumstances may be the real key to making depression less difficult to treat.
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Affiliation(s)
- Nancy K Grote
- Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh, Pittsburgh, Pennsylvania 15213, USA
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Grote NK, Naylor KE, Clark MS. Perceiving the division of family work to be unfair: do social comparisons, enjoyment, and competence matter? J Fam Psychol 2002; 16:510-522. [PMID: 12561295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
Past research has revealed that women, working or not, perform more family labor (i.e., housework and child care) than do men. Yet, women often do not perceive this as unfair. Drawing on the theoretical work of L. Thompson (1991) and B. Major (1993), the authors hypothesized that this paradox might be explained by women perceiving greater fairness in the lopsided division of family work (a) when they compare the amount of family work they do with other women (who perform similar amounts) rather than with the spouse; (b) when they enjoy performing family work; and/or (c) when they and their spouses believe that they are especially competent at family work. Data from a 3-panel, longitudinal study of married couples expecting their first child were consistent with the second and third predictions but not the first. Further, prospective analyses suggested that perceiving inequity in family work leads wives and husbands to make more frequent comparisons with the spouse and sometimes with same-sex others.
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Affiliation(s)
- Nancy K Grote
- School of Social Work, University of Pittsburgh, Pittsburgh, Pennsylvania 15260, USA
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Grote NK, Clark MS. "Perceiving unfairness in the family: Cause or consequence of marital distress?": Correction to Grote and Clark (2001). J Pers Soc Psychol 2001. [DOI: 10.1037/h0087888] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Abstract
This research tests a model suggesting that marital distress leads individuals to scrutinize what is given and received in the relationship. This scrutiny elicits perceptions of unfairness that maintain or exacerbate marital distress. In a 3-panel longitudinal study tracking married couples across the transition to parenthood, both wives' and husbands' reports of marital conflict and wives' marital dissatisfaction at Time 1 positively predicted perceived unfairness of the allocation of household tasks at Time 2, controlling for earlier perceptions of unfairness. In addition, there was evidence of perceived unfairness of division of labor at Time 2 predicting marital conflict and marital dissatisfaction for wives at Time 3, controlling for earlier conflict and dissatisfaction. This model of relationship distress and perceptions of unfairness is contrasted with prior interpretations of links between perceived injustice and distress in relationships.
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Affiliation(s)
- N K Grote
- School of Social Work, Center for Mental Health Services Research, University of Pittsburgh, Pennsylvania 15260, USA.
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Grote NK, Frieze IH, Schmidt LC. Political Attitudes and the Vietnam War: A Study of College-Educated Men of the Vietnam Generation1. J Appl Social Pyschol 1997. [DOI: 10.1111/j.1559-1816.1997.tb01619.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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