Reducing depression among mothers in a residential treatment setting: building evidence for the PST4PPD intervention

ABSTRACT

Objective

The prevalence of postpartum depression (PPD) nearly doubles among low-income mothers in the United States compared to the general population. Problem Solving Therapy (PST) is an effective treatment for populations of low-income women and more accessible than costly, long term interventions. This study aimed to assess the feasibility of implementing a problem-solving-focused intervention originally designed for home visits. Method: This study was conducted in a residential treatment facility (RTF). A chemical dependency counselor delivered the 5-session intervention named “PST4PPD”. A one-group pretest/posttest design was adopted. The standardized tools: Edinburgh Postnatal Depression Scale (EPDS) and Patient Health Questionnaire (PHQ-9) were used to assess depressive symptoms. The New General Self-Efficacy Scale (NGSE) was used to measure self-efficacy. Results: Among the 41 eligible women, 90% (n = 37) completed the intervention. The research found statistically significant decreases in depression (EPDS t(36) = 6.70, p <.001; PHQ-9 t(36) = 4.67, p <.001) and increases in self-efficacy (NGSE t(36) = ?2.41, p =.02). Conclusions: This pilot study finds positive results and feasibility of “PST4PPD”, a community-based, affordable intervention to lower symptoms of postpartum depression. Recommendations for future research and practice, including suggestions for engaging and retaining low-income mothers in PPD interventions, are discussed.     

Acculturative Stress and Depressive Symptoms Among Korean Immigrant Elders Residing in Non-Korean Ethnic Enclaves

This cross-sectional structured survey examined the relationships of personal factors, acculturative stress, and depressive symptoms among Korean immigrant elders (N = 108) residing in areas without any Korean ethnic enclave. Multiple regression and path analyses indicated that personal factors such as levels of acculturation and socioeconomic status might influence acculturative stress and depressive symptoms negatively; however, acculturative stress was the most significant risk factor for depressive symptoms. Culturally relevant programs and services are important vehicles through which to enhance personal resources and reduce lingual and cultural barriers among Korean immigrant elders residing in non-Korean ethnic enclaves.     

Predictors of suicidal ideation among college students: A prospective cohort study

ABSTRACT

This prospective cohort study investigated longitudinal predictors of suicidal ideation among college students. A non-clinical cohort of college students (N = 171) completed baseline and 3-month follow-up surveys. Depressive symptoms, worst-point suicidal ideation, and suicide attempt history significantly predicted follow-up suicidal ideation severity after adjusting covariates. Similarly, depressive symptoms and worst-point suicidal ideation (but not attempt history) were significant predictors of follow-up suicidal ideation intensity in an adjusted model. The results suggest that current depressive symptoms and lifetime worst-point suicidal ideation are independently valuable constructs that may provide relatively short-term predictive information when screening for suicidal ideation among college students.     

Racial/ethnic differences in body weight perception among U.S. college students

Objective: To examine racial/ethnic differences in weight perception by sex among U.S. college students. Participants: a national sample (N = 70,267) of college students selected from 2- and 4-year postsecondary institutions (N = 62) during the Fall semester from 2011 to 2014. Methods: This is a secondary data analysis using 4 years of American College Health Association-National College Health Assessment IIb data. Sex-stratified multinomial logistic regression was performed to investigate racial/ethnic differences in body weight perception. Results: Compared with non-Hispanic whites, non-Hispanic black men and women were more likely to underestimate their body weight (p < .01). Asian men and women were more likely to overestimate their body weight than non-Hispanic whites (p < .001). Conclusions: Weight-related interventions should take into account racial/ethnic differences in body weight perception.     

Does Nursing Home Ownership Change Affect Family Ratings on Experience with Care?

Person-centeredness may suffer in nursing homes (NHs) with recent ownership changes. This study identifies associations between ownership change and reported care experiences, important measures of person-centered care for long-term residents in Maryland NHs. Care experience measures and ownership change data were collected from Maryland Health Care Commission reports, which reported data on 220 Maryland NHs from 2011 and 2012. Facility and market covariates were obtained from 2011 NH Compare and Area Health Resource Files. Linear regression was used to examine whether ownership change in 2011 was associated with lower care experience ratings reported during April to June 2012. Dependent variables were overall care rating (scale 1–10), percentage of respondents answering that they would recommend the NH, and assessments of five care and resident life domains (scale 1–4). Care experiences reported in 2012 were high; however, after controlling for covariates, ownership change was associated with significant decreases in 6 out of 7 measures, including a 0.39-point decrease in overall care rating (p = .001). NH managers and policy makers should consider strategies to improve patient-centeredness after ownership change.     

Family Functioning and Mental Health of Transgender and Gender-Nonconforming Youth in the Trans Teen and Family Narratives Project

Transgender and gender-nonconforming (TGN) youth are at increased risk for adverse mental health outcomes, but better family functioning may be protective. This study describes TGN youth’s mental health and associations with family functioning in a community-based sample. Participants were from 33 families (96 family members) and included 33 TGN youth, ages 13 to 17 years; 48 cisgender (non-transgender) caregivers; and 15 cisgender siblings. Participants completed a survey with measures of family functioning (family communication, family satisfaction) and mental health of TGN youth (suicidality, self-harm, depression, anxiety, self-esteem, resilience). TGN youth reported a high risk of mental health concerns: suicidality (15% to 30%), self-harm (49%), clinically significant depressive symptoms (61%); and moderate self-esteem (M = 27.55, SD = 7.15) and resiliency (M = 3.67, SD = 0.53). In adjusted models, better family functioning from the TGN youth’s perspective was associated with better mental health outcomes among TGN youth (β ranged from ?0.40 to ?0.65 for self-harm, depressive symptoms, and anxious symptoms, and 0.58 to 0.70 for self-esteem and resiliency). Findings from this study highlight the importance of considering TGN youth’s perspectives on the family to inform interventions to improve family functioning in families with TGN youth.     

A Pilot Study to Evaluate Ethnic/Racial Differences in Depressive Symptoms,Self-Esteem,and Sexual Behaviors Among Men Who Have Sex with Men

Men who have sex with men (MSM) are at risk for certain physical and psychological health conditions. Ethnic minority MSM are at an increased risk related to the combination of sexual minority and ethnic minority status. The purpose of this pilot study was to compare the levels of depressive symptoms, self-esteem, and sexual behaviors by ethnicity in a sample of MSM (N = 70) residing in South Florida. More than one-third of the sample (N = 26; 37%) had high levels of depressive symptoms. Using non-parametric statistics, statistically significant differences were noted in the levels of depressive symptoms as African-American MSM had higher levels of depressive symptoms when compared to the other ethnic groups. Statistically significant differences were not found when self-esteem and sexual behaviors were compared by ethnicity. Regardless of ethnicity, MSM in this study were at risk for the sequela of depressive symptoms and infections with HIV and/or sexually transmitted infections because of the high levels of unsafe sexual behaviors. More research is needed to explore the relationship of mental health and sexual behaviors among the various ethnic groups of MSM.     

Early Age of First Sexual Intercourse and Depressive Symptomatology among Adolescents

Past literature has provided conflicting evidence for the association between adolescent sexual intercourse and depressive symptomatology. Whereas some studies conclude that sexually active youth may be at risk for depression, others provide contrary results. Thus, it is unclear as to whether depression results directly from coitus or if this relationship is explained by other factors—that is, there may be biological, psychological, or sociological predictors of both depressive symptomatology and early sexual intercourse. Using the National Longitudinal Study of Adolescent Health dataset, depressive symptomatology in adolescents over a seven-year time period was analyzed. The final sample (n = 6,510) was comprised of 49.35% male (n = 3,213) and 50.65% female (n = 3,297) participants. Although an earlier age of first coitus was predictive of future depressive symptoms, both variables appear to be concomitant outcomes of the biopsychosocial process. Thus, although one may be able to use early coitus as a marker for subsequent depressive symptomatology, it does not appear to occur because of early sexual intercourse. Furthermore, the reverse relationship was not found to be significant in this study—that is, higher levels of previous depressive symptomatology did not predict an earlier age of first sexual intercourse in adolescents.     

Harassment Due to Gender Nonconformity Mediates the Association Between Sexual Minority Identity and Depressive Symptoms

The visibility of a stigmatized identity is central in determining how individuals experience that identity. Sexual minority status (e.g., identifying as gay, lesbian, or bisexual) has traditionally been identified as a concealable stigma, compared with race/ethnicity or physical disability status. This conceptualization fails to recognize, however, the strong link between sexual minority status and a visible stigma: gender nonconformity. Gender nonconformity, or the perception that an individual fails to conform to gendered norms of behavior and appearance, is strongly stigmatized, and is popularly associated with sexual minority status. The hypothesis that harassment due to gender nonconformity mediates the association between sexual minority status and depressive symptoms was tested. Heterosexual and sexual minority–identified college and university students (N = 251) completed questionnaires regarding their sexual minority identity, experiences of harassment due to gender nonconformity, harassment due to sexual minority status, and depressive symptoms. A mediational model was supported, in which the association between sexual minority identity and depressive symptoms occurred via harassment due to gender nonconformity. Findings highlight harassment due to gender nonconformity as a possible mechanism for exploring variability in depressive symptoms among sexual minorities.     

Cultural,individual, and familial risk and protective factors associated with depressive symptoms in Pacific youth living in New Zealand

ABSTRACT

This article examines cultural, individual, and familial risk and protective factors associated with depressive symptoms in Pacific youth living in New Zealand. At ages 11 (n = 950) and 14 (n = 931), Pacific youth participated in multidisciplinary interviews that included the Children’s Depression Inventory. Across time points, factors significantly associated with higher depressive symptoms were involvement in bullying and gang activities. Positive parenting was significantly associated with lower depressive symptoms, and Tongan youth were significantly less likely to report depressive symptoms than Samoan youth. Time-varying factors were gender, problem behaviour syndromes, and maternal education. Gaining more knowledge about modifiable risk and protective factors that contribute to depression in Pacific youth is an important tool to support new approaches that promote adaptive psychological adjustment during adolescence.     

Grandfriends,an Intergenerational Program for Nursing-Home Residents and Preschoolers: A Randomized Trial

Intergenerational programs may improve meaningful engagement for people with dementia and for attitudes toward older people in youth. Grandfriends, a 12-week program increased passive engagement and enjoyment among nursing home residents when interacting with preschoolers (n = 21) in comparison to usual activities. Grandfriends participants (n = 20) did not show changes on quality of life, agitation, or sense of community in comparison to residents (n = 20) randomized to usual care. Suggestions for future programs are given.     

Do Children With Gender Dysphoria Have Intense/Obsessional Interests?

This study examined whether children clinically referred for gender dysphoria (GD) show increased symptoms of autism spectrum disorder (ASD). Circumscribed preoccupations or intense interests were considered as overlapping symptoms expressed in GD and ASD. In gender-referred children (n = 534; 82.2% male) and their siblings (n = 419; 57.5% male), we examined Items 9 and 66 on the Child Behavior Checklist, which measure obsessions and compulsions, respectively. Non-GD clinic-referred (n = 1,201; 48.5% male) and nonreferred (n = 1,201; 48.5% male) children were also examined. Gender-referred children were elevated compared to all other groups for Item 9, and compared to siblings and nonreferred children for Item 66. A gender-related theme was significantly more common for gender-referred boys than male siblings on Item 9 only. A gender-related theme was not significantly more common for gender-referred girls compared to their female siblings on either item. The findings for Item 9 support the idea that children with GD show an elevation in obsessional interests. For gender-referred boys in particular, gender-related themes constituted more than half of the examples provided by their mothers. Intense/obsessional interests in children with GD may be one of the factors underlying the purported link between GD and ASD.     

Heterogeneity among adolescent mothers and home visiting program outcomes

Despite the challenges of early parenting, many adolescents navigate motherhood successfully, underscoring an overlooked heterogeneity among adolescent mothers. The present study used Latent Class Analysis (LCA) to identify subgroups of adolescent mothers (n = 704) enrolled in a randomized controlled trial (RCT) evaluation of a home visiting program for young parents. The model incorporated demographic and background characteristics, as well as indicators of psychological vulnerability. Analyses revealed four distinct subgroups: (a) non-Hispanic high vulnerability (n = 209, 30%); (b) Hispanic high vulnerability (n = 98, 14%); (c) non-Hispanic moderate vulnerability (n = 241, 34%); and (d) Hispanic moderate vulnerability (n = 156, 22%). Mothers in the two high vulnerability subgroups exhibited the poorest personal and parenting functioning outcomes measured approximately two years postpartum, particularly in terms of child maltreatment (non-Hispanic high vulnerability) and depressive symptoms (Hispanic high vulnerability). Analyses revealed positive effects of the home visiting program within specific latent classes on such outcomes as healthy baby at birth, high school or GED attainment, and repeat birth.     

Controlling Anxiety Mediates the Influence of Childhood Adversities on Risky Sexual Behaviors Among Emerging Adults

Relatively little research has assessed the exposure-response relationship of childhood adversities on engaging in risky sexual behaviors. Also, no previous research has examined the interrelationship among childhood adversities, adult anxiety and depressive symptoms, and risky sexual behaviors. This study aimed to investigate their interrelationships. We used data from a multisite survey of emerging adults aged 18 to 29 studying at four universities in Hong Kong between September and December 2015. Structural equation modeling (SEM) was used to examine the pathways from childhood adversities to risky sexual behaviors. Participants who had higher childhood adversity scores reported more severe adult anxiety symptoms (β = 0.20, p = 0.002); and adult anxiety symptoms were associated with significantly more risky sexual behaviors (β = 0.46, p < 0.0001). The model with adult anxiety symptoms as the mediator between childhood adversities and risky sexual behaviors showed good fit (root mean square error of approximation [RMSEA] = 0.04, comparative fit index [CFI] = 0.96, Tucker-Lewis index [TLI] = 0.94 and standardized root mean square residual [SRMSR] = 0.04). However, adult depressive symptoms failed to mediate between childhood adversities and risky sexual behaviors. This study demonstrates the link between childhood adversities and risky sexual behaviors via adult anxiety but not adult depressive symptoms. It is essential to reduce anxious symptoms in dealing with emerging adults who have risky sexual behaviors to prevent sexually transmitted infections (STIs) and unintended pregnancy.     

Minority ethnicity,social status and Uyghur community involvement in urban Xinjiang

Using a dataset (n = 4,012) from a 2001 survey in Xinjiang, I examine the effect of minority status and social status on neighbouring behaviour in urban China. Data analysis indicates that Uyghur Muslims are more neighbouring than Han Chinese. However, there is no evidence that the Uyghur approach to neighbourhood interaction can be attributed to Uyghur culture as many inter-group differences fade away once ethnic parity in social status is attained. I use my study to consider some methodological approaches used in research on ethnic behaviour in China.     

Is Ethnic Identity a Buffer? Exploring the Relations Between Racial Microaggressions and Depressive Symptoms Among Asian-American Individuals

ABSTRACT

This study explores the moderating role of ethnic identity in the relations between racial microaggressions and depressive symptoms. Using survey data from 353 Asian-American college students, we found that racial microaggressions significantly predicted depressive symptoms and accounted for 24% of the variance in a hierarchical multiple regression analysis. In addition, ethnic identity moderated the relations between racial microaggressions and depressive symptoms. Thus, ethnic identity buffers Asian-Americans against the negative mental health effects of racial microaggressions. Implications for research and practice in the field of social work are discussed.     

Differences in Sexual Orientation Diversity and Sexual Fluidity in Attractions Among Gender Minority Adults in Massachusetts

This study characterized sexual orientation identities and sexual fluidity in attractions in a community-based sample of self-identified transgender and gender-nonconforming adults in Massachusetts. Participants were recruited in 2013 using bimodel methods (online and in person) to complete a one-time, Web-based quantitative survey that included questions about sexual orientation identity and sexual fluidity. Multivariable logistic regression models estimated adjusted risk ratios (aRRs) and 95% confidence intervals (95% CIs) to examine the correlates of self-reported changes in attractions ever in lifetime among the whole sample (n = 452) and after transition among those who reported social gender transition (n = 205). The sample endorsed diverse sexual orientation identities: 42.7% queer, 19.0% other nonbinary, 15.7% bisexual, 12.2% straight, and 10.4% gay/lesbian. Overall, 58.2% reported having experienced changes in sexual attractions in their lifetime. In adjusted models, trans masculine individuals were more likely than trans feminine individuals to report sexual fluidity in their lifetime (aRR = 1.69; 95% CI = 1.34, 2.12). Among those who transitioned, 64.6% reported a change in attractions posttransition, and trans masculine individuals were less likely than trans feminine individuals to report sexual fluidity (aRR = 0.44; 95% CI = 0.28, 0.69). Heterogeneity of sexual orientation identities and sexual fluidity in attractions are the norm rather than the exception among gender minority people.     

Mental Health Treatment Barriers Among Racial/Ethnic Minority Versus White Young Adults 6 Months After Intake at a College Counseling Center

Abstract

Objective: This study examined mental health treatment barriers following intake at a counseling center among racially/ethnically diverse college students. Methods: College students (N = 122) seen for intake at a college counseling center in 2012–2013 completed self-reports of depressive symptoms, suicidal ideation, and mental health treatment barriers 6 months later. Results: Racial/ethnic minority students less often reported previous mental health treatment and treatment after being seen at the counseling center, compared with white students. They also endorsed more treatment barriers—most commonly, financial concerns and lack of time—and more often endorsed stigma-related concerns. Treatment barriers were associated with not following through with counseling center recommendations and with greater depressive symptom severity but not with suicidal ideation during follow-up. Conclusions: Improving mental health treatment seeking among racial/ethnic minority college students should involve decreasing treatment barriers, improving access to affordable options, providing flexible scheduling or time-limited options, and decreasing stigma.,     

“Gay Equals White”? Racial,Ethnic, and Sexual Identities and Attitudes Toward LGBT Individuals Among College Students at a Bible Belt University

While past research has certainly explored a variety of correlates of attitudes toward lesbian, gay, bisexual, and transgender (LGBT) individuals, the current study is among the first in an emerging line of inquiry that examines attitudes toward each of these groups separately utilizing an intersectional framework with special attention to racial, ethnic, and sexual identities. Using a college sample of students from the Bible Belt of the United States (N = 1,940), I investigated the roles of racial and ethnic identities (Caucasian/White, African American/Black, Asian/Pacific Islander, Native American/Alaskan Native, other race, and Hispanic/Latinx), religiosity, patriarchal gender norms, parental perspectives, and the intersections among these identities and experiences as they relate to attitudes toward LGBT individuals among heterosexual (n = 1,551) and LGB respondents (n = 389). This moves beyond explorations of White heterosexual people’s attitudes about “homosexuals” (i.e., away from a focus only on gayness and Whiteness) and expands to include non-White LGB people’s LGBT attitudes. Overall, results indicate that racial, ethnic, and sexual identities play a significant role in southern college students’ LGBT attitudes, and these patterns are further complicated by interacting cultural experiences with religiosity, patriarchy, and family dynamics. Campus policy and program implications are provided.     

Comparing the efficacy of electronic-tablet to paper-based surveys for on-site survey administration

This study compares cost, completion times, and percent completion of electronic tablet (n = 244) to paper-based (n = 398) questionnaires administered to participants of scenic raft trips on the Snake River, Grand Teton National Park. We hypothesized e-tablet questionnaires would (1) cost less (2) be completed faster and (3) be completely filled more frequently than paper-based questionnaires. Our survey resulted in a greater per unit cost of e-tablet compared to paper-based questionnaires ($4.17 and $1.80, respectively). Although e-tablets were completed faster (230 [±66] s) than paper questionnaires (235 [±57] s), the difference was not significant (t₍₆₄₁₎ = 1.97, p = 0.39). E-tablets were filled completely more frequently than paper questionnaires (80% vs. 51%, respectively; χ² = 3.84, p < 0.01). We suggest that for multi-year projects with a sample size target of ≥100, and length ≥ 5 pages, e-tablets are more cost effective and efficient than paper-based surveys.