Women's status and child well-being: a state-level analysis

We conducted an ecologic analysis of the relation between women's status and child well-being in the 50 United States. State-level women's status was assessed via four composite indices: women's political participation, economic autonomy, employment and earnings, and reproductive rights. Child well-being was measured via five outcomes: percentage of low birthweight babies, infant mortality, teen mortality, high school dropout rate, and teen birth rate. Higher state-level women's status on all indicators was associated with significantly better state-level child well-being in unadjusted analyses. Several associations remained significant after adjusting for income inequality and state racial composition. Women's political participation was associated with a significantly lower percentage of low birthweight babies (p<.001) and lower teen birth rates (p<.05). Women's employment and earnings was associated with lower infant mortality (p<.05) and teen birth rates (p<.05). More economic and social autonomy for women was associated with better child outcomes on all measures (p<.01 all). Greater reproductive rights were associated with significantly lower infant mortality (p<.01). We conclude that child well-being is worse in states where women have lower political, economic, and social status. Women's status is an important aspect of children's social context which may impact their well-being. Multi-level analyses of the association between state-level women's status and child well-being are needed.     

Women's status and the health of women and men: a view from the States

We examined the status of women in the 50 American states in relation to women's and men's levels of health. The status of women in each state was assessed by four composite indices measuring women's political participation, economic autonomy, employment and earnings, and reproductive rights. The study design was cross-sectional and ecologic. Our main outcome measures were total female and male mortality rates, female cause-specific death rates and mean days of activity limitations reported by women during the previous month. Measures of women's status were strikingly correlated with each of these health outcomes at the state level. Higher political participation by women was correlated with lower female mortality rates (r = -0.51), as well as lower activity limitations (-0.47). A smaller wage gap between women and men was associated with lower female mortality rates (-0.30) and lower activity limitations (-0.31) (all correlations, P < 0.05). Indices of women's status were also strongly correlated with male mortality rates, suggesting that women's status may reflect more general underlying structural processes associated with material deprivation and income inequality. However, the indices of women's status persisted in predicting female mortality and morbidity rates after adjusting for income inequality, poverty rates and median household income. Associations were observed for specific causes of death, including stroke, cervical cancer and homicide. We conclude that women experience higher mortality and morbidity in states where they have lower levels of political participation and economic autonomy. Living in such states has detrimental consequences for the health of men as well. Gender inequality and truncated opportunities for women may be one of the pathways by which the maldistribution of income adversely affects the health of women.     

Longitudinal Study of Depressive Symptoms and Health-Related Quality of Life During Pregnancy and After Delivery: The Health Status in Pregnancy (HIP) Study

Objective Depressive symptoms are known to affect functioning in early pregnancy. We estimated the effect of a change in depressive symptoms status on health-related quality of life (HRQoL) throughout pregnancy and after delivery. Methods Longitudinal study of 200 women. The independent variable was depressive symptoms, defined as a Center for Epidemiologic Studies Depression (CES-D) score of ≥16. The dependent variable was HRQoL from 8 domains of the Medical Outcomes Study (SF-36) Short Form. Women were categorized based on the change in CES-D score: (1) never depressed, (2) became well, (3) became depressed and (4) always depressed. A random effects model was used to (1) estimate the effect of a change in depressive symptomatology from the first to the second trimester on HRQOL in the second trimester and (2) estimate the change in depressive symptomatology from the second to the third trimester on HRQoL in the third trimester and after delivery, adjusting for covariates. Intra-individual correlations were accounted for using generalized estimating equations (GEE). Results The proportion of women with depressive symptoms was 15%, 14%, and 30% in the first, second and third trimesters, respectively, and 9% after delivery. Women who became depressed had scores in the social domains that were 10–23 points and 19–31 points lower in the second and third trimesters, respectively, compared to women with no depressive symptoms. Women who became well had scores that were 3–31 points lower, compared to women with no depressive symptoms. Conclusions Alterations in depressive symptomatology have a substantial effect on functioning during pregnancy and after delivery. This paper was presented, in part, at the 134th Annual Meeting of the American Public Health Association, Boston, MA on November 8, 2006.     

Determinants of depressive symptoms in the early weeks after miscarriage.

OBJECTIVES. We tested whether and under what conditions miscarriage increases depressive symptoms in the early weeks following loss. METHODS. We interviewed 232 women within 4 weeks of miscarriage and 283 pregnant women and 318 community women who had not recently been pregnant. Depressive symptoms were measured with the Center for Epidemiologic Studies Depression (CES-D) Scale. RESULTS. Among women who had miscarried, the proportion who were highly symptomatic on the CES-D was 3.4 times that of pregnant women and 4.3 times that of community women. Among childless women, the proportion of women who had miscarried who were highly symptomatic was 5.7 times that of pregnant women and 11.0 times that of community women. Women who had miscarried were equally depressed regardless of length of gestation; among pregnant women, depressive symptoms declined with length of gestation. Among women who had miscarried, symptom levels did not vary with attitude toward the pregnancy; among pregnant women, depressive symptoms were elevated in those with unwanted pregnancies. Prior reproductive loss and advanced maternal age (35+ years) were not associated with symptom levels in any cohort. CONCLUSIONS. Depressive symptoms are markedly increased in the early weeks following miscarriage. This effect is substantially modified by number of living children, length of gestation at loss, and attitude toward pregnancy.     

Body mass, depressive symptoms and menopausal status: an examination of the "Jolly Fat" hypothesis.

PURPOSE: Estrogens are linked with depression due to their ability to alter the function of the serotonin neural systems. We hypothesize that postmenopausal women should have a higher degree of depressive symptoms than premenopausal women. Further, because estrogen levels in postmenopausal women positively correlate with body fat, we hypothesize that there is an inverse relationship between body fat and depressive symptoms among postmenopausal women. METHODS: We enrolled 1156 Polish urban women aged 45 to 64 in a cross-sectional study. Depressive symptoms were assessed by the Center for Epidemiologic Studies-Depression Scale (CES-D) scale. Menopausal status and education level was assessed by a standardized questionnaire. MAIN FINDINGS: Postmenopausal women had higher mean CES-D scores of depressive symptoms than premenopausal women (14.4 versus 13.2 respectively, p = .018). Both among pre- and postmenopausal women, those with higher education had lower scores of depressive symptoms. In addition, in postmenopausal women with lower education an inverse relationship was observed between body mass index (BMI) and depressive symptoms: a higher BMI was associated with a lower score of depressive symptoms (p = .009). Such a relationship was not present among premenopausal women or women who were postmenopausal but better educated. CONCLUSIONS: This study indicates that menopausal status is related to differences in the degree of occurrence of depressive symptoms. Our results support the "Jolly Fat" hypothesis for postmenopausal women with lower education, namely, a higher BMI is associated with lower score of depressive symptoms.     

Women’s Autonomy and Unintended Pregnancy Among Currently Pregnant Women in Bangladesh

This paper examines the net effect of women's autonomy on their pregnancy intention status among currently pregnant Bangladeshi women. This study is based on data from the Bangladesh Demographic Health Survey, 2007 (BDHS). A subset of interviews from currently pregnant women (718) were extracted from 10,146 married women of reproductive age. The BDHS 2007 used a pre-tested, structured questionnaire to collect sociodemographic, women's empowerment, and pregnancy information. Associations between unintended pregnancy and explanatory variables were assessed using bivariate analysis. Logistic regression was used to assess the net effect of women's autonomy on current pregnancy intention status after controlling for other variables. Results indicate that women's autonomy is a significant predictor of unintended pregnancy after adjusting for other factors. A unit increase in the autonomy scale decreases the odds of unintended pregnancy by 16%. Besides autonomy, our results also indicate that current age, number of children ever born, age at marriage, religion, media access, and contraceptive use exert strong influences over unintended pregnancy. Women who have ever used contraceptives are 82% more likely to classify their current pregnancies as unintended compared with women who are non-users of contraceptives. Improvement in women's autonomy and effective and efficient use of contraceptives may reduce unintended pregnancies as well as improve reproductive health outcomes.     

Impact of a Health Promotion Intervention on Maternal Depressive Symptoms at 15?months Postpartum

Given that diet, physical activity, and social support are associated with depression, we examined whether a health promotion intervention designed to modify these factors in low-income, postpartum women would reduce depressive symptoms. This study used a randomized, controlled design to examine the effect of the Just for You (JFY) Program, an educational intervention promoting healthy lifestyles through home visits by nutrition paraprofessionals and motivational telephone counseling, on postpartum depressive symptoms. A total of 679 women income-eligible for the Special Supplemental Nutrition Program for Women, Infants and Children (WIC) were recruited at 6-20 weeks post delivery and randomized to Usual WIC Care or JFY. Using an intention-to-treat analysis, the authors modeled depressive symptoms on the Center for Epidemiologic Studies Depression Scale (CES-D) among 403 women (59%) completing follow-up at a mean of 15 months infant age, adjusting for baseline CES-D, age, household income and randomization strata (body mass index (BMI), race/region). As a secondary analysis, the authors evaluated potential mediators related to social support and self-efficacy to change one or more health behaviors targeted by the intervention. Women randomized to JFY reported 2.5 units lower CES-D score (P = 0.046) compared with those receiving Usual WIC Care alone. This relationship was attenuated by change in self-efficacy (β = −2.3; P = 0.065), suggesting this construct may partially have mediated the effect of JFY on maternal depressive symptoms. A health promotion intervention delivered through home visits and telephone calls can reduce depressive symptoms at 15 months postpartum among low-income, ethnically diverse women.     

Long-Term Effects of Chronic Depressive Symptoms Among Low-Income Childrearing Mothers

Objectives: Longitudinal studies of maternal depression in the postpartum period have demonstrated that a chronic state of depressive symptoms is not rare. In spite of this, however, the characteristics of chronically depressed mothers have rarely been studied. This study examines the demographic and socioenvironmental characteristics across time of childrearing women with chronic depressive symptoms. Methods: A cohort of 476 childrearing lower-income mothers was interviewed from the first trimester of pregnancy through the tenth year postpartum. The Center for Epidemiologic Studies-Depression Scale (CES-D; Radloff, L. (1977) Appl Psychol Meas 1:385–401) was used to define depressive symptomatology. Four groups were defined based on the CES-D scores at 18 months, 3, 6 and 10 years: never-depressed (CES-D < 16), depressed only at one phase (CES-D ≥ 16), chronically mildly depressed (CES-D > 16 and ≤24 at three or more phases), and chronically severely depressed (CES-D ≥ 25 at three or more times). Demographic and socioenvironmental characteristics of the groups were evaluated across time. Results: Chronically depressed women compared to never-depressed women were less likely to be married, had less education, had lower family income, and were more likely to use substances. They reported more frequent arguments with close family members or friends, separation/divorce with partners, financial problems, less social support, and more financial strain. Conclusions: Women who continue to be depressed across the 10 postpartum years have less optimal outcomes compared to women who are not depressed and those who are only intermittently depressed. Pregnancy and delivery and subsequent pediatric visits are important times to identify women who are depressed.     

Low-income rural women and depression: factors associated with self-reporting

OBJECTIVE: To examine factors associated with self-reporting depression for low-income rural women experiencing depressive symptoms. METHODS: Data were from 219 Rural Families Speak participants with CES-D scores >15. Chi-square and multiple logistic regression were utilized. RESULTS: Just over one half (52.5%) of respondents who were experiencing depressive symptoms self-reported depression, whereas 47.5% of respondents self-reported no depression. Women reporting depression were significantly likelier to report physical health problems, injury/illness, and more frequent physician visits. Women reporting no depression were significantly likelier to have been pregnant in the previous 3 years. CONCLUSIONS: Women reporting depression had more health care system exposure and perhaps depressive symptomotology knowledge. Public health campaigns should educate about depressive symptoms, including postpartum depression, to reduce stigma and increase treatment-seeking.     

Depressive Symptoms in Young Women of the Piedmont

ABSTRACT. Depression rates in women are twice that of men In certain groups of women depression exceeds 40 percent. These groups include urban, poor, young mothers, and women who use primary health care facilities. We hypothesized that rates of depressive symptoms in rural women users of primary care would exceed those reported in population studies. Depressive symptoms were expected to be associated with common risk factors for depression. To test these hypotheses, 181 rural women, ages 18 to 52, were interviewed by telephone using the Center for Epidemiologic Studies Depression Scale (CES-D). Of these, 41.4 percent reported depressive symptoms exceeding the cutoff score of 16 on the CES-D. The mean CES-D score for the entire sample was 15.3 and was 27.6 for women scoring over 16 on the CES-D. Young, unemployed and poorly educated women were most likely to report depressive symptoms.     

Racial disparities in elevated prenatal depressive symptoms among black and white women in eastern north Carolina

PURPOSE: Black women have an increased risk for preterm birth compared with white women, and prior research indicated that maternal prenatal depressive symptoms are associated with increased risk for preterm outcomes among black women. Race-related differences in prenatal depression could be of etiologic significance in understanding racial disparities in preterm birth. Our study focused on Center for Epidemiologic Studies' Depression Scale (CES-D) scores of pregnant black and white women. METHODS: Women were administered the CES-D at the time of their first visit to hospital-based prenatal clinics. Two cutoff scores for the CES-D were used: 16 or higher, which indicates "significant" depressive symptoms, and 23 or higher, which indicates major depressive disorder. RESULTS: For the sample of 1163 women, mean CES-D scores were significantly higher among black (17.4) than white (13.7) women. Of black women, 49% had CES-D scores higher than 15 compared with 33.5% of white women. Also, 27.5% of black women had scores higher than 22 compared with 16% of white women. After adjustment for maternal age, marital status, and education, odds ratios for race for both CES-D cutoff scores were approximately 1.5. CONCLUSIONS: Results of this study indicate that black women have greater rates of prenatal depression than white women.     

Intimate Partner Violence/Abuse and Depressive Symptoms among Female Health Care Workers: Longitudinal Findings

Intimate partner violence and abuse (IPV/A) have been shown to have a major impact on mental health functioning. This study assessed the longitudinal association between recent IPV/A and depressive symptoms to identify potential targets for preventive interventions for women. Random effects models were used to examine four waves of data collected at 6-month intervals from a cohort of 1,438 female health care workers. IPV/A (e.g., sexual and physical violence, psychological abuse) in the past 5 years was associated with higher Center for Epidemiologic Studies Depression Scale (CES-D) 10 scores across four waves after adjustment for age, time, marital status, and childhood trauma. Women who reported IPV/A in the past 5 years had higher CES-D 10 scores (β, 1.31; 95% confidence interval, 0.79–1.82; p < .0001) than nonabused women. This association was generally constant with time, suggestive of a cross-sectional association across all four waves of data. Additionally, recent IPV/A was associated with change in depressive symptoms over time among the full cohort and those with CES-D 10 scores below 10 (the threshold for likely depression) at baseline. Recent IPV/A was independently associated with depressive symptoms both cross-sectionally and longitudinally. The longitudinal association was stronger among those not depressed at baseline. Implications for health care settings and workplace policies addressing IPV/A are discussed.     

Demographic characteristics, menopausal status, and depression in midlife immigrant women

The purpose of this cross-sectional analysis is to examine symptoms of depressed mood in relation to age, menopausal status, and length of residence in the United States in midlife women who are recent immigrants from the former Soviet Union. Data for this analysis are from a longitudinal study of the impact of acculturation on postimmigration health status and psychological well-being. The mean score for the Center for Epidemiological Studies-Depression (CES-D) scale was 23.56, with 77.3% of the women obtaining a score greater than the usual screening cutoff score for referral. Women taking antidepressant medications had a mean score of 30.52. CES-D scores varied significantly by age group. The lowest CES-D scores were reported by women aged 40-50, and women aged 55-60 had significantly higher scores than younger women and those over 65 years old. Total CES-D scores did not vary significantly by length of residence in United States or use of hormone therapy. Regression analysis indicated that even when use of antidepressant medication was held constant, age and residence in the United States were significant independent contributors to CES-D score: women who were older, had lived fewer years in the United States, and those who took antidepressants had higher CES-D scores. Cultural and immigration-related explanations for high scores on the depression scale are suggested.     

Convergence and divergence in spouses' perspectives on women's autonomy in rural India

This study explores similarities and differences in the perceptions of rural Indian women and their husbands with regard to various dimensions of women's autonomy and investigates the extent to which various reproductive outcomes--contraception, unmet need, recent fertility, and spousal communication--are influenced by individual partners' views of women's autonomy. Data are drawn from a 1993-94 community-based study of women's autonomy in Uttar Pradesh and Tamil Nadu, states that are, respectively, more and less patriarchal. Matched data were obtained from 1,660 women and their husbands. Results indicate no more than a loose agreement between women and their husbands concerning the dimensions of women's autonomy within the home. Where disagreement is expressed, husbands are more likely to project a comparatively liberal picture of their wives' autonomy than do their wives, and the inference can be made that in surveys men tended to provide more "acceptable" responses than when they were questioned in greater depth. Findings also suggest that cultural context affects the influences that wives' and their husbands' perceptions of women's autonomy have on reproductive outcomes. A clear regional divide is seen, net of individual and household characteristics, in the influence of almost every aspect of women's autonomy.     

Women's health after pregnancy and child outcomes at age 3 years: a prospective cohort study

OBJECTIVES: This study examined the persistence and comorbidity of women's physical and mental health conditions after pregnancy and the association of these conditions with child outcomes. METHODS: A national cohort of women who recently gave birth were surveyed in 1988 and again in 1991. We examined longitudinal data on maternal poor physical health, depressive symptoms, and smoking, and maternal report of child outcomes (at age approximately 3 years). RESULTS: Women's poor physical health and smoking had strong, graded associations with children's physical health and behavior problems, whereas women's depressive symptoms were associated with children's delayed language and behavior problems. CONCLUSIONS: Substantial persistence and comorbidity of women's health conditions exist after pregnancy with adverse effects on early child outcomes. Child health professionals should support services and policies that promote women's health outside the context of pregnancy.     

Depressive Symptoms Among Reservation-based Pregnant American Indian Adolescents

Objectives To examine rates and correlates of depressive symptoms among pregnant reservation-based American Indian (AI) adolescents from the Southwestern United States (N = 53). Methods Data were derived from a study evaluating a home-visiting program designed to promote positive parenting among young families. Participants included a volunteer, convenience sample of expectant mothers who completed behavioral and mental health self-report questionnaires. Depressive symptoms were assessed using the Center for Epidemiological Studies-Depression scale (CES-D). Three risk domains were analyzed in relation to depressive symptoms: sociodemographics, family relations, and psychosocial functioning. Results Forty-seven percent of expectant mothers scored at or above the widely accepted clinical cutoff score of 16 on the CES-D; 30% scored at or above 20, a score more likely to reflect elevated depressive symptoms among adolescents; and almost 20% scored at or above 28 (one standard deviation above the mean), a score suggestive of clinical depression. Higher levels of depressive symptoms were associated with less use of public assistance, external locus of control, less social support, and lower self-esteem. Conclusions Data suggest that a large proportion of pregnant AI adolescents reported elevated depressive symptoms, though rates are similar to non-pregnant AI adolescent samples.     

Depressive symptoms and their relationship with endogenous reproductive hormones and sporadic anovulation in premenopausal women

PurposeTo determine whether depressive symptoms are associated with ovulation or reproductive hormone concentrations in eumenorrheic women without a reported diagnosis of clinical depression.MethodsA prospective cohort of 248 regularly menstruating women, aged 18 to 44 years (27.3 ± 8.2) were evaluated for depressive symptoms at baseline using the 20-item Center for Epidemiological Studies Depression (CES-D) scale and categorized dichotomously (<16, no depressive symptoms [92%] vs. ≥16, depressive symptoms [8%]). Serum concentrations of estradiol, progesterone, luteinizing hormone, and follicle-stimulating hormone were measured up to eight times per cycle for up to two menstrual cycles. Linear mixed models estimated associations between depressive symptoms and hormone concentrations, whereas generalized linear mixed models assessed their relationship with sporadic anovulation.ResultsNo significant associations were identified between depressive symptoms and reproductive hormone levels (all P > .05) or the odds of sporadic anovulation (adjusted odds ratio, 1.1; 95% confidence interval, [0.02–5.0]), after adjusting for age, race, body mass index, perceived stress level, and alcohol consumption.ConclusionsDespite reported associations between mental health and menstrual cycle dysfunction, depressive symptoms were not associated with reproductive hormone concentrations or sporadic anovulation in this cohort of regularly menstruating women with no recent (within 1 year) self-reported history of clinical depression.     

Common symptoms in middle aged women: their relation to employment status, psychosocial work conditions and social support in a Swedish setting

STUDY OBJECTIVE: Over the past few decades there has been a growing interest among researchers, in women's overall life circumstances and their relation to women's health status. For example, paid employment has been considered an important part of women's living conditions in Western societies as the number of women entering the labour market has grown constantly over the past decades. When comparing men's and women's health, one of the most consistent findings is a higher rate of symptoms among women. The most commonly reported symptoms in women are depressive symptoms, symptoms of bodily tension and chronic pain from muscles and joints. The aim of this study was to investigate whether socioeconomic factors, employment status, psychosocial work conditions and social network/support are associated with middle aged women's health status in terms of common symptoms. DESIGN: A mailed questionnaire was used in a cross sectional design assessing socioeconomic factors, employment status, psychosocial work conditions according to the demand/control model, social network/support and an index based on the 15 most frequent symptoms presented by middle aged women when seeking health care. SETTING: A rural community with 13,200 inhabitants in the western part of Sweden. PARTICIPANTS: Women were randomly selected from the general population in the study area, 40 to 50 years of age. The response rate was 81.7 per cent. MAIN RESULTS: Women who were non-employed had a significantly increased odds of a high level of common symptoms (OR = 2.82; 95% confidence intervals 1.69, 4.70), as well as women exposed to job strain (OR = 3.27; 1.92, 5.57), independently of the level of social network/support. Furthermore, exposure to low social support, low social anchorage or low social participation independently showed significantly increased odds of a high level of common symptoms (OR = 2.75; 1.71, 4.42; OR = 2.91; 1.81, 4.69 and OR = 1.69; 1.10, 2.61, respectively). CONCLUSIONS: Work related factors, such as non-employment and job strain, and circumstances within the private sphere, such as social network/support, seem equally important for middle aged women's health status. These findings ought to have important policy implications and also to be of major importance in a primary health care setting when meeting women who seek health care because of common symptoms.     

Violence against women, symptom reporting, and treatment for reproductive tract infections in Kerala state, Southern India

In this article we examine factors associated with women's self-reports of reproductive ill health symptoms and factors associated with seeking and receiving treatment for the symptoms. We focus on indicators of women's societal position, especially empowerment (indicated by experience of and attitudes toward violence against women), autonomy, and education. We used data from the National Family Health Survey-2 from Kerala state in Southern India. Based on our results we suggest that violence against women, whether actually experienced or internalized as acceptance of its justification, is associated with increased ill health symptoms, and the acceptance of violence is associated with decreased chance of treatment. Women's higher formal education appeared to reduce treatment seeking for reproductive ill health, perhaps due to the stigma associated with sexually transmitted disease (STD) in this cultural setting. Women's work participation had no significant impact, nor did indicators of women's economic and personal autonomy.     

Family Work Demands,Employment Demands and Depressive Symptoms in Women with Rheumatoid Arthritis

The effects of psychological demands, work autonomy and social support on psychological well-being are evaluated in a sample of employed women with rheumatoid arthritis (RA). Two hundred sixty-seven employed women with a diagnosis of RA were recruited from a national random sample of private rheumatology practices. Women were interviewed by telephone and data were obtained on demographic variables, health status, demands in paid and family work, autonomy in paid and family work, social support and depressive symptoms. Women reported relatively high levels of psychological demands in both paid and family work, with time constraints being the most frequent problem Women also had relatively high levels of autonomy in family work. Hierarchical regression analysis showed that family demands appeared to be more important than paid work demands in psychological well-being. High autonomy in family work seemed to mediate the effects of family demands. Having higher social support reduced the effects of work demands on depressive symptoms in employed women with RA.