Maternal role strain and depressive symptoms among female sex workers in Mexico: the moderating role of sex work venue

ABSTRACT

Stressors that arise in parenting are likely to have an adverse impact on the psychological well-being of female sex workers (FSWs), particularly in low- to middle-income countries (LMIC). This study examined the association between maternal role strain and depressive symptoms among 426 FSW mothers with dependent-age children (aged < 18 years) in Tijuana and Cd. Juarez, Mexico (2016–2017). Four dimensions of maternal role strain (e.g., child emotional and behavioral problems) were examined in relation to maternal depressive symptoms. We also investigated whether the relationship between maternal role strain and depressive symptoms was modified by venue of sex work. Compared to indoor/establishment-based FSWs, street-based FSWs reported significantly more child-related financial strain. In multiple regression analysis, having more depressive symptoms was associated with identifying as a street-based FSW, greater use of drugs, lower emotional support, more child-related financial strain and more emotional and behavioral problems in children. A significant interaction was identified such that the association between maternal role strain and depressive symptoms was stronger for indoor/establishment-based compared to street-based FSWs. These findings suggest the need to address parenting strain and type of sex work venue in the development of counseling programs to improve the mental health of FSWs in LMIC.     

Health-Related Quality of Life in Adolescents With Inflammatory Bowel Disease: The Relation of Parent and Adolescent Depressive Symptoms

Adolescents with IBD are at risk for depressive symptoms and lower HRQOL. The association of adolescent and parent depressive symptoms with adolescent HRQOL is examined while controlling for disease activity. Adolescents (N = 86) and their caregivers completed measures of depressive symptoms. Adolescents completed an IBD-specific HRQOL measure. Parent depression significantly moderated the relation between adolescent-reported depressive symptoms and HRQOL. HRQOL decreased as adolescent depressive symptoms increased. This relation was only significant among adolescents with parents reporting higher depressive symptoms. Adolescent depressive symptoms are associated with lower HRQOL. The presence of parent depressive symptoms intensifies this relation.     

Depressive Symptoms and Neurocognitive Performance Among HIV-Infected Women

The aims of this article were to explore the relationship between depressive symptoms and neuropsychological performance in a sample of HIV-infected women, and to examine the contribution of demographic, HIV-related variables, and depressive symptoms to neurocognitive performance. In this cross-sectional study, a sample of 103 HIV-infected women, recruited from February to December 2010, were assessed for depressive symptoms (with the Beck Depression Inventory) and neurocognitive performance (with the HIV Dementia Scale). Severe depressive symptoms were reported by 31.1% of the women. Findings indicated that severe levels of depressive symptoms were significantly associated with reduced cognitive functioning in HIV-infected women, particularly in domains of attention, psychomotor speed, and construction. Older age and low education level were significantly associated with neurocognitive impairment in univariate analyses. In the multivariate model, only depressive symptoms were significantly related to neurocognitive impairment. Compared to participants with none/minimal depressive symptoms, those with moderate and severe depressive symptoms had odds ratios for neurocognitive impairment of 5.03 (95% CI, 1.33–18.99) and 3.22 (95% CI, 1.15–9.06), respectively. These findings support continued investigation of the presence of neurocognitive impairment, particularly among women, and may help mental health providers with early detection, planning, and implementation of more effective interventions.     

Spouse and Adult-Child Dementia Caregivers in Chinese American Families: Who Are More Stressed Out?

ObjectivesThough many studies have explored differences between spouses and adult children in dementia care, empirical evidence is lacking on racial- and ethnic-minority populations. To fill this research gap, this study examined care tasks, caregiver burden, and depressive symptoms of Chinese spouse and adult-child caregivers in dementia care. Guided by the stress process model, this study asked 3 questions: Do spouse and adult-child caregivers take up different care tasks and experience different levels of caregiver burden and depressive symptoms? Does gender moderate the differences between spouse and adult-child caregivers? Whether care tasks and burden mediate the association between being a spouse/adult-child caregiver and depressive symptoms?Setting and ParticipantsData were collected from a questionnaire-based survey of Chinese Americans who provided care for their family members with dementia in New York City. The analytical sample included 126 Chinese spouse or adult-child caregivers.MethodsCare tasks was indicated by intensity of 8 types of care tasks. Caregiver burden and depressive symptoms were measured by Zarit's Burden Interview and the 10-item Center for Epidemiologic Studies Depression Scale. Linear regression, interaction term (spouse/adult-child caregiver by gender), and path analysis were conducted to address the 3 questions.ResultsThe results of linear regression show no significant difference in care tasks between the 2 groups, but spouse caregivers had significantly higher levels of caregiver burden and depressive symptoms than adult children. Wives had higher levels of caregiver burden and depressive symptoms than husbands, daughters, and sons. Caregiver burden mediated the association between being a spouse caregiver and higher depressive symptoms, whereas care tasks did not shape such association.Conclusions and ImplicationsThis study highlighted the emotional stress of Chinese American older adults in providing care for their spouses. The findings indicate the necessity of developing culturally meaningful activities to support Chinese American spouse caregivers.     

Risk Factors Associated with the Development of Tuberculosis Among HIV-Infected Patients in Khartoum in 2010

BackgroundTuberculosis (TB) screening among patients infected with Human Immunodeficiency Virus (HIV) is one of the approaches for controlling TB-HIV co-infection. The absence of typical TB symptoms among HIV-infected patients makes diagnosis challenging. Identifying predisposing risk factors of TB among HIV-infected patients could possibly guide TB diagnosis and treatment. This study was designed to identify some important factors associated with TB among HIV-infected patients and to quantify the strength of this association.MethodologyIn 2010, a case control study was conducted in Khartoum State, Sudan. Cases and controls were selected by simple random sampling with a 1:2 ratio; 97 cases and 194 controls were enrolled in the study. A logistic regression model was built to estimate and quantify the strength of the association between the study variables and the outcome; a p-value less than 0.05 was considered the cut-off point for a significant statistical association.ResultsPast history of TB, CD4 count < 200 cells/µl, late clinical stages, non-employment, and no formal education were found to be risk factors for developing TB among HIV-infected patients. The adjusted ORs and 95% CIs were (6.9: 3.75–12.99), (4.8: 1.57–15.26), (5.8: 1.88-17.96), (2.5: 1.26–5.03), and (2.5: 1.28–4.63), respectively. Poor adherence, marital status, age, and gender are not associated with developing TB among HIV patients.ConclusionHIV patients who have at least one of the risk factors found in this analysis are at higher risk of TB; therefore, they should be screened more frequently and treated promptly, especially HIV patients with previous TB.     

HIV discrimination and the health of women living with HIV

Women living with HIV are especially vulnerable to discrimination because of the stigma associated with the disease, as well as their race, gender and class status. To investigate the association between self-reported HIV discrimination and health outcomes among African- American and white women living with HIV, 366 women living with HIV were recruited from HIV/AIDS clinics in Georgia and Alabama. In this cross-sectional study, participants completed an interview that assessed self-reported HIV discrimination and depressive symptomatology, suicidal ideation, self-esteem, stress, quality of life, sexual health and HIV/AIDS related health care seeking. Nearly a sixth of the sample reported experiencing HIV discrimination. Women reporting HIV discrimination had higher mean scores for stress, suicidal ideation, depressive symptoms, number of unprotected sexual episodes; they had lower mean scores for self-esteem, and quality of life, and were more likely to have not sought medical care for HIV/AIDS. In race-specific analyses, none of the relationships between HIV discrimination and health outcomes were significant for white women. African-American women who reported HIV discrimination had higher mean scores for stress, suicidal ideation, depressive symptoms, number of unprotected sexual episodes; they had lower mean scores for self-esteem, and quality of life, and were more likely not to have sought medical care for HIV/AIDS. The findings indicated that HIV discrimination adversely affects women's mental, sexual and physical health. However, separate race-specific analyses indicated that compared to white women, African-American women were markedly more likely to experience the adverse affects of HIV discrimination. Eradication of HIV discrimination remains an important public health priority.     

HIV Discrimination and the Health of Women Living with HIV

ABSTRACT

Women living with HIV are especially vulnerable to discrimination because of the stigma associated with the disease, as well as their race, gender and class status. To investigate the association between self-reported HIV discrimination and health outcomes among African-American and white women living with HIV, 366 women living with HIV were recruited from HIV/AIDS clinics in Georgia and Alabama. In this cross-sectional study, participants completed an interview that assessed self-reported HIV discrimination and depressive symptomatology, suicidal ideation, self-esteem, stress, quality of life, sexual health and HIV/AIDS related health care seeking. Nearly a sixth of the sample reported experiencing HIV discrimination. Women reporting HIV discrimination had higher mean scores for stress, suicidal ideation, depressive symptoms, number of unprotected sexual episodes; they had lower mean scores for self-esteem, and quality of life, and were more likely to have not sought medical care for HIV/AIDS. In race-specific analyses, none of the relationships between HIV discrimination and health outcomes were significant for white women. African-American women who reported HIV discrimination had higher mean scores for stress, suicidal ideation, depressive symptoms, number of unprotected sexual episodes; they had lower mean scores for self-esteem, and quality of life, and were more likely not to have sought medical care for HIV/AIDS. The findings indicated that HIV discrimination adversely affects women's mental, sexual and physical health. However, separate race-specific analyses indicated that compared to white women, African-American women were markedly more likely to experience the adverse affects of HIV discrimination. Eradication of HIV discrimination remains an important public health priority.     

Racial Differences in Perinatal Depression among HIV-infected Women

BackgroundPerinatal depression may further complicate the health of women with human immunodeficiency virus (HIV) infection. Diagnosis and subsequent treatment of depressive symptoms may significantly improve the health of mother and newborn.ObjectiveWe sought to examine the association between race and perinatal depression among a sample of low-income women with HIV infection.MethodsThis retrospective cohort study used data from a multi-state Medicaid administrative claims database to study HIV-infected perinatal women between 2003 and 2007. Multivariate regression analysis was used to study the objective.ResultsThe overall prevalence of perinatal depression in the sample (n = 650) was 27.8%. Black women had significantly lower odds of experiencing perinatal depression (odds ratio 0.328; 95% confidence interval 0.225-0.479) compared with non-black women. Non-black women showed significantly higher comorbidity severity scores than black women (0.356 vs. 0.220, P = .035).ConclusionsThis study found that non-black women may be more vulnerable to perinatal depression. Improved health care provider vigilance for depressive symptoms among low-income, HIV-infected women of all races during the perinatal period is warranted.     

103例癌症患者照料者抑郁症状的影响因素研究

目的通过测量癌症患者照料者的抑郁症状水平,以了解照料者的心理健康状况,探讨照料者抑郁症状的影响因素,为改善其心理健康状况提供依据。方法以流调用抑郁自评CES-D量表为测量工具,采用横断面调查方便抽样的方法,面对面结构化访谈收集调查问卷,对癌症患者家属的主要照料者的抑郁症状进行测量。结果癌症患者照料者中抑郁症状的发生率为47.57%。年龄、婚姻状况和照料者的关系对抑郁症状有显著性影响,健康影响是抑郁症状的危险因素,而睡眠时间和心理一致感是抑郁症状的保护性因素。结论癌症患者照料者抑郁症状的发生率较高,改善措施应当针对减轻护理工作量建立轮流护理的补偿机制以及增强照料者应对能力等措施。     

Associations between employment and financial and parental stress in low-income single black mothers.

Using a sample of 188 low-income single black mothers (93 employed and 95 nonemployed), this study investigated financial strain, maternal depressive affect, and parenting stress among former welfare recipients who are now working, and current welfare recipients who are not employed. The findings suggested that being employed did not reduce financial strain, as the two groups reported similar levels of strain. However, regression analyses indicated that not being employed was associated with reporting higher levels of stress. Parenting stress was also associated with attaining less education, having boys, reporting more financial strain and depressive affect. Correlates of maternal depressive affect were mother's education and financial strain. Interaction effects were found for employment by financial strain, indicating that higher levels of depressive affect were related to more financial strain among nonemployed mothers. The findings suggest that although employment is associated with better mental health for poor mothers, entry into the workforce is associated with stronger links between financial strain, parenting stress and depressive affect for mothers leaving welfare.     

Prevalence and predictors of depressive symptoms among caregivers of children with attention-deficit/hyperactivity disorder attending a tertiary care facility: a cross-sectional analytical study from Muscat,Oman

ABSTRACT

A number of studies suggested that the rates of depression in Euro-American populations are higher among caregivers of children with attention-deficit/hyperactivity disorder (ADHD) than typically developing children. There is a dearth of studies in this field among non-Western populations. This study attempts to explore the depressive symptoms’ prevalence and predictors among a systematic random sample of caregivers of children with a diagnosis of ADHD who sought consultation from a child and adolescent mental health services unit in Muscat. The prevalence and predictors of depressive symptoms were quantified using the Patient Health Questionnaire-9. Results showed that depressive symptoms are common among caregivers of children with ADHD in Oman. A binary regression analysis revealed that low income, being the only caregiver in the family and hyperactive/impulsive and combined types of ADHD were significant predictors of depression.     

Child behaviour and parenting in HIV/AIDS-affected families in China

Human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS) among families in China poses many challenges for caregivers and their children. A total of 154 caregivers of HIV/AIDS-affected children were interviewed to examine child behaviour in HIV/AIDS-affected families. Parenting skills were found to be correlated with child delinquency, and this correlation was influenced by the number of children in the family and the child's age. Illiterate caregivers were more likely to have delinquent children, and parenting skills had less of an association with child delinquency among illiterate caregivers. Study findings underscore the necessity of emphasizing good parenting skills in interventions with caregivers of HIV/AIDS-affected children in China in order to improve child behaviour and overall family well-being.     

Examining the relationship of social support and family cohesion on ART adherence among HIV-positive adolescents in southern Uganda: baseline findings

Several studies in sub-Saharan Africa have linked social support to better ART (antiretroviral therapy) adherence among adults living with HIV. Less is known about the role of social support and family cohesion in ART adherence among children below 18 years. This paper focuses on HIV-infected adolescents as they transition through the vulnerable developmental stage of adolescence to examine the association between family cohesion and social support, and ART adherence in southern Uganda. We utilized baseline data from Suubi+Adherence study, a five-year randomized longitudinal clinical trial with the overall goal of examining the impact and cost associated with an innovative asset-based social intervention to increase adherence to HIV treatment for HIV-infected adolescents in Uganda. This study employed self-reports to measure social support, family cohesion and ART adherence to treatment from 702 participants in 39 clinics situated in southern Uganda. Regression results indicated that after adjusting for socio-demographic characteristics that family cohesion and social support from caregivers/family were associated with self-reported adherence to ART among HIV-infected adolescents. Social support from classmates, teachers, and friends were not associated with ART adherence. Study results suggest that strengthening family relationships and promoting social support within families caring for adolescents living with HIV can be crucial in addressing ART adherence challenges among adolescents in sub-Saharan Africa.     

Psychosocial Functioning and Depressive Symptoms Among HIV-Positive Persons Receiving Care and Treatment in Kenya,Namibia, and Tanzania

In sub-Saharan Africa, the prevalence of depressive symptoms among people living with HIV (PLHIV) is considerably greater than that among members of the general population. It is particularly important to treat depressive symptoms among PLHIV because they have been associated with poorer HIV care-related outcomes. This study describes overall psychosocial functioning and factors associated with depressive symptoms among PLHIV attending HIV care and treatment clinics in Kenya, Namibia, and Tanzania. Eighteen HIV care and treatment clinics (six per country) enrolled approximately 200 HIV-positive patients (for a total of 3,538 participants) and collected data on patients’ physical and mental well-being, medical/health status, and psychosocial functioning. Although the majority of participants did not report clinically significant depressive symptoms (72 %), 28 % reported mild to severe depressive symptoms, with 12 % reporting severe depressive symptoms. Regression models indicated that greater levels of depressive symptoms were associated with: (1) being female, (2) younger age, (3) not being completely adherent to HIV medications, (4) likely dependence on alcohol, (5) disclosure to three or more people (versus one person), (6) experiences of recent violence, (7) less social support, and (8) poorer physical functioning. Participants from Kenya and Namibia reported greater depressive symptoms than those from Tanzania. Approximately 28 % of PLHIV reported clinically significant depressive symptoms. The scale-up of care and treatment services in sub-Saharan Africa provides an opportunity to address psychosocial and mental health needs for PLHIV as part of comprehensive care.     

Associations Between Employment and Financial and Parental Stress in Low-Income Single Black Mothers

SUMMARY

Using a sample of 188 low-income single black mothers (93 employed and 95 nonemployed), this study investigated financial strain, maternal depressive affect, and parenting stress among former welfare recipients who are now working, and current welfare recipients who are not employed. The findings suggested that being employed did not reduce financial strain, as the two groups reported similar levels of strain. However, regression analyses indicated that not being employed was associated with reporting higher levels of stress. Parenting stresswas also associated with attaining less education, having boys, reporting more financial strain and depressive affect. Correlates of maternal depressive affect were mother's education and financial strain. Interaction effects were found for employment by financial strain, indicating that higher levels of depressive affect were related to more financial strain among nonemployed mothers. The findings suggest that although employment is associated with better mental health for poor mothers, entry into the workforce is associated with stronger links between financial strain, parenting stress and depressive affect for mothers leaving welfare.     

Changes in symptoms and health-related quality of life in a nationally representative sample of adults in treatment for HIV

Patient-centered measures of functioning and well-being are needed to monitor and improve health for HIV-infected persons. We estimated the associations between HRQOL and symptoms over time in HIV-infected persons, adjusting for demographic and clinical characteristics using a longitudinal study of a nationally representative cohort of 2267 patients in care for HIV infection surveyed in 1996 and again in 1998. We used two global measures of HRQOL (overall health and overall quality of life) scored to have a mean of 50 and standard deviation of 10 in the sample. The total number of symptoms decreased (−1.29, p<0.001 for the difference), and overall health (1.09, p<0.001 for the difference) and overall quality of life (1.31, p<0.001 for the difference) improved over the period. Controlling for baseline symptoms and HRQOL, each additional symptom at follow-up (B=−1.14, p<0.001) was associated with worsened overall health and worsened overall quality of life (B=−0.95, p<0.001). The association of two additional symptoms with lower global HRQOL was similar in magnitude to the effect of having significant depressive symptoms or the diagnosis of AIDS. In conclusion, among HIV-infected patients, symptoms are significantly related to HRQOL over time. The functioning and well-being of patients with HIV is inextricably linked to the symptoms they experience.     

Family, religion, and depressive symptoms in caregivers of disabled elderly

STUDY OBJECTIVE: To explain the variations in depressive symptomatology among primary caregivers of community dwelling activities of daily living disabled elderly and to evaluate the role of family and religiosity on the mental health consequences of caregiving in Spain. DESIGN: Cross sectional study. SETTING: City of Leganés in the metropolitan area of Madrid, Spain. PARTICIPANTS: All caregivers of a representative sample of community dwelling activities of daily living disabled persons, aged 65 and over were approached. The response rate was 85% (n = 194). Depression was assessed by the Center for Epidemiologic Studies Depression (CES-D) Scale. MAIN RESULTS: Controlling for caregivers' income, education, health status, and caregiving stress, religiosity was associated with more depressive symptoms among children caregivers while for spouses the association was negative. Emotional support was negatively associated with depression, but instrumental support was not significant. CONCLUSIONS: Depressive symptomatology is frequent among Spanish caregivers of disabled elderly. This study concludes that religiosity and family emotional support play an important part in the mental health of Spanish caregivers. The role of religiosity may be different according to kinship tie and needs further investigation.     

Body Mass Index,Depression, and Condom Use Among HIV-Infected Men who have Sex with Men: A Longitudinal Moderation Analysis

Findings have been inconsistent regarding the association of obesity and sexual risk behaviors. The purpose of the current study was to assess the prospective nature of body mass index (BMI), depression, and their interaction in predicting condom use during anal intercourse among HIV-infected men who have sex with men (MSM). The sample (N = 490) was obtained from a large, HIV clinical cohort from four sites across the U.S. The following inclusion criteria were employed: identification as MSM and had completed at least one wave of patient-reported measures (e.g., depression, as measured by the PHQ-9) in the clinical cohort study. Longitudinal linear mixed-effects modeling revealed a significant BMI by depression interaction. Depressive symptoms were predictive of less frequent condom use for obese but not overweight men. Analogous results were found in regard to comparisons between normal weight and overweight men. Obesity, in the context of depression, is a risk factor for unprotected anal intercourse among HIV-infected MSM. Cognitive behavioral interventions to reduce HIV transmission risk behaviors among HIV-infected MSM should adopt an integrated perspective, combining sexual risk reduction with treatment for depression and body-related concerns.     

The role of spirituality in sustaining the psychological well-being of HIV-positive black women

Historically, spirituality has been an instrumental component to the survival of Black women. In an era when the HIV epidemic disproportionately compromises their health, it is imperative to explore spirituality's role in sustaining the psychological health of Black women living with HIV. This study examined the relationship between spirituality and self-reported depression among Black women living with HIV. A sample of 308 HIV-positive Black women were recruited from HIV/ AIDS clinics in the Southeastern United States. Participants completed an interview assessing demographics, quality of life, depression, coping, and spirituality. A hierarchical multiple regression was used to determine the association between spirituality and depression. The results suggest that in our sample, spirituality accounted for a small, yet significant proportion of variance in reducing depressive symptoms, above and beyond variance accounted for by demographic variables and other theoretically important psychosocial factors. In light of these findings, future studies with HIV-positive Black women should assess spirituality as a salient factor affecting psychological health. Developing interventions that address spirituality may serve to enhance women's psychological adjustment to living with HIV.