Multiple domains of stress predict postpartum depressive symptoms in low-income Mexican American women: the moderating effect of social support

Prenatal stress can have a lasting effect on women’s mental health after childbirth. The negative effects may be particularly salient in women from low income and ethnic minority backgrounds, who are at increased risk for postpartum depression. However, social support may have the potential to attenuate the negative impact of stress. The present study evaluated 269 Mexican American women (ages 18–42; 83 % Spanish-speaking; median income $10,000–$15,000) for prenatal stress (daily hassles, family stress, partner stress, and culture-specific stress) in relation to depressive symptoms 6 weeks postpartum. Prenatal social support was examined as a buffer against the impact of prenatal stress. Partner stress, family stress, and daily hassles uniquely predicted depressive symptoms. Moderate and high levels of social support attenuated risk for depression due to family stressors. Prenatal interpersonal and daily stressors negatively impact the mental health of women after birth, but social support can mitigate some of these effects. Among Mexican American pregnant women, effective interpersonal support and stress management may be associated with reduced risk for postpartum depression.     

Cognitive depressive symptoms associated with delayed heart rate recovery following interpersonal stress in healthy men and women

Among cardiac patients, research suggests that somatic depressive symptoms are more strongly associated with altered cardiovascular responses to stress than cognitive depressive symptoms. This study sought to determine whether this was also the case in healthy individuals. One hundred and ninety-nine adults from the community completed the Beck Depression Inventory II (BDI-II) and underwent psychological laboratory stressors while their blood pressure, heart rate, and heart rate variability were monitored. A cognitive-affective factor and somatic-affective factor were identified within the BDI-II, but only the cognitive factor was associated with reduced heart rate recovery following the stressors in multivariate analyses examining both factors simultaneously. This suggests that cognitive depressive symptoms may be more strongly related to altered stress physiology following psychological stressors.     

Self-Reported Health in HIV-Positive African American Women: The Role of Family Stress and Depressive Symptoms

This prospective study examined the association between stressful life events and self-reported health in 72 inner-city, low-income African American women with HIV. Depressive symptoms were examined as a potential mediator of this association. Findings indicated that family stressors predicted deterioration in self-reported health status over the 15-month assessment period. Additionally, the association between family stress and self-reported physical health was mediated by depressive symptoms such that the strength of the association between family stress and self-reported health was no longer statistically significant after depressive symptoms were entered in the model. This study suggests a potentially important target for prevention and intervention efforts aimed at enhancing the quality of life of women with HIV.     

Work stressors,depressive symptoms and sleep quality among US Navy members: a parallel process latent growth modelling approach across deployment

The present study examined whether work stressors contribute to sleep problems and depressive symptoms over the course of deployment (i.e. pre‐deployment, post‐deployment and 6‐month reintegration) among US Navy members. Specifically, we examined whether depressive symptoms or sleep quality mediate the relationships between work stressors and these outcomes. Participants were 101 US Navy members who experienced an 8‐month deployment after Operational Enduring Freedom/Operation Iraqi Freedom. Using piecewise latent growth models, we found that increased work stressors were linked to increased depressive symptoms and decreased sleep quality across all three deployment stages. Further, increases in work stressors from pre‐ to post‐deployment contributed to poorer sleep quality post‐deployment via increasing depressive symptoms. Moreover, sleep quality mediated the association between increases in work stressors and increases in depressive symptoms from pre‐ to post‐deployment. These effects were maintained from post‐deployment through the 6‐month reintegration. Although preliminary, our results suggest that changes in work stressors may have small, but significant implications for both depressive symptoms and quality of sleep over time, and a bi‐directional relationship persists between sleep quality and depression across deployment. Strategies that target both stress and sleep could address both precipitating and perpetuating factors that affect sleep and depressive symptoms.     

Depression and anxiety among postpartum and adoptive mothers

Similar to biological mothers during the postpartum period, women who adopt children experience increased stress and life changes that may put them at risk for developing depression and anxiety. The purpose of the current study was to compare levels of depression and anxiety symptoms between postpartum and adoptive women and, among adoptive women, to examine associations between specific stressors and depressive symptoms. Data from adoptive mothers (n = 147), recruited from Holt International, were compared to existing data from postpartum women (n = 147). Differences in the level of depression and anxiety symptoms as measured by the Inventory of Depression and Anxiety Symptoms among postpartum and adoptive women were examined. Associations between specific stressors and depressive symptoms were examined among adoptive mothers. Postpartum and adoptive women had comparable levels of depressive symptoms, but adoptive women reported greater well-being and less anxiety than postpartum women. Stressors (e.g., sleep deprivation, history of infertility, past psychological disorder, and less marital satisfaction) were all significantly associated with depressive symptoms among adoptive women. The level of depressive symptoms was not significantly different between the two groups. In contrast, adoptive women experienced significantly fewer symptoms of anxiety and experienced greater well-being. Additionally, adoptive mothers experienced more depressive symptoms during the year following adoption when the stressors were present. Thus, women with these characteristics should be routinely screened for depression and anxiety.     

Mastery,Intimacy, and Stress Resistance during War

The relationship between war-related stressors and emotional and behavioral adjustment during the Israel-Lebanon war was studied on a sample of 220 Israeli students, many of whom had been in combat. Mastery had direct effects on the well-being of both sexes. There was limited support for the stress-buffering effect of intimacy for men, such that those who had less intimate ties were increasingly negatively affected by greater exposure to war-related stressors, whereas those with more intimate relationships were relatively unaffected; the buffering effect applied both to emotions and behavior. No stress-buffering effect of intimate ties was found for women, but women were not affected by war-related stress at this time. The diagnosis post-traumatic stress disorder is examined in terms of the fact that normally healthy populations may be at increased risk of long-term adjustment difficulties following exposure to extreme stress if the threat of recurrence of the stressor continues. Implications for Vietnam veterans are also discussed.     

Adjustment of children and their mothers with breast cancer

OBJECTIVE: To examine the adjustment of children of mothers with both active and nonactive breast cancers in comparison with a healthy community control sample. METHODS: Participants included 80 mothers and their children. Half of the mothers had breast cancer or a history of breast cancer. Children in both groups ranged in age from 8 to 19 years. Assessments included measures of maternal stressors and resources, maternal and child adjustment and posttraumatic stress, and maternal coping and illness uncertainty reported by both mothers and their children. RESULTS: Few differences were found between the groups, although there was a trend for girls of mothers with breast cancer to have a higher frequency of depressive symptoms. Children of mothers who perceived support from friends and family had fewer depressive symptoms, after we controlled for child gender. CONCLUSIONS: The social support perceived by mothers with breast cancer may serve as a protective factor for their children's psychological adjustment.     

A longitudinal study of the hopelessness theory of depression: testing the diathesis-stress model within a differential reactivity and exposure framework

A ten-week prospective longitudinal study was conducted to test the diathesis-stress component of the hopelessness theory and to test whether negative attributional style leads to an increased exposure to stressors. Participants completed initial measures of attributional style and depressive symptoms followed by weekly assessments of depressive symptoms and daily hassles. Consistent with the diathesis-stress hypothesis, Hierarchical Linear Modeling revealed that attributional style moderated the impact of daily hassles on depressive symptoms. Negative attributional style predicted greater depressive symptom reactivity in response to stress. The results also indicated that attributional style was not predictive of the number of subsequent daily hassles. Thus, the data were supportive of a differential reactivity to stress model, but not supportive of a differential exposure to stress model. Implications for understanding the mechanisms involved in the hopelessness theory are discussed.     

Depression and sensitization to stressors among young women as a function of childhood adversity

The authors tested a stress-sensitization version of a diathesis-stress approach to depression. In a 2-year longitudinal follow-up design, exposure to stressful life events was examined in young women in the transition to adulthood. The authors hypothesized that those who had experienced one or more significant childhood adversities would have a lower threshold for developing a depressive reaction to stressors. Results indicated that women with exposure to one or more childhood adversities--such as family violence, parent psychopathology or alcoholism, and others--were more likely to become depressed following less total stress than women without such adversity. The results could not be accounted for by chronic stress or prior depression. Both biological and psychological sensitization mechanisms may be speculated to play a role, but the actual mechanisms of stress sensitization remain to be explored.     

Depressive symptoms and survival of patients with coronary artery disease

OBJECTIVE: Multiple studies have shown that high levels of depressive symptoms increase the mortality risk of patients with established coronary disease. This investigation divided depressive symptoms into groups to assess their relative effectiveness in predicting survival. METHODS: Questionnaires about the presence of depressive symptoms were administered to 1250 patients with significant coronary disease while they were hospitalized for diagnostic coronary angiography. Follow-up for mortality due to cardiac disease was conducted annually for up to 19.4 years. Factor analysis was used to divide items on the Zung Self-Rating Depression Scale into four groups: Well-Being, Negative Affect, Somatic, and Appetite. In addition, responses to a single item regarding feelings of hopelessness were available for 920 patients. RESULTS: Well-Being and Somatic symptoms significantly predicted survival (p < or = .01). Negative Affect items were also related to survival (p = .0001) and interacted with age. A 2-SD difference in the Negative Affect term was associated with a relative risk of 1.29 for patients >50 years old and 1.70 for younger ones. Only Negative Affect remained significant in a model with the other symptom groups. Hopelessness also predicted survival with a relative risk of 1.5. Both the Hopelessness and Negative Affect items remained as independent predictors in the same model. All models controlled for severity of disease and treatment. With one exception (income and Hopelessness), results were essentially unchanged by additional controls for age, gender, and income. CONCLUSIONS: Depressive symptoms differentially predicted survival, with depressive affect and hopelessness being particularly important. These effects were independent of disease severity and somatic symptoms and may be especially important in younger patients.     

ENVIRONMENTAL STRESSORS,SOCIAL SUPPORT,AND INTERNALIZING SYMPTOMS AMONG AFRICAN AMERICAN YOUTH

The relations among chronic environmental stressors, social support, and anxiety and depressive symptoms among urban, African American youth are unclear. In this study, we test theoretical models of support and examine the specific relations between community violence exposure and neighborhood disadvantage and three types of anxiety symptoms as well as depressive symptoms. Participants included 188 African American youth in Grades 5 through 8 from 2 low‐income urban schools. Results suggest victimization and neighborhood disadvantage were most significantly associated with symptoms, and in the context of these stressors, parent support was associated with fewer fear and concentration and depressive symptoms. Parent and friend support buffered the effects of stressors on depressive symptoms. These findings contribute to the literature in terms of testing specific stressor‐psychopathology relations and theory‐based social support models with urban, at‐risk youth. Implications for intervention are discussed.     

Stress generation, avoidance coping, and depressive symptoms: a 10-year model

This study examined (a) the role of avoidance coping in prospectively generating both chronic and acute life stressors and (b) the stress-generating role of avoidance coping as a prospective link to future depressive symptoms. Participants were 1,211 late-middle-aged individuals (500 women and 711 men) assessed 3 times over a 10-year period. As predicted, baseline avoidance coping was prospectively associated with both more chronic and more acute life stressors 4 years later. Furthermore, as predicted, these intervening life stressors linked baseline avoidance coping and depressive symptoms 10 years later, controlling for the influence of initial depressive symptoms. These findings broaden knowledge about the stress-generation process and elucidate a key mechanism through which avoidance coping is linked to depressive symptoms.     

Depressive symptoms, social isolation, and progression of coronary artery atherosclerosis: the Stockholm Female Coronary Angiography Study

BACKGROUND: Although both depressive symptoms and social isolation in relation to coronary heart disease have been studied previously, few have examined their joint effects on coronary atherosclerosis progression in women. METHOD: Among the women enrolled in the Stockholm Female Coronary Angiography Study, Sweden, between 1991 and 1994, 102 were evaluated for coronary atherosclerosis progression using a computer-assisted standardized assessment, repeated quantitative coronary angiographic documentation, of the mean luminal diameter change over 3 years in 10 predefined coronary segments. Depressive symptoms and social isolation were assessed by standard questionnaires. RESULTS: Multivariable controlled mixed model ANOVAs revealed that women who were both depressed and socially isolated had the greatest disease progression: their absolute mean luminal diameter decreased by 0.18 mm [95% confidence interval (CI) = 0.11-0.24] and their percent narrowing was 5.5% (95% CI = 3.6-7.4), whereas in women who lacked both psychological risk factors, the mean luminal diameter decrease was 0.04 mm and their percent narrowing was 0.9%. These associations were independent of the baseline luminal diameter and standard risk factors, including age, smoking history, hypertension, and high-density lipoproteins. CONCLUSIONS: In women with coronary disease, depressive symptoms and social isolation in combination accelerated disease progression, suggesting a direct psychosocial effect on the atherosclerotic process. These findings provide an additional opportunity for therapeutic and preventive efforts against progression of coronary disease in women.     

The relationship of demographic variables, antepartum depression, and stress to postpartum depression

This study examined the contributions of demographic variables, antepartum depressive symptoms, and sources of stress to level of postpartum depression. The Beck Depression Inventory (BDI) and demographic data sheet were administered to 69 women during the eighth month of pregnancy. One month after delivery, subjects completed the post-delivery questionnaire and BDI. A stratified hierarchical regression analysis revealed that marital status, antepartum depressive symptoms, and difficulty of pregnancy predicted level of postpartum depression. Somatic stressors of pregnancy may trigger depressive symptoms that persist after childbirth, particularly in unmarried mothers.     

Psychosocial work characteristics,sleep disturbances and risk of subsequent depressive symptoms: a study of time‐varying effect modification

Job strain and low social support at work are recognized risk factors for depression. However, people with poor sleep may represent a high‐risk group more likely to benefit from interventions against work stress. The present study examined whether the associations between these work stressors and depressive symptoms differed by strata of sleep disturbances (effect modification/effect moderation) considering repeat measures of work characteristics and sleep. The study was based on five biennial measurements of the Swedish Longitudinal Occupational Survey of Health, including 1537 respondents recurrently in paid work, from an originally representative sample of the Swedish working population. High work demands, low decision authority and low social support were measured waves 2 and 4, sleep disturbances (putative moderator/modifier) waves 1 and 3, and depressive symptoms (outcome) wave 5. Causal effect modification, whether the effect of working conditions differed by strata of sleep disturbances, was analysed by structural nested mean modelling estimated using a regression‐with‐residuals with inverse‐probability‐of‐treatment weighting approach. High demands and low social support, but not low decision authority, influenced subsequent depressive symptoms. The relationship between social support and depressive symptoms was not apparently modified by sleep disturbances. However, disturbed sleep wave 3 modified the effect of high demands wave 4 (coefficient 1.77, P < 0.05) on depressive symptoms wave 5. The results indicate that high job demands is a stronger risk factor for depressive symptoms in people with pre‐existing sleep disturbances, suggesting that targeted workplace interventions may be more effective when it comes to preventing negative effects of job demands.     

Lack of association between depressive symptoms and markers of immune and vascular inflammation in middle-aged men and women

BACKGROUND: Disturbed immune activity and vascular inflammation are associated both with clinical depression and coronary atherogenesis, and may constitute a mechanism through which depression contributes to coronary heart disease. If this is the case, then non-clinical depressive symptoms and psychological distress should be associated with immune activation and vascular inflammation. We tested this hypothesis in a healthy middle-aged sample. METHOD: Measures of depressive symptoms and hopelessness were obtained from 226 volunteers (122 men, 104 women) aged 47-59 years, drawn from the Whitehall II epidemiological cohort. C-reactive protein, fibrinogen, plasma interleukin-6, tumour necrosis factor alpha, interleukin-1 receptor antagonist, and T- and B-lymphocyte, and natural killer cells numbers and percentages were assessed. RESULTS: There were no associations between measures of depressive symptoms or hopelessness and markers of immune activation or inflammatory response. CONCLUSIONS: Factors such as the measures of depressive symptoms, the choice of inflammatory and immune indices, and sample size, are unlikely to be responsible for these null effects. Associations may be confined to clinically depressed or older age populations, but there are problems of confounding by co-morbidity and health compromising behaviours in this literature. We conclude that disturbances of immune function and inflammatory processes are unlikely to be primarily responsible for the associations between depressive symptoms and coronary heart disease described in the literature, and that other pathways are involved.     

Relationship of depressive symptoms to hypertension in a household survey in Harlem

OBJECTIVE: Two possible explanations for an hypothesized association between depression and hypertension were examined: (1) shared stress-related risk factors are associated with both depression and hypertension and (2) life-style factors associated with depression lead to hypertension. METHODS: A predominantly black sample of 695 adults were interviewed in the Harlem Household Survey. Two measures of hypertension were used and compared-1) self-report and 2) elevated blood pressure (above 140/90 mm Hg)-on the basis of the mean of two blood pressure measures. Depressive symptoms were measured by use of a 24-item scale based on the Diagnostic Interview Schedule. Logistic regression models were used to test associations between hypertension and depressive symptoms, stressors, and life-style factors. RESULTS: Depressive symptoms were associated with self-reported hypertension but not with elevated blood pressure. The association between self-reported hypertension and depressive symptoms was explained partly by shared stress-related risk factors but not by life-style factors. Several stressors and life-style variables were risk factors for elevated blood pressure independently of depressive symptoms. The findings are consistent with studies that have measured hypertension variously by either self-report or blood pressure. Possible explanations were explored (labeling and help-seeking) but were not supported by the data. CONCLUSIONS: An association was found between self-reported hypertension and depressive symptoms, which was explained partly by shared stress-related risk factors. Elevated blood pressure was associated with stressors and life-style factors but not with depressive symptomatology. Research on illness representations and cultural dimensions of health suggest avenues for further investigation.     

Resilience in the midst of chaos: Socioecological model applied to women with depressive symptoms and socioeconomic disadvantage

Socioeconomic disadvantage is extremely common among women with depressive symptoms presenting for women's health care. While social stressors related to socioeconomic disadvantage can contribute to depression, health care tends to focus on patients’ symptoms in isolation of context. Health care providers may be more effective by addressing issues related to socioeconomic disadvantage. It is imperative to identify common challenges related to socioeconomic disadvantage, as well as sources of resilience. In this qualitative study, we interviewed 20 women's health patients experiencing depressive symptoms and socioeconomic disadvantage about their views of their mental health, the impact of social stressors, and their resources and skills. A Consensual Qualitative Research approach was used to identify domains consisting of challenges and resiliencies. We applied the socioecological model when coding the data and identified cross‐cutting themes of chaos and distress, as well as resilience. These findings suggest the importance of incorporating context in the health care of women with depression and socioeconomic disadvantage.     

Intergenerational transmission of depression: a launch and grow model of change across adolescence

The present study tested a "launch-and-grow" type of cascade model in which an earlier risk factor (e.g., exposure to maternal depression by age 12) was hypothesized to predict several risk processes during development (e.g., stress, family relationships, self-worth [SW]), which then set the course for the growth of children's depressive symptoms over time. Participants were 240 mothers and children (mean age = 11.87 years, SD = 0.57) who were evaluated annually across 6 years. The Structured Clinical Interview for DSM diagnoses was used to assess mothers' psychiatric history; 185 mothers had had a mood disorder and 55 mothers were lifetime free of psychiatric diagnoses. At each assessment, mothers completed measures of their current level of depressive symptoms and stressful life events; adolescents completed measures about their perceptions of the family environment and their SW; and clinicians rated adolescents' level of depressive symptoms based on separate interviews with the adolescent and mother. Latent growth curve analyses revealed that history of maternal depression significantly predicted the intercepts of the growth trajectories of adolescents' depressive symptoms, mothers' current depressive symptoms, stressful life events, family environment, and adolescents' SW. The intercepts of each of these variables then predicted the trajectory (i.e., slope) of the growth of adolescents' depressive symptoms across the 6 years of the study. These results were consistent with the hypothesized model of maternal depression launching a set of risk factors, which in turn predict the growth of depressive symptoms during adolescence. Implications for interventions aimed at preventing depression in at-risk youth are discussed.     

Risk factors for major depressive disorder and the psychological impact of hysterectomy: a prospective investigation

The authors prospectively evaluated the risk of major depressive disorder and the psychological impact of recent hysterectomy in 68 women who underwent hysterectomy for non-malignant conditions. Depression, anxiety, body image, sexual functioning, family support, life stress, and subjective gynecological symptoms were assessed 2 weeks before surgery and at 1 month and 4 months after surgery. Depression, anxiety, body image, and subjective gynecological symptoms improved after surgery; however, sexual functioning worsened after surgery. Previous emotional problems and poorer body image, sexual functioning, and higher stress 1 month after surgery are risk factors for post-hysterectomy major depressive disorder.