An HIV self-care symptom management intervention for African American mothers

BACKGROUND: Human immunodeficiency virus (HIV) infection has become a serious health problem for low-income African American women in their childbearing years. Interventions that help them cope with feelings about having HIV and increase their understanding of HIV as a chronic disease in which self-care practices, regular health visits, and medications can improve the quality of life can lead to better health outcomes. OBJECTIVE: This study aimed to determine the efficacy of an HIV self-care symptom management intervention for emotional distress and perceptions of health among low-income African American mothers with HIV. METHOD: Women caregivers of young children were randomly assigned to self-care symptom management intervention or usual care. The intervention, based on a conceptual model related to HIV in African American women, involved six home visits by registered nurses. A baseline pretest and two posttests were conducted with the mothers in both groups. Emotional distress was assessed as depressive symptoms, affective state, stigma, and worry about HIV. Health, self-reported by the mothers, included the number of infections and aspects of health-related quality of life (i.e., perception of health, physical function, energy, health distress, and role function). RESULTS: Regarding emotional distress, the mothers in the experimental group reported fewer feelings of stigma than the mothers in the control group. Outcome assessments of health indicated that the mothers in the experimental group reported higher physical function scores than the control mothers. Within group analysis over time showed a reduction in negative affective state (depression/dejection and tension/anxiety) and stigma as well as infections in the intervention group mothers, whereas a decline in physical and role function was found in the control group. CONCLUSIONS: The HIV symptom management intervention has potential as a case management or clinical intervention model for use by public health nurses visiting the home or by advanced practice nurses who see HIV-infected women in primary care or specialty clinics.     

The relationship between prematurity and maternal mental health during the first postpartum year

Studies concerning the effect of a premature birth on maternal mental health suggest symptoms of depression and anxiety are more prevalent in mothers of premature infants compared to mothers of term infants. However, most studies investigating depressive symptoms only relate to a few months postpartum, whilst no anxiety measures used have been postpartum-specific. Additionally, symptoms of anxiety and depression in mothers of extremely premature infants (<28 weeks’ gestation) are relatively understudied. The aim of this study was to investigate the relationship between early gestational age and symptoms of anxiety and depression, with a secondary emphasis on mothers of extremely premature infants. 225 mothers of infants aged between birth and 12 months completed the Edinburgh Postnatal Depression Scale and the Postpartum Specific Anxiety Scale via an online questionnaire. Hierarchical regression models revealed that gestational age was associated with postpartum specific anxieties and was differentially associated with subscales of the PSAS. Furthermore, mothers of extremely premature infants experience specific subscales in the PSAS to a higher extent than mothers of term infants. There was no association between prematurity and depressive symptoms. These findings demonstrate the need for specific, targeted interventions for mothers of premature infants.     

Weight change of infants, age birth to 12 months, born to abused women.

Abuse to pregnant women can affect maternal health and infant birthweight. To examine the rate of weight change among infants, ages birth to 12 months, born to women abused by the male intimate, an ethnically stratified cohort of 121 infants and their mothers were followed. Infants were weighed on a beam balance scale at birth, 6, and 12 months of age. At the same time, abused mothers were asked if the abuse had ended. Rate of change in infant weight was calculated for birth to 6 months and 6 months to 1 year. The rate of change in infant weight from birth to 6 months did not differ significantly based on whether or not the mother reported that the abuse had ended by 6 months or 12 months. However, the rate of change in infant weight from 6 to 12 months was significantly greater (p = .046) for those infants whose mothers reported the abuse had ended by 12 months and even greater (p = .019) if the mother reported that the abuse had ended by 6 months. When controlling for ethnicity and parity, abuse ending at 6 months was a significant (p = .029, r2 = .102) predictor of the rate of infant weight change from 6 to 12 months. To maximize infant growth and the health and wellbeing of mother and child, routine screening and intervention for abuse of women is recommended during child health visits.     

Evaluation of an Interagency Home Visiting Program to Reduce Postneonatal Mortality in Disadvantaged Communities

Abstract This paper describes an interagency home visiting program, Resources, Education and Care in the Home (REACH), designed to reduce preventable causes of morbidity among normal, socioeconomically disadvantaged infants at risk for adverse outcomes due to social factors. Home nursing visits by a trained nurse-community worker team were made throughout the first year of life to 1,269 infants from predominantly African American families. Results demonstrate that repeated home visits with ongoing infant health monitoring plus individualized and culturally sensitive teaching helped mothers maintain good health practices and identify illnesses early. Infants' outcomes during the neonatal period and at 12 months showed consistent, though statistically nonsignificant, positive effects on physical health. The postneonatal mortality rate among REACH infants was 4.7 deaths per 1000 live births in communities where rates for nonpar ticipants ranged from 5.2 to 10.9 per 100. The evaluation demonstrates a need in this population for more intensive services with greater continuity of care. Specific areas where more education is needed include home safety, skin care, and early identification and treatment of upper respiratory infections. Infants from communities with high infant mortality rates present numerous preventable morbidities requiring interventions, even when they are not considered medically high-risk at birth.     

Comparing the Effect of a Moderate Physical Activity Intervention on the Mental Health Outcomes of African American and Caucasian Dementia Family Caregivers: A Secondary Data Analysis

Increased attention to the effects of the stressful demands of caregiving on the mental health of dementia caregivers has resulted in the development of numerous interventions. The current study is a secondary analysis of a randomized controlled trial that tested a 12-month moderate physical activity intervention with dementia caregivers. Our secondary data analysis examined racial differences in caregiver mental health outcomes including subjective burden, depressive symptoms, and positive affect, as well as differences in physical activity. A total of 211 community-dwelling dementia family caregivers were randomly assigned to a 12-month Enhanced Physical Activity (treatment) Intervention (EPAI) or a Caregiver Skill Building (control) Intervention (CSBI). Of these, 34 African American and 80 Caucasian caregivers completed the study. At baseline, race was associated with subjective burden and positive affect, but not with depressive symptoms. Post intervention (12 months), there were no racial differences in subjective burden or depressive symptoms. However, race was significantly associated with decreased positive affect (p = 0.003) and decreased total minutes of physical activity (p = 0.012). Findings suggest that the mental health needs of African American caregivers warrant additional exploration, where physical activity may be of benefit. These findings provide a cultural perspective to consider during intervention development for future nurse-driven research.     

Severe postpartum distress in Icelandic mothers with difficult infants: a follow-up study on their health care

This article describes help seeking and health care of mothers with a difficult infant who suffered long-term depressive symptoms and a high degree of parenting stress. A subsample of severely distressed mothers (n = 37) was recruited from a cross-sectional national survey and followed up 2 months later by a semi-structured telephone interview. The survey included all Icelandic women who gave birth during a quarter of a year and had a live baby 2 months later (n = 1053). All distressed mothers with a difficult infant were selected from sample respondents on preset scores of two self-report distress measures. The study sample emerged during the selection process for an intervention study from which it was excluded on grounds of very high distress scores. Results showed that 5% of the surveyed population were postpartum severely distressed. Findings from this follow-up study revealed that only one woman of four received health care for severe distress by various professionals. One woman of six received help from others. Very few women utilized the services available at Health Care Centers. About half of the women held attitudes that hindered them in seeking help and health care. It is concluded that postpartum severely distressed women receive little primary health care for mental health problems and the majority of them show little initiative to seek out for help. More active outreach by health professionals is recommended.     

Mothers' health post-partum and their patterns of seeking vaccination for their infants

A cohort of 159 mothers were recruited post-partum and followed for seven months to examine the relationship between mothers' health post-partum and their patterns of seeking vaccination for their infants. Vaccination records for infants were obtained from a state-wide database. Only 44% of the mothers had maintained all age-appropriate vaccinations for their infant up to six months of age. Mothers who had two or more older children were four times more likely to have an infant who was not age-appropriately vaccinated at six months. Women experiencing mental health problems including anxiety and depression, seven months following the birth, were between three to five times more likely to have started the vaccination schedule late or not at all. The findings have implications for midwives and for nurses practising in maternal and child health, paediatrics and public health environments. Strategies focusing on enhancing mothers' psychosocial well-being postnatally through improved service delivery should improve their patterns of seeking vaccination for their infants.     

Association of maternal chronic disease and negative birth outcomes in a non-Hispanic Black-White Mississippi birth cohort

OBJECTIVE: To investigate the impact of selected maternal chronic medical conditions, race, and age on preterm birth (PTB), low birth weight (LBW), and infant mortality among Mississippi mothers from 1999 to 2003. DESIGN: A retrospective cohort analysis of linked birth and death certificates. SAMPLE: The 1999-2003 Mississippi birth cohort comprising 202,931 singleton infants born to African American and White women. MEASUREMENTS: The relationship between maternal chronic conditions and the dependent variables of PTB, LBW, and infant mortality were investigated using logistic regression analysis. RESULTS: PTB, LBW, and infant mortality were more prevalent among African American women, very young women (< or =15 years), and women with certain chronic medical conditions. Among White mothers, maternal chronic hypertension was significantly associated with PTB and LBW, and maternal diabetes with PTB and infant mortality. Among African American mothers, maternal cardiac disease was significantly associated with PTB and LBW; maternal chronic hypertension was significantly associated with LBW and infant mortality; and maternal diabetes with PTB. CONCLUSIONS: Maternal chronic hypertension and diabetes were significantly associated with negative birth outcomes regardless of maternal race. Maternal cardiac disease was only significantly associated with PTB and LBW among African Americans.     

Factors associated with depressive symptoms in African American crack cocaine smokers

Few studies have examined factors associated with depressive symptoms in crack cocaine smokers, although cocaine use has been linked to depression. The purpose of this study was to identify correlates of depressive symptoms in a sample of 799 HIV‐positive and HIV‐seronegative African‐American crack cocaine smokers. Multiple regression modelling revealed that anxiety was strongly and positively associated with depressive symptoms. In addition, being female and more frequent crack smoking were also found to be associated. Higher self‐esteem and decision‐making confidence were found to be associated with less often experiencing depressive symptoms. The model accounted for 64% of the variance in the data. It was noteworthy that HIV infection, as such, was not associated with depressive symptoms. The study has important implication for mental health and health promotion interventions targeting crack cocaine smokers.     

Flying under the radar: engagement and retention of depressed low-income mothers in a mental health intervention

A randomized trial of in-home psychotherapy for depressive symptoms that targeted low-income mothers of infants and toddlers used innovative design features to reduce stigma and enhance acceptability. Despite these features, advanced practice psychiatric mental health nurses used specialized, relationship-based strategies to engage and retain these high-risk mothers in the intervention. Data revealed that the nurses needed to diligently maintain contact, provide encouragement, use empathy for rapid assessment and response, and control the intensity of the relationship-based contacts in order to retain mothers.     

In our grandmother's footsteps: perceptions of being strong in African American women with HIV/AIDS

One of the most significant challenges facing the health of black women in the 21st century is the growing numbers of human immunodeficiency virus/acquired immunodeficiency disease (HIV/AIDS) infections. An ethnographic study of African American mothers living with HIV/AIDS revealed that they believed in a tradition and heritage of strength that fostered their survival during difficult life experiences such as living and mothering with HIV/AIDS. They enacted this strength in culturally significant ways. This article discusses the importance of recognizing and supporting cultural strengths of African American women to help manage illness, while remaining cognizant of the context of oppression, discrimination, and stigma that distort cultural traditions and instead penalize women when they are ill.     

Infant Weaning Patterns and Related Maternal-Infant Health Outcomes

We prospectively investigated the weaning practices and fertility and birth control patterns of 95 educated, middle-class, urban-suburban, married, North American women in the year after the birth of their first child. Mothers recruited from childbirth classes responded to questions about their infant feeding and contraceptive practices during that year. Eighty-nine percent (n = 85) of the infants were initially breast fed, and the mean age of weaning for the 63 infants who had been weaned by 58 weeks was 26.9 weeks. The pattern of weaning was described, including the introduction of solid foods, food-related infant illness, and reasons for weaning. Although 70 percent of the mothers reported using artificial contraception, their fertility rate was higher than that reported for third-world women using only breast feeding as conception control. The data suggest that later weaning, even in this relatively affluent group, may result in direct contraceptive and physical benefits to the health of women and infants. The findings also suggest that the influence of health care practitioners on infant feeding practices may be as great as the influence of cultural values or material resources.     

Effectiveness of cognitive-behavioral counseling on the mental health of premature infants’ mothers in neonatal intensive care unit

Introductionand Purpose: Mental health of mothers at the time of birth of premature infants is one of the important factors in the mental health of children and stability of their families. Maternal mental disorders impose heavy burdens on the second generation and the community. Due to psychological and emotional sensitivities, women are more susceptible than men to psychological injuries such as depression, anxiety, and other disorders during their children's sever problems. In such a situation, mothers can no longer establish a normal relationship with their children and the fear of taking care of premature hospitalized neonates leads to these disorders. Counseling with mothers at the time of hospitalization may help to improve their mental health. Therefore, the present study was done to investigate the effect of cognitive-behavioral counseling on the mental health of mothers with premature infants in Neonatal Intensive Care Unit.MethodThis study was a clinical trial conducted on 50 mothers with premature infants in neonatal intensive care unit of Zeinabiyyeh Hospital of Shiraz in 2016-2017. Through purposive sampling, mothers who agreed to attend the sessions and fulfilled the inclusion criteria, were randomly assigned to the control and intervention group. Goldberg-Hiller Questionnaire was used to measure their general mental health. The data were analyzed using SPSS Software Version 19.ResultsThe results showed that there was no significant difference between the control and intervention group before the counseling with regard to mean mental health scores and its subscales. After the intervention, a significant difference was observed between physical symptoms and anxiety/insomnia subscales and total mental health scores but no difference was observed with regard to social function and depression dimensions between two groups.ConclusionCognitive-behavioral counseling improved mental health and subscales of physical symptoms, anxiety/insomnia of mothers under study. This method can be used to improve the acute negative effects on the mental health of mothers with premature infants in neonatal intensive care units (NICU)s.     

Length of stay, admission types, psychiatric diagnoses, and the implications of stigma in African Americans in the nationwide inpatient sample

African Americans purportedly have a higher prevalence of mental illnesses but are often misdiagnosed and less likely to seek treatment. Delayed treatment has been associated with the stigma related to these disorders. The demographic characteristics, length of stay, most prevalent psychiatric diagnoses, and hospital admissions of African Americans were compared to other U.S. populations using a nationwide sample (N = 4,474,732). African American participants were younger, had significantly longer lengths of stay, and were admitted more often through the emergency room than the other groups in this sample. Psychosis, alcohol/drug dependence, and depressive neurosis were the most prevalent psychiatric diagnoses reported for African American participants. Research is needed to explain these results so that strategies can be instituted to improve the poor mental health outcomes often observed in African American populations.     

LENGTH OF STAY,ADMISSION TYPES,PSYCHIATRIC DIAGNOSES,AND THE IMPLICATIONS OF STIGMA IN AFRICAN AMERICANS IN THE NATIONWIDE INPATIENT SAMPLE

African Americans purportedly have a higher prevalence of mental illnesses but are often misdiagnosed and less likely to seek treatment. Delayed treatment has been associated with the stigma related to these disorders. The demographic characteristics, length of stay, most prevalent psychiatric diagnoses, and hospital admissions of African Americans were compared to other U.S. populations using a nationwide sample (N = 4,474,732). African American participants were younger, had significantly longer lengths of stay, and were admitted more often through the emergency room than the other groups in this sample. Psychosis, alcohol/drug dependence, and depressive neurosis were the most prevalent psychiatric diagnoses reported for African American participants. Research is needed to explain these results so that strategies can be instituted to improve the poor mental health outcomes often observed in African American populations.     

The influence of maternal and child characteristics and paternal support on interactions of mothers and their medically fragile infants

The influences of maternal characteristics, infant characteristics, and paternal support on maternal positive involvement and developmental stimulation were examined over time in 59 mothers and their medically fragile infants using an ecological framework. Higher maternal education was associated with greater maternal positive involvement. More maternal depressive symptoms, more infant technological dependence, and lower birthweights were associated with less maternal positive involvement at 6 months but greater involvement at 12 months. Higher paternal helpfulness facilitated positive involvement in mothers with low depressive symptoms but not in those with elevated symptoms. Higher maternal education and more depressive symptoms were associated with more developmental stimulation. Thus, maternal interactive behaviors are affected by maternal, infant, and environment factors, and these effects change over time.     

Childhood Physical and Sexual Abuse: Their Relationship with Depressive Symptoms in Adulthood

The purposes of this study were to determine the prevalence of childhood physical and sexual abuse among 206 low-income single mothers and to examine the relationship of childhood abuse to current maternal depressive symptoms. Severe physical abuse was reported by 36 percent of the women. The prevalence of sexual abuse was 22 percent; more than one-half of these women were violently abused. High depressive symptoms were reported by 51 percent of the mothers. Both severe physical abuse and sexual abuse in childhood were associated with high depressive symptoms. Women who experienced violent sexual abuse were almost four and one-half times more likely to report high depressive symptoms, compared to the women who were not sexually abused. These findings provide further evidence that childhood abuse may have long-term consequences for women's mental health .