“You Don't Go Tell White People Nothing”: African American Women's Perspectives on the Influence of Violence and Race on Depression and Depression Care

Objectives. We sought to understand how African American women''s beliefs regarding depression and depression care are influenced by racism, violence, and social context.Methods. We conducted a focus group study using a community-based participatory research approach. Participants were low-income African American women with major depressive disorder and histories of violence victimization.Results. Thirty women participated in 4 focus groups. Although women described a vicious cycle of violence, depression, and substance abuse that affected their health, discussions about health care revolved around their perception of racism, with a deep mistrust of the health care system as a “White” system. The image of the “strong Black woman” was seen as a barrier to both recognizing depression and seeking care. Women wanted a community-based depression program staffed by African Americans that addressed violence and drug use.Conclusions. Although violence and drug use were central to our participants'' understanding of depression, racism was the predominant issue influencing their views on depression care. Providers should develop a greater appreciation of the effects of racism on depression care. Depression care programs should address issues of violence, substance use, and racism.Although it is unclear whether racial disparities in depressive symptoms can be explained by cultural or socioeconomic factors,^1–6 there is ample evidence that important differences exist in depression care. African Americans are significantly less likely than Whites to receive guideline-appropriate depression care.^7,8 Several studies have shown that in real-world settings primary care physicians are less likely to detect, treat, refer, or actively manage depression in minority patients than in White patients.^9–13 Also, African Americans are less likely than Whites to seek specialty mental health care, accept recommendations to take antidepressants, or view counseling as an acceptable option.^8,14–16Part of understanding a woman''s depression is recognizing the social context in which she lives. Violence is a huge problem in our society, and minority and low-income populations bear a disproportionate burden. Studies consistently show that the prevalence of intimate partner violence (IPV) is higher among African American women than among non-Hispanic Whites,^17–20 although much of this disparity can be attributed to economic factors.²¹ There is a strong association between violence victimization and depression.^22–31 Despite the important relationship between IPV and mental health, several studies conducted in predominantly non-Hispanic White populations have shown that depressed women with a history of IPV are less likely than other depressed women to seek mental health care.^32,33 African American violence survivors may have even greater distrust of the mental health system and encounter more systemic and cultural barriers to receiving care than non-Hispanic Whites.Our objective in this qualitative study was to understand the experiences and beliefs of depressed African American women residing in Portland, Oregon, a city with relatively low racial diversity, regarding depression and depression care. We focused in particular on understanding how their social context and their experiences of violence influenced their beliefs and choices.     

Smoking in Pregnancy and Parenthood: What is the Role of Depression,Anxiety and Nicotine Addiction?

This paper presents some of the findings from the Smoking in Pregnancy study of attitudes towards smoking among pregnant women, mothers of young children and their partners in East Surrey. As part of the study, respondents completed a General Health Questionnaire to identify mental health difficulties and, if they were smoking at the time of the study, they also completed the Fagerstrom nicotine addiction test. Eleven female respondents had high scores on the General Health Questionnaire, suggesting symptoms of depression, anxiety and/or social dysfunction for these women. There was no evidence that smokers were suffering from greater mental health difficulties than ex-smokers or non-smokers. However, the General Health Questionnaire scores of smokers were positively associated with their level of nicotine dependence. Furthermore, when General Health Questionnaire scores of all respondents were compared with self-reported health status there was a marked discrepancy suggesting under-reporting of symptoms by women.     

Osteoporosis Medications Used by Older African–American Women: Effects of Socioeconomic Status and Psychosocial Factors

This study examined the effects of socioeconomic status, knowledge and Health Belief Model variables on ever use of hormone therapy and other osteoporosis medications among older African–American women. One-hundred and two African–American women, 60 years old or older, randomly selected from Registers of Voters and a list of participants in educational activities of a university hospital, were interviewed in their homes. Data collected concerned knowledge of osteoporosis, Health Belief Model variables, and cues to action such as history of hysterectomy, personal and family history of cancer, bone mineral density testing, and discussion with a physician about osteoporosis. Socioeconomic status indicators included years of education and household income. The average respondent age was 71.1 years; 47% were current or previous users (ever users) of hormone therapy, and 11% were ever users of other osteoporosis medications. Knowledge of osteoporosis, (odds ratio = 1.4), Hormone therapy benefits, (odds ratio = 1.63), a hysterectomy (odds ratio = 4.35), and a family history of cancer (odds ratio = 4.0) increased the odds of ever using hormone therapy. Perceptions of susceptibility (odds ratio = 3.5) and discussion with a physician about osteoporosis (odds ratio = 6.4) increased odds of ever using other osteoporosis medications. Socioeconomic status mediated the effects of knowledge of osteoporosis on ever using hormone therapy. Efforts to promote bone health to older African–American women should focus primary efforts to increasing perceptions of susceptibility to fracture and persuading physicians to initiate discussions about fracture prevention with African–American patients before a fracture occurs.NIH Grant No. 5P60-AG1363111 supported this paper. Dr. Unson was connected with the Center on Aging, University of Connecticut Health Center when this study was conducted.     

Stressful Life Events Around the Time of Unplanned Pregnancy and Women’s Health: Exploratory Findings from a National Sample

Objective Little is known about how women’s social context of unintended pregnancy, particularly adverse social circumstances, relates to their general health and wellbeing. We explored associations between stressful life events around the time of unintended pregnancy and physical and mental health. Methods Data are drawn from a national probability study of 1078 U.S. women aged 18–55. Our internet-based survey measured 14 different stressful life events occurring at the time of unintended pregnancy (operationalized as an additive index score), chronic disease and mental health conditions, and current health and wellbeing symptoms (standardized perceived health, depression, stress, and discrimination scales). Multivariable regression modeled relationships between stressful life events and health conditions/symptoms while controlling for sociodemographic and reproductive covariates. Results Among ever-pregnant women (N?=?695), stressful life events were associated with all adverse health outcomes/symptoms in unadjusted analyses. In multivariable models, higher stressful life event scores were positively associated with chronic disease (aOR 1.21, CI 1.03–1.41) and mental health (aOR 1.42, CI 1.23–1.64) conditions, higher depression (B 0.37, CI 0.19–0.55), stress (B 0.32, CI 0.22–0.42), and discrimination (B 0.74, CI 0.45–1.04) scores, and negatively associated with ≥?very good perceived health (aOR 0.84, CI 0.73–0.97). Stressful life event effects were strongest for emotional and partner-related sub-scores. Conclusion Women with adverse social circumstances surrounding their unintended pregnancy experienced poorer health. Findings suggest that reproductive health should be considered in the broader context of women’s health and wellbeing and have implications for integrated models of care that address women’s family planning needs, mental and physical health, and social environments.     

What’s In an Identity Label? Correlates of Sociodemographics,Psychosocial Characteristics,and Sexual Behavior Among African American Men Who Have Sex With Men

African American men who have sex with men (AAMSM) are vastly overrepresented among people with HIV/AIDS. Using data from 595 AAMSM in Philadelphia, we explored differences in sociodemographics, psychosocial characteristics related to beliefs about ethnicity, sexuality and masculinity, and sexual behavior with men and women by self-reported sexual identity (gay, bisexual, down low, straight). Roughly equivalent numbers identified as gay (40.6 %) and bisexual (41.3 %), while fewer identified as straight (7.6 %) or down low (10.5 %), with significant differences in age, income, history of incarceration, HIV status, alcohol and drug problems, childhood sexual abuse, and connection to the gay community evident among these groups. Analysis of psychosocial characteristics theorized to be related to identity and sexual behavior indicated significant differences in masculinity, homophobia, and outness as MSM. Gay and straight men appeared to be poles on a continuum of frequency of sexual behavior, with bisexual and down low men being sometimes more similar to gay men and sometimes more similar to straight men. The percentage of men having total intercourse of any kind was highest among down low and lowest among gay men. Gay men had less intercourse with women, but more receptive anal intercourse with men than the other identities. There were no significant differences by identity in frequency of condomless insertive anal intercourse with men, but gay men had significantly more condomless receptive anal intercourse. There were significant differences by identity for condomless vaginal and anal intercourse with women. This study demonstrates the importance of exploring differences in types of sex behavior for AAMSM by considering sexual identity.     

Androgen Deprivation Therapy for Prostate Cancer Prevention: What Impact Do Related Adverse Events Have on Quality of Life?

ObjectivesTo elicit utilities for health-related quality-of-life (HRQL) impact of adverse events (AEs) associated with androgen-deprivation therapy (ADT) for prostate cancer prevention.Study DesignCross-sectional, online survey of men aged ≥55 years, experiencing symptoms similar to one or more AEs related to ADT (erectile dysfunction [ED], loss of libido, gynecomastia, ejaculatory problems) outside the context of treatment for prostate cancer (n = 190, plus n = 10 had prostate cancer, included to allow greater representation of men with gynecomastia) and an age/sex equivalent control group (n = 100). Utilities were collected using the EQ-5D and a condition-specific measure of sexual HRQL from which a preference-based single index could be scored (SQoL-3D). Regression analysis was used to estimate the impact of the AE on utility values using a variety of model types.ResultsMany participants reported more than one symptom, including ED (most common at n = 139), reduced libido (n = 99), ejaculatory disorder (n = 98), and gynecomastia (n = 20). EQ-5D and SQoL-3D utilities were weakly correlated (r = 0.296). From the ordinary least squares regression, EQ-5D and SQoL-3D disutilities were estimated for ED (?0.042; ?0.074), reduced libido (?0.053; ?0.048), ejaculatory disorder (?0.047; ?0.028), and gynecomastia (?0.043; ? 0.038), respectively. The use of tobit regression did not improve model predictions.ConclusionsUtility values elicited in this study provide useful indicators of the impact of AEs related to ADT in older men for use in cost-effectiveness evaluation of prophylaxis for prostate cancer, and of benefits of treatments for sexual dysfunction or gynecomastia in older men.     

Attractiveness in African American and Caucasian women: Is beauty in the eyes of the observer?

Traditional body image studies have been constrained by focusing on body thinness as the sole component of attractiveness. Evidence suggests that African American women may hold a multifactorial view of attractiveness that extends beyond size to include factors such as dress attire and race. The current study employed a culturally sensitive silhouette Model Rating Task (MRT) to examine the effects of attire, body size, and race on attractiveness. Unexpectedly, minimal differences on attractiveness ratings emerged by attire, body size, or model race between African American and Caucasian women. Overall, participants preferred the dressed, underweight, and African American models. Factors such as exposure to diverse groups and changes in African American culture may explain the present findings. Future studies to delineate the components of attractiveness for African American and Caucasian women using the MRT are needed to broaden our understanding and conceptualization of attractiveness across racial groups.     

Lack of time for physical activity: perception or reality for African American and Hispanic women?

Lack of time is a well-known barrier to physical activity. It is not known, however, whether this barrier reflects actual time commitments. This study examined time commitments of women and assessed the relationship between time commitments and perceived lack of time for physical activity. Participants were 249 African American and Hispanic women, aged 45 to 70 years. These women devoted much of their time to their responsibilities as workers, housekeepers, mothers and wives. They also spent 28 hours per week in sedentary leisure-time activity. Actual time commitments did not predict perceived lack of time for physical activity. These findings can be used to address the misperceptions of women about time available to them for physical activity.     

What Does It Mean When We Screen? A Closer Examination of Perinatal Depression and Psychosocial Risk Screening Within One MCH Home Visiting Program

Perinatal depression screening has become an imperative for maternal and child health (MCH) home visitation programs. However, contextual life experiences and situational life stress may be equally important in determining program response. As one component of a larger research study with an urban MCH home visitation program, we examined the results from multiple measures of depression and anxiety symptoms, social support and stressful life events in a sample of 30 newly enrolled program participants. We compared commonly used tools in identifying women who were “at risk” for perinatal depression. The analysis used published and agency practice cut-off scores, examined correlations between measures, and reflected on the role of stressful life events in this assessment. In this low-income, predominantly African-American sample, the assessed tools were inconsistent in identifying “at risk” women for perinatal depression, ranging from 22 % (Edinburgh Perinatal Depression Scale) to 75 % (Center for Epidemiological Studies, Depression Scale) depending on the instrument. Depression and anxiety were correlated across most measures, although provider-collected data did not correlate as anticipated with other measures. The combination of screening for perinatal depression and stressful life events offered an additional perspective on possible symptom alleviation and psychosocial intervention that could occur within the home visiting program. Our experience suggests that introducing a brief inventory of stressful life events accompanying perinatal depression screening allowed for a more comprehensive understanding of women’s experiences than perinatal depression screening alone. We encourage psychosocial risk screening which integrates assessment of social support, stressful life events and perinatal depression symptoms.     

Having Fun on Facebook?: Mothers’ Enjoyment as a Moderator of Mental Health and Facebook Use

This study reports results of a study that examined the extent to which contextual factors (i.e., income level and number of children) might predict a mother’s mental health quality, which, in turn, may predict level of engagement with Facebook. Results supported this model, finding that mothers with more children and lower income possess lower mental health quality, and lower mental health quality predicted more frequent Facebook use. However, this pattern was qualified by a mother’s level of enjoyment of Facebook, such that mental health quality did not significantly predict Facebook intensity when enjoyment of Facebook was low. This research extends practitioners’ knowledge of mothers’ mental health quality by identifying a behavior that may indicate lower mental health quality and enhance abilities to recognize mothers who may need support or treatment. Future directions for this research are included.     

Suburban Migration and the Birth Outcome of Chicago-Born White and African–American Women: The Merit of the Healthy Migrant Theory?

The healthy migrant theory posits that women who migrate before pregnancy are intrinsically healthier and therefore have better birth outcomes than those who don’t move. Objective. To determine whether migration to the suburbs is associated with lower rates of preterm (<37 weeks) birth among Chicago-born White and African–American mothers. We performed stratified and multilevel logistic regression analyses on an Illinois transgenerational dataset of non-Latino White and African–American infants (1989–1991) and their mothers (1956–1976) with appended US census income information. Forty percent of Chicago-born White mothers (N = 45,135) migrated to Suburban Cook County and 30 % migrated to the more geographically distant collar counties. In contrast, 10 % of Chicago-born African–American mothers (N = 41,221) migrated to Suburban Cook and only two percent migrated to the collar counties. Chicago-born White and African–American migrant mothers to Suburban Cook County had lower preterm birth rates than their non-migrant counterparts; RR = 0.8 (0.8–0.9) and 0.8 (0.7–0.8), respectively. When neighborhood income was singularly taken into account, the protective association of suburban migration and preterm birth disappeared among Chicago-born Whites. In race-specific multilevel multivariate regression models which included neighborhood income, the adjusted odds ratio of preterm birth, low birth weight, and small for gestational-age for Chicago-born White and African–American migrant (compared to non-migrant) mothers approximated unity. Neighborhood income underlies the protective association of suburban migration and birth outcome among Chicago-born White and African–American mothers. These findings do not support the healthy migrant hypothesis of reproductive outcome.     

The Edinburgh Postnatal Depression Scale: Screening Tool for Postpartum Anxiety as Well? Findings from a Confirmatory Factor Analysis of the Hebrew Version

Objectives The Edinburgh Postnatal Depression Scale (EPDS) was originally created as a uni-dimensional scale to screen for postpartum depression (PPD); however, evidence from various studies suggests that it is a multi-dimensional scale measuring mainly anxiety in addition to depression. The factor structure of the EPDS seems to differ across various language translations, raising questions regarding its stability. This study examined the factor structure of the Hebrew version of the EPDS to assess whether it is uni- or multi-dimensional. Methods Seven hundred and fifteen (n = 715) women were screened at 6 weeks postpartum using the Hebrew version of the EPDS. Confirmatory factor analysis (CFA) was used to test four models derived from the literature. Results Of the four CFA models tested, a 9-item two factor model fit the data best, with one factor representing an underlying depression construct and the other representing an underlying anxiety construct. Conclusions for Practice The Hebrew version of the EPDS appears to consist of depression and anxiety sub-scales. Given the widespread PPD screening initiatives, anxiety symptoms should be addressed in addition to depressive symptoms, and a short scale, such as the EPDS, assessing both may be efficient.     

Child Feeding Practices in Families of Working and Nonworking Mothers of Indonesian Middle Class Urban Families: What Are the Problems?

This study aims to explore the feeding practices in families of working and nonworking mothers with children (aged 12–36 months) of different nutritional status and types of domestic caregiver in Indonesian urban middle class families. It was designed as a qualitative multiple case study. Mothers and caregivers from 26 families were interviewed in depth, and caregivers were categorized as family and domestic-paid caregivers. The result suggested that offering formula milk to young children was a common practice, and there was a high recognition and familiarity toward a range of formula milk brands. Mothers reported challenges in encouraging their children to eat, and in some cases they appeared to lack knowledge on overcoming their child's feeding problem. The findings suggested the need to address the child feeding problems experienced by mothers in order to overcome the double burden of child nutrition in Indonesia.     

What does “occupation” represent as an indicator of socioeconomic status?: Exploring occupational prestige and health

The association between socioeconomic status (SES) and health has been widely documented. However, the role of occupation in this association is not clear because occupation is less often used than income and education as an indicator of SES, especially in the United States. This may be caused by the ambiguity in what occupation represents: both health-enhancing resources (e.g., self-affirmation) and health-damaging hazards (e.g., job stress). SES has two aspects: resources and status. While income and education represent resources and imply status, occupational prestige is an explicit indicator of the social status afforded by one’s occupation. Using data from the US General Social Survey in 2002 and 2006 (n = 3151), we examine whether occupational prestige has a significant association with self-rated health independent from other SES indicators (income, education), occupational categories (e.g., managerial, professional, technical, service), and previously established work-related health determinants (job strain, work place social support, job satisfaction). After all covariates were included in the multiple logistic regression model, higher occupational prestige was associated with lower odds of reporting poor/fair self-rated health. We discuss potential mechanisms through which occupational prestige may impact health. Our findings not only suggest multiple ways that occupation is associated with health, but also highlight the utility of occupational prestige as an SES indicator that explicitly represents social standing.     

What does “occupation” represent as an indicator of socioeconomic status?: Exploring occupational prestige and health

The association between socioeconomic status (SES) and health has been widely documented. However, the role of occupation in this association is not clear because occupation is less often used than income and education as an indicator of SES, especially in the United States. This may be caused by the ambiguity in what occupation represents: both health-enhancing resources (e.g., self-affirmation) and health-damaging hazards (e.g., job stress). SES has two aspects: resources and status. While income and education represent resources and imply status, occupational prestige is an explicit indicator of the social status afforded by one’s occupation. Using data from the US General Social Survey in 2002 and 2006 (n = 3151), we examine whether occupational prestige has a significant association with self-rated health independent from other SES indicators (income, education), occupational categories (e.g., managerial, professional, technical, service), and previously established work-related health determinants (job strain, work place social support, job satisfaction). After all covariates were included in the multiple logistic regression model, higher occupational prestige was associated with lower odds of reporting poor/fair self-rated health. We discuss potential mechanisms through which occupational prestige may impact health. Our findings not only suggest multiple ways that occupation is associated with health, but also highlight the utility of occupational prestige as an SES indicator that explicitly represents social standing.     

Mountain Dew® or Mountain Don't?: A Pilot Investigation of Caffeine Use Parameters and Relations to Depression and Anxiety Symptoms in 5th‐ and 10th‐Grade Students

BACKGROUND: Caffeine, the only licit psychoactive drug available to minors, may have a harmful impact on students' health and adjustment, yet little is known about its use or effects on students, especially from a developmental perspective. Caffeine use in 5th- and 10th-grade students was examined in a cross-sectional design, and relations and potential mediators of caffeine use to depression and anxiety symptoms were investigated.
METHODS: Children ( n = 135) and adolescents ( n = 79) completed a measure of naturalistic use of caffeinated and noncaffeinated beverages. Furthermore, daily availability, perceived benefits, and stimulating, psychological, and withdrawal effects of caffeinated and noncaffeinated beverages were assessed. Measures of depression and anxiety were also administered.
RESULTS: Fifth and 10th graders used caffeine frequently. Depression was positively related to caffeine use for both cohorts, though mediated by caffeine withdrawal effects. Surprisingly, anxiety was unrelated to use. Fifth graders reported less daily access to caffeine, but more psychological and stimulating effects of caffeine than 10th graders.
CONCLUSIONS: Although both children and adolescents experience negative caffeine-related outcomes, intake is seemingly not greatly limited in either cohort. In particular, youth appear vulnerable to increased depressive symptoms with increasing caffeine consumption. Implications for school policy regarding students' caffeine use are discussed.     

Gender-Based Violence Is a Human Rights Violation: Are Donors Responding Adequately? What a Decade of Donor Interventions in Colombia,Kenya, and Uganda Reveals

Gender-based violence (GBV) is a violation of human rights and must be addressed as such. This paper examines whether donor practices align with a rights-based approach, using data from our comprehensive study of foreign funding flows related to GBV in Colombia, Kenya, and Uganda from 2010 to 2020. By analyzing data from 1,180 grants—and providing parallel analyses of the state of GBV, and GBV reporting and interventions in each country—we demonstrate donors’ role in shaping GBV outcomes and their consequent duty to address policies and practices that violate rights. Accordingly, we propose changes in donor practices to promote realization of the right to freedom from violence.