Cumulative psychosocial stress,coping resources,and preterm birth

Preterm birth constitutes a significant international public health issue, with implications for child and family well-being. High levels of psychosocial stress and negative affect before and during pregnancy are contributing factors to shortened gestation and preterm birth. We developed a cumulative psychosocial stress variable and examined its association with early delivery controlling for known preterm birth risk factors and confounding environmental variables. We further examined this association among subgroups of women with different levels of coping resources. Utilizing the All Our Babies (AOB) study, an ongoing prospective pregnancy cohort study in Alberta, Canada (n?=?3,021), multinomial logistic regression was adopted to examine the independent effect of cumulative psychosocial stress and preterm birth subgroups compared to term births. Stratified analyses according to categories of perceived social support and optimism were undertaken to examine differential effects among subgroups of women. Cumulative psychosocial stress was a statistically significant risk factor for late preterm birth (OR?=?1.73; 95 % CI?=?1.07, 2.81), but not for early preterm birth (OR?=?2.44; 95 % CI?=?0.95, 6.32), controlling for income, history of preterm birth, pregnancy complications, reproductive history, and smoking in pregnancy. Stratified analyses showed that cumulative psychosocial stress was a significant risk factor for preterm birth at <37 weeks gestation for women with low levels of social support (OR?=?2.09; 95 % CI?=?1.07, 4.07) or optimism (OR?=?1.87; 95 % CI?=?1.04, 3.37). Our analyses suggest that early vulnerability combined with current anxiety symptoms in pregnancy confers risk for preterm birth. Coping resources may mitigate the effect of cumulative psychosocial stress on the risk for early delivery.     

Sexual assault history,PTSD, and mental health service seeking in a national sample of women

This study examined correlates of posttraumatic stress disorder (PTSD) and mental health service seeking for women sexually assaulted in childhood and/or adulthood (N = 619) identified from the National Comorbidity Survey (1990–1992). Factors related to correlates of PTSD and mental health service seeking varied according to sexual assault history. Ethnic minority women with less formal education, more traumatic and stressful life events, and longer duration of sexual abuse had greater odds of PTSD within certain sexual assault history subgroups. Mental health service seeking was predicted by demographics (e.g., more education, Caucasian race), as well as other psychosocial factors (e.g., life events, social support), and medical insurance status, especially for adult sexual assault victims. Implications for mental health treatment and intervention are drawn for women with different sexual assault histories. © 2002 Wiley Periodicals, Inc.     

Paternal support and preterm birth, and the moderation of effects of chronic stress: a study in Los Angeles County mothers

Maternal psychosocial stress is an important risk factor for preterm birth, but support interventions have largely been unsuccessful. The objective of this study is to assess how support during pregnancy influences preterm birth risk and possibly ameliorates the effects of chronic stress, life event stress, or pregnancy anxiety in pregnant women. We examined 1,027 singleton preterm births and 1,282 full-term normal weight controls from a population-based retrospective case–control study of Los Angeles County, California women giving birth in 2003, a mostly Latina population (both US-born and immigrant). We used logistic regression to assess whether support from the baby’s father during pregnancy influences birth outcomes and effects of chronic stress, pregnancy anxiety, and life event stress. Adjusted odds of preterm birth decreased with better support (OR 0.73 [95%CI 0.52, 1.01]). Chronic stress (OR 1.46 [95%CI 1.11, 1.92]), low confidence of a normal birth (OR 1.57 [95% CI 1.17, 2.12]), and fearing for the baby’s health (OR 1.67 [95%CI 1.30, 2.14]) increased preterm birth risk, but life events showed no association. Our data also suggested that paternal support may modify the effect of chronic stress on the risk of preterm birth, such that among mothers lacking support, those with moderate-to-high stress were at increased odds of delivering preterm (OR 2.15 [95%CI 0.92, 5.03]), but women with greater support had no increased risk with moderate-to-high chronic stress (OR 1.13 [95%CI 0.94, 1.35]). Paternal support may moderate the effects of chronic stress on the risk of preterm delivery.     

Maternal postpartum stress and toddler developmental delays: Results from a multisite study of racially diverse families

Maternal psychosocial stress during pregnancy can adversely influence child development, but few studies have investigated psychosocial stress during the postpartum period and its association with risk of toddler developmental delays. Moreover, given the expanding diversity of the U.S. population, and well-documented health and stress disparities for racial and ethnic minorities, research examining the effect of postpartum stress on risk of developmental delays in diverse populations is of critical importance. In this study, data from the Community Child Health Network provided the opportunity to test maternal postpartum stress as a predictor of toddler risk of developmental delay in a sample of African American, Latina and non-Hispanic White women and their toddlers (N = 1537) recruited in urban, suburban, and rural communities. Postpartum maternal stress over 1 year was operationalized as perceived stress, life events, and negative impact of life events. Regression results revealed higher risk of developmental delays in toddlers whose mothers experienced more negative life events, greater negative impact of events, and higher perceived stress over the year. Prenatal stress, pregnancy/birth complications, and postpartum depression did not explain these associations. Maternal postpartum stress may contribute to increased risk for developmental delays and is an important target for psychosocial intervention.     

Correlates of resilient outcomes among highly stressed African-American and White urban children

Compared test variables that differentiated stress-affected and stress-resilient outcomes within separate subsamples of highly stressed 4th–6th grade urban African-American and White children. Similar variables differentiated resilient and stress affected children in the two racial groups. Key common differentiators associated with resilient outcomes under chronically stressful life conditions included: perceived competence; positive self-views; empathy; and realistic control attributions. There was also substantial overlap in the sets of six test variables in the discriminant functions that best predicted (85% accuracy) resilient outcomes among these highly stressed African-American and White children. © 1999 John Wiley & Sons, Inc.     

Stressful life events and changes in substance use among a multiracial/ethnic sample of adolescent boys

This paper presents a comparative analysis of the prevalence of stressful life events and of the relationships between stressful life events and alcohol, illicit drug, and cigarette use among a multi-ethnic community sample (N = 2,446) of early adolescent boys. The data were derived from a longitudinal study of substance use behaviors and their psychosocial correlates among Hispanic, African-American, and White non-Hispanic adolescent boys residing in Dade County, Florida. Similar levels of event exposure were found among the subgroups, with one exception. African Americans were significantly more likely to experience a death-related event in the past year. Stressful life events were not significantly related with substance use among African-American students. Among Hispanics and White non-Hispanics, however, a number of significant positive relationships were found. A number of bidirectional events (i.e., those events that could be either an antecedent to and/or the result of substance use) were significantly related with stressful events, highlighting the importance of longitudinal research in delineating the temporal ordering of events and outcomes. The authors conclude that future stress research with adolescents should pay particular attention to the important moderating influences of culture and ethnicity as well as to the bidirectional nature of life events and substance use.     

The interaction of social network size and stressful life events predict delayed-type hypersensitivity among women with metastatic breast cancer.

This study examined relationships between social support, stressful life events and antigen-specific cell-mediated immunity. Participants were 72 women with documented metastatic breast carcinoma, who completed self-report measures of social support and life stress. Immune response was assessed using the delayed type hypersensitivity (DTH) skin test. Number of positive antigens was significantly related to the interaction of social network size and stressful life events (p<0.05). Number of positive antigens was greater for women who had experienced a high frequency of stressful life events but who reported a larger network of support. However, social network size was inversely related to DTH response among women who had experienced fewer stressful life events. Average induration size was not significantly related to the quality of social support, life stress per se, or their interactions. The relationship between social network size and immune response in women with metastatic breast cancer depends on prior stressful life experience.     

Lower rates of low birthweight and preterm births in the California Black Infant Health Program

OBJECTIVES: The objective of this study was to determine the impact of prenatal interventions in the California Black Infant Health (BIH) Program on low birthweight (LBW) and preterm births (PTB) outcomes. METHODS: A prospective observational study design with a comparison group was used. BIH participants with a delivery recorded between July 1996 and September 1998 were included in the birthweight and PTB analyses. These outcomes for BIH participants who entered the BIH program prior to 32 weeks' gestation (n=1,553) were compared to those of all African-American women in the BIH Program targeted ZIP codes (n=11,633). RESULTS: No statistically significant differences in LBW and PTB were found between the BIH population and the comparison group. However, a comparison of the BIH infant VLBW (<1,500 g) rate (1.9%) with the VLBW rate for the comparison group (3.0%) shows that the BIH rate is 63% of the comparison group rate. For very PTB (<32 weeks), the BIH rate (3.5%) is 81% of the comparison group rate (4.3%). BIH participants had higher risk profiles (pregnancy history, current pregnancy, and psychosocial; p=<0.01) than women in the comparison group. CONCLUSIONS: The BIH Program retained high-risk women in the program to delivery and assisted them with maintenance of prenatal care. Even though the program participants were higher risk, their LBW and PTB outcomes were comparable to the geographic area overall. More importantly, there was a trend among women in the BIH Program toward better outcomes than the comparison group in both VLBW and VPTB.     

Stressful life events, psychological appraisal and coping style in postmenopausal women

Objectives

The study aim was to investigate what life events postmenopausal women attending a menopause clinic, report as stressful and how psychological appraisal of these events, menopausal symptoms and general stress mediate coping style.

Methods

An observational design was used to recruit 179 postmenopausal women attending a menopause clinic for the first time. Data was collected using self-report questionnaires assessing socio-demographic information, menopausal symptoms, perceived stress, named stressful event, psychological appraisal and coping styles employed.

Results

All of the women were postmenopausal, with a mean age of 50.74 years (SD = 4.75). Stressful events were categorised into family problems, menopause symptoms, work problems, daily hassles and other health problems. The most commonly reported coping styles were in order, catharsis (68%), direct action (66%), and seeking social support (63%). Logistic regression was used to determine what predicts coping style. Socio-demographic variables, menopausal symptoms and general stress levels were not predictive of coping styles in this study. Specific aspects of psychological appraisal were predictive of distraction, direct action, catharsis and seeking social support.

Conclusions

Coping styles most commonly implemented were also the ones predicted by psychological appraisal of the stressful event in this study and tend to be used more so by older women. This information could be used to develop more appropriate interventions for postmenopausal women.     

The association of perceived discrimination with low back pain

A handful of recent studies have documented perceived discrimination as a correlate of poor physical and mental health status among ethnic and racial minority groups. To date, however, despite a proliferation of research on ethnic disparities in the severity and impact of a number of persistent pain conditions, there have been no reports on associations between perceived discrimination and pain-related symptoms. Using data from a national survey (the National Survey of Midlife Development in the United States; MIDUS), we explore the relationships between perceived discriminatory events and the report of back pain among African-American and white men and women. As expected, African-American participants reported substantially greater perceptions of discrimination than white participants. Moreover, in models that included a variety of physical and mental health variables, episodes of major lifetime discriminatory events were the strongest predictors of back pain report in African-Americans, and perceived day-to-day discrimination was the strongest predictor of back pain report specifically in African-American women. Among white participants, perceptions of discrimination were minimally related or unrelated to back pain. To our knowledge, these are the first data documenting an association between perceived discrimination and report of back pain; the fact that perceptions of discrimination were stronger predictors than physical health variables highlights the potential salience and adverse impact of perceived discrimination in ethnic and racial minority groups.     

Socioeconomic status and stress in Mexican–American women: a multi-method perspective

Stress is a hypothesized pathway in socioeconomic status (SES)-physical health associations, but the available empirical data are inconsistent. In part, this may reflect discrepancies in the approach to measuring stress across studies, and differences in the nature of SES-stress associations across demographic groups. We examined associations of SES (education, income) with general and domain-specific chronic stressors, stressful life events, perceived stress, and stressful daily experiences in 318 Mexican–American women (40–65 years old). Women with higher SES reported lower perceived stress and fewer low-control experiences in everyday life (ps < .05), but greater chronic stress (education only, p < .05). Domain-specific analyses showed negative associations of income with chronic housing and financial stress (ps < .05), but positive associations of SES with chronic work and caregiving stress (all ps < .05 except for income and caregiving stress, p < .10). Sensitivity analyses showed that most SES-stress associations were consistent across acculturation levels. Future research should adopt a multi-dimensional assessment approach to better understand links among SES, stress, and physical health, and should consider the sociodemographic context in conceptualizing the role of stress in SES-related health inequalities.     

Racial/Ethnic differences in self-reported health problems and herbal use among older women

The purpose of this study was to examine the racial/ethnic differences in self- reported health problems and herbal use as a self-care practice between white American and African-American older women, and between herbal users and nonusers. Two data sets collected in 1998 and 2002 were combined to perform this study. The total sample (143 participants) consisted of 85 white Americans and 58 African-American women > or = 65 years, living independently in the community. While there were statistically significant differences in education (chi-squared = 19.085, p=0.0001) and annual income (chi-squared = 21.905, p=0.0001) between white American and African-American women, no differences were found in the use of herbals between the two groups. There was a significant relationship between the number of herbals used and the number of nonprescribed medications used (gamma = 0.320, p<0.01). No relationship was detected between the number of herbals used and self-reported health problems (gamma = 0.075, p<0.01), and between the number of nonprescribed medications used and self-reported health problems (gamma = 0.047, p<0.01). White American herbal users utilized the highest number of combination products (prescribed, nonprescribed and herbals) of all. African-American herbal users indicated a higher number of combination products than African-American nonusers. Results suggested that herbals were used as a complementary rather than an alternative therapy to manage perceived health concerns in both groups.     

Five psychosocial variables related to the existence of post-traumatic stress disorder symptoms

Sixty Vietnam veterans from a midwestern VA Medical Center were surveyed to determine the relationship between symptoms of Post-Traumatic Stress Disorder (PTSD) and five psychosocial variables: Intensity of combat experienced in Vietnam, current subjective impact of the previously experienced stress of Vietnam experiences, current level of life stress, extent and nature of social support available to the veteran during the first year of return from Vietnam, and pre-service psychosocial functioning. A stepwise discriminant function analysis revealed that combat intensity, current impact of the previously experienced events in Vietnam, and current level of life stress correctly classified 75% of the total cases. These findings were supported by other lines of analyses, including tests of correlation and stepwise regression analysis. Current levels of life stress, especially disruption in interpersonal relationships, also were associated significantly with PTSD symptoms. These findings are consistent with previous reports on the etiology and correlates of PTSD symptoms and suggest the existence of a quantifiable constellation of symptoms associated with psychological sequelae of severely stressful trauma.     

Effects of stress and social support on recurrence in bipolar disorder

BACKGROUND: Limited research has examined the impact of social support on the course of bipolar disorder, although results suggest a probable link. This study examines prospectively the effects of stressful events and social support on episode recurrence in bipolar I disorder. METHODS: Fifty-two outpatients with bipolar I disorder recruited from an urban community were followed every 3 months for up to 1 year. At the initial interview, individuals reported separately on perceived social support from a best friend, parent, and romantic partner, combined to form a total network support score. Ongoing prospective assessments of stressful life events, symptomatology, and medication compliance were completed over 1 year. Logistic regressions were utilized to predict episode recurrence. RESULTS: As predicted, both higher levels of stress and lower levels of social support from the total network independently predicted depressive recurrence over a 1-year follow-up, after controlling for clinical history and compliance. Social support did not moderate the impact of stress. LIMITATIONS: Only a 1-year follow-up was obtained, and sample sizes may have been insufficient to detect prediction of manic episodes. Direction of causality between support and recurrence is hypothesized but cannot be definitively determined. CONCLUSIONS: Higher levels of stress and perceptions of less available and poorer quality close relationships are associated with recurrence. Interventions that target these psychosocial vulnerabilities may help alter the course of bipolar I disorder. Research with larger samples should further examine the possible polarity-specific effects of social risk factors.     

The impact of nurse case management home visitation on birth outcomes in African-American women

The views expressed in this article are those of the authors and do not necessarily reflect the official policy or position of the Uniformed Services University of the Health Sciences, Department of the Navy, Department of Defense or the U. S. government. Dr. Wells is a military service member (employee of the U.S. government). This work was prepared as a part of her official duties. Title 17, USC Section 101 defines a U.S. government work as a work prepared by a military service member or employee of the U.S. government as part of the person's official duties. Despite substantial reductions in U.S. infant mortality rates, racial disparities persist, with black Americans experiencing 2.4 times the rate of their white counterparts. Low birthweight and preterm delivery contribute to this disparity. METHODS: To examine the association between antepartum nurse case management home visitation and the occurrence of low birthweight and preterm deliveries in African-American women in Montgomery County, MD, a retrospective cohort study was conducted using existing data from 109 mothers who were enrolled in the Black Babies Start More Infants Living Equally Healthy (SMILE) program. Logistic regression analysis was used. RESULTS: Women who received antepartum home visits were 0.37 (CI 0.15-0.94) times less likely to experience preterm delivery than women who did not receive antepartum home visits. The effect of antepartum home visits on preterm delivery was independent of level of prenatal care, negative life events and number of prior live births. There was no significant association between antepartum home visits and low birthweight. CONCLUSION: Antepartum home visits appeared to be protective against preterm delivery and could contribute to reducing racial disparities in infant mortality. Further study is needed to understand and replicate specific program components that may contribute to improved birth outcomes in African-American women.     

Social stress and women's risk for recurrent depression

Summary The lives of depressed women appear to be stressful. Based on data from a community sample of women with histories of depression, support for an interpersonal stress perspective on women's depression is presented. Women often find themselves embedded in environments with high levels of chronic stress and negative life events. Compared to never-depressed women, those who are currently depressed, and even those with prior but not current depression, are relatively more likely to experience divorce and marital difficulties, spouses with psychiatric disorders, problematic relationships with their children, children with high rates of disorder, and recent elevated rates of personal stressful life events. Such life challenges may increase the likelihood of further depressive experiences. While both psychosocial and genetic factors may contribute to the interpersonal vulnerabilities, once caught up in depression-maintaining environments, treatments for women may require intervention in the family and interpersonal domains. Received October 15, 2002; accepted November 17, 2002 Published online January 17, 2003 RID="*" ID="*"  Presented at the First World Congress on Women's Mental Health, Berlin, March, 2001; Symposium: Understanding the interaction of stress and gender in the prediction of major depression and treatment response. Correspondence: Constance Hammen, Ph.D., Department of Psychology, University of California, Los Angeles, 405 Hilgard Ave., Los Angeles, CA 90095, U.S.A.; e-mail: hammen@psych.ucla.ed     

Late middle-aged and older men living with HIV/AIDS: race differences in coping, social support, and psychological distress

Although AIDS mental health research has recently devoted more attention to the psychosocial needs of older adults living with human immunodeficiency virus (HIV) disease, studies of this population have typically combined older African-American and white participants into one large sample, thereby neglecting potential race differences. The current study examined race differences in stressor burden, ways of coping, social support, and psychological distress among late middle-aged and older men living with HIV/AIDS. Self-administered surveys were completed by 72 men living with HIV/AIDS in New York City and Milwaukee, WI (mean age = 53.4 years). Older African-American and white men experienced comparable levels of stress associated with AIDS-related discrimination, AIDS-related bereavement, financial dilemmas, lack of information and support, relationship difficulties, and domestic problems. However, in responses to these stressors, older African-American men more frequently engaged in adaptive coping strategies, such as greater positive reappraisal and a stronger resolve that their future would be better. Compared to their African-American counterparts, HIV-infected older white men reported elevated levels of depression, anxiety, interpersonal hostility, and somatization. African-American men also received more support from family members and were less likely to disclose their HIV serostatus to close friends. As AIDS becomes more common among older adults, mental health-interventions will increasingly be needed for this group. The development of intervention programs for this group should pay close attention to race-related differences in sociodemographic, psychosocial, and behavioral characteristics.     

Chronic social stress: effects on limbic brain structures

Different types of stressors are known to activate distinct neuronal circuits in the brain. Acute physiological stimuli that are life threatening and require immediate reactions lead to a rapid stimulation of brainstem and hypothalamus to activate efferent visceral pathways. In contrast, psychological stressors activate higher-order brain structures for further interpretations of the perceived endangerment. Common to the later multimodal stressors is that they need cortical processing and, depending on previous experience or ongoing activation, the information is assembled within limbic circuits connecting, e.g., the hippocampus, amygdala and prefrontal cortex to induce neuroendocrine and behavioral responses. In view of the fact that stressful life events often contribute to the etiology of psychopathologies such as depressive episodes, several animal models have been developed to study central nervous mechanisms that are induced by stress. The present review summarizes observations made in the tree shrew chronic psychosocial stress paradigm with particular focus on neurotransmitter systems and structural changes in limbic brain regions.     

Psychosocial factors in the etiology of breast cancer: review of a popular link

Breast cancer is the most frequently occurring type of cancer in women in the western world. The etiology of a large proportion of breast cancers is still unexplained, and the possibility that psychosocial factors could play a role is not ruled out. Already in pre-Christian times, it was assumed that psychological factors might play a significant role in the development of breast cancer. However, studies have failed to produce conclusive results. There is still a lack of knowledge on the relationship between breast cancer development and psychosocial factors such as stressful life events, coping styles, depression, and the ability to express emotions. The results of this review show that there is not enough evidence that psychosocial factors like 'ways of coping' or 'non-expression of negative emotions', play a significant role in the etiology of breast cancer.     

Income,race/ethnicity,and exposure to violence in youth: Results from the national survey of adolescents

This study examined the associations between household income, race/ethnicity, and exposure to violence in a nationally representative sample of youth. Participants included a national probability sample of adolescents (ages 12-17), who completed a telephone interview that assessed lifetime occurrences of witnessing violence, receipt of physically abusive punishment, physical assault, and sexual assault. Results indicated that as household income increased prevalence of witnessing violence, receipt of physically abusive punishment, physical assault, and sexual assault decreased for Caucasian but not African-American or Hispanic youth. In addition to the interaction of household income with race/ethnicity, a main effect of race/ethnicity across income groups was apparent for witnessing violence. More specifically, African-American and Hispanic youth reported significantly higher rates of witnessing violence at each income level relative to their Caucasian counterparts. Findings from this nationally representative sample of youth suggest that it may be simplistic to interpret high rates of violence exposure among minority youth as due to their disproportionate representation among the economically disadvantaged in the United States. This study illustrates the importance of examining risk and protective factors separately for each type of violence experienced by youth, and underscores the need to assess the generalizability of risk and protective factors across racial/ethnic groups. � 2000 John Wiley & Sons, Inc.