Depression in South Asian women: Asian women's beliefs on causes and cures

A qualitative, grounded theory approach within a constructivist paradigm is employed to explore perceptions of causes and cures of depression in South Asian women. Ten Asian women suffering from depression and three of their carers were interviewed about their beliefs around the cause of their own and their relative's depression, and the implications of these beliefs for treatment. Findings suggested that understanding their experience of conflicting cultural expectations, distinctions between psychosocial, spiritual, physical health problems and communication problems (general and culture specific) were central to these women's experiences of depression The implications of results for services are discussed and limitations of the study considered in line with criteria developed for constructivist research.     

Adverse childhood experiences and autonomic regulation in response to acute stress: the role of the sympathetic and parasympathetic nervous systems

Background and objectives: After a previous report demonstrated blunted heart rate (HR) reactivity in association with adverse childhood experiences (ACEs) [Voellmin, A., Winzeler, K., Hug, E., Wilhelm, F. H., Schaefer, V., Gaab, J.,?…?Bader, K. (2015). Blunted endocrine and cardiovascular reactivity in young healthy women reporting a history of childhood adversity. Psychoneuroendocrinology, 51, 58–67. doi:10.1016/j.psyneuen.2014.09.008], the present analysis aimed at clarifying the role of the sympathetic and parasympathetic branches of the autonomic nervous system in this relationship.

Design and Methods: One hundred eighteen healthy young women provided data on ACEs and underwent psychosocial stress testing. Systolic blood pressure (SBP) and respiratory sinus arrhythmia (RSA, quantified by high-frequency HR variability) were assessed as measures of sympathetic and parasympathetic cardiovascular activity, respectively. A mediation model was calculated to test the indirect effects of ACEs on HR via SBP and RSA.

Results: The effect of ACEs on HR reactivity was mediated by SBP reactivity but not by RSA reactivity. ACEs were associated with reduced SBP at rest.

Conclusions: ACEs were associated with down-regulation in a measure of sympathetic but no alteration in a measure of parasympathetic cardiovascular stress reactivity in adulthood. Future research will need to clarify whether this indicates risk or resilience.     

Psychosocial mediators of a lifestyle physical activity intervention in women

ObjectivesA lifestyle physical activity intervention in women based on the transtheoretical model and social–cognitive theory effectively increased physical activity. The aim of the present study was to examine possible mediators (perceived benefits and barriers of physical activity, self-efficacy, processes of change, and social support) of these physical activity changes.MethodsMembers of four units of a women's organization followed a six-month minimal-contact physical activity program. The intervention program included one group meeting, a self-help booklet and five monthly reminder letters. Members of two other units served as control group. Physical activity (accelerometer counts), and psychosocial constructs (self-report questionnaires) were assessed at baseline (pretest) and directly after the intervention (posttest). Women who completed all measurements (n = 101) were included in the mediation analyses.ResultsParticipants in the intervention group reported significantly greater increases in the use of behavioral processes from pretest to posttest than participants in the control group. None of the proposed psychosocial constructs showed a mediating effect on changes in physical activity.ConclusionsThe mechanisms proposed by the transtheoretical model and social–cognitive theory could not explain the positive effect of the intervention on physical activity. Identifying the working components of an intervention remains a challenging and necessary step in the development of effective low-cost and high-reach physical activity interventions.     

Support during birth interacts with prior trauma and birth intervention to predict postnatal post-traumatic stress symptoms

Background: Many women experience childbirth as traumatic and 2% develop post-traumatic stress disorder. This study examined the role of health practitioner support and personal control during birth as predictors of post-traumatic stress (PTS) symptoms, adjusting for vulnerability factors of prior trauma, depression, control beliefs and birth intervention. It also investigated interactions between support, prior trauma and birth intervention and their association with PTS symptoms.

Methods: A prospective longitudinal survey of 138 women recruited from UK NHS maternity clinics. Measures were taken in pregnancy, 3 weeks and 3 months after the birth.

Results: Support and control during birth were not predictive of postnatal PTS symptoms. However, support was predictive of PTS symptoms in a subset of women with prior trauma (β?=??0.41, R ²?=?16%) at both 3-weeks and 3-months postpartum. The interaction of birth intervention and support was associated with PTS symptoms 3 months after birth, the relationship between support and PTS symptoms was stronger in women experiencing more intervention.

Conclusions: Low support from health practitioners is predictive of postnatal PTS symptoms in women who have a history of trauma. Longer term effects of low support on postnatal PTS symptoms are also found in women who had more intervention during birth.     

Health-related behaviours and their correlates in a general population sample of 45-year old women

Abstract

Preventive strategies for menopausal women to reduce the risks for osteoporosis and cardiovascular disease has been the focus of considerable attention, but understanding of mid-aged women's behavioural risk factors for these diseases is meagre. The current study describes a range of health-related behaviours and their psychosocial correlates, in a sample of 45-year old women, recruited from five general practices and assessed by postal survey (N=106, response rate 60%). Results suggest that health promotion for this group might best focus upon increases in regular exercise, calcium intake and breast awareness, and decreases in cigarette and caffeine consumption. The behaviours assessed were generally not inter-related. However, several associations were identified between behaviours and health and psychosocial variables. The main ones were the association between menopausal status and smoking, and the relationship between body weight, self-esteem and physical exercise. It is argued that the menopause transition can be an opportunity for preventive work.     

Risk factors for psychological morbidity in women attending a one-stop diagnostic clinic with suspected breast disease

Abstract

The present study was designed to identify risk factors for psychological morbidity in women attending a one-stop diagnostic clinic with suspected breast disease. A cohort of 158 women were recruited and were asked to complete scales measuring psychological morbidity and psychosocial factors in the period immediately before their appointment and to repeat the assessments of psychological morbidity on the day of the appointment. Relevant clinical and demographic data were also collated. Within the cohort 1.4% of respondents received a diagnosis of malignant disease. Psychological morbidity, both prior to and during the diagnostic appointment was strongly predicted by psychosocial factors (i.e., acceptance-resignation coping, personal self esteem and discrepancies in social support), accounting for 54% and 63% of the variance at pre-appointment and appointment day phases respectively. Other measured variables were found not to be correlated with and/or to account for a significant proportion of the variance in the measures of morbidity. These results suggest that these psychosocial variables should be targeted in interventions designed to reduce psychological morbidity in this patient group.     

Cumulative trauma and midlife well-being in American women who served in Vietnam: effects of combat exposure and postdeployment social support

Background and Objectives: Research increasingly demonstrates that trauma exposure can have cumulative effects, yet much remains to be learned about effects of cumulative trauma, particularly regarding longer term adjustment. One such trauma, combat exposure, is insufficiently understood, especially for women, who are increasingly engaged in professional combat activities. Design: The study comprised a cross-sectional survey assessing multiple aspects of current well-being in women approximately 25 years after their service in Vietnam during the Vietnam War. Methods: Participants were 1374 women (78% military and 22% nonmilitary; mean age = 59.7). This study investigated the relations between three separate categories of trauma exposure (childhood, adulthood, and combat) and well-being and examined whether perceived social support at return from Vietnam moderated the association between combat exposure and well-being. Results: While both childhood and adulthood trauma exposure related to midlife well-being, combat exposure still uniquely predicted outcomes. Further, postdeployment perceived social support moderated the association of combat and well-being: recollected higher perceived social support at homecoming buffered participants from the links between combat exposure and well-being. Conclusions: These results may have important implications for interventions to reduce the impact of traumatic experiences, particularly in light of the increasing exposure of women to direct combat events.     

Physical fitness and prior physical activity are both associated with less cortisol secretion during psychosocial stress

Background: Evidence linking fitness and decreased psychosocial stress comes from studies of athletes and typically relies upon self-report measures. Furthermore, there is little evidence regarding the impact of physical activity (PA) prior to a stressor. The aims of this study were to determine whether fitness and prior PA influence cortisol concentrations during psychosocial stress.

Methods: Seventy-five non-athletic participants took part in a submaximal walk prior to the Trier Social Stress Test for Groups (TSST-G). During the walk, fitness was assessed using heart rate (HR). A further 89 participants took part in the TSST-G without the walk. Stress responsiveness was assessed using salivary cortisol collected at 10-min intervals on seven occasions.

Results: Hierarchical multiple regression revealed that average walking HR accounted for 9% of the variance in cortisol secretion (P?=?.016), where a higher HR was associated with higher cortisol secretion. Between-subjects ANCOVA revealed that the walking group had a significantly lower cortisol secretion than the non-walking group (P?=?.009).

Conclusions: These findings indicate that fitter individuals have reduced cortisol secretion during psychosocial stress. They also indicate that prior PA can reduce cortisol concentrations during psychosocial stress and are suggestive of a role of PA in reducing the impact of stress on health.     

Legacies of War: Asian American Women and War Trauma

ABSTRACT

Although Asian Americans are diverse in many ways, such as language, culture, ethnicity, religion, generational status, and more, many share a common experience: that of having experienced war first hand or being progeny of war survivors. World War II, the Korean War, the Vietnam War, the Cambodian genocide, along with centuries of oppressive and authoritarian rule, have brought experiences of trauma, directly and historically, to the lives of many Asians. Subsequent experiences of migration and resettlement, as well as life in the United States as an ethnic minority, have also compounded the layers of oppression for many Asian Americans. Sexism in our cultures of origin, as well as sexism in the U.S., represents additional realities and traumas faced by Asian American women. In this article, we explore the experiences of war and subsequent traumas in the lives of Asian American women. We present a brief review of the current state of mental health as it relates to the experiences of war trauma, with the goal of providing a crucial contextual backdrop for our review of the best practices in mental health services to Asian American women. We review some of the best practices and conclude with a narrative reflection based on our own involvement in a small professional women’s group that yielded insights, discoveries, healing, and empowerment from the legacy of war trauma.     

How do psychosocial challenges associated with living with congenital heart disease translate into treatment interests and preferences? A qualitative approach

Objectives: There is an increasing amount of research being conducted regarding the psychosocial challenges associated with living with congenital heart disease (CHD), however little is known about how these challenges influence the type of psychosocial services patients want. This study investigated (1) the type of services patients want; (2) how they want to access these services; and (3) why they want these services.

Methods: Three focus groups with adults with CHD (total of 14 participants aged 19–67) were conducted and thematic analysis was used to identify emerging themes.

Results: Participants described wanting to access specific psychosocial services in three broad categories (counselling, connecting with other adults with CHD and psycho-education) and in three main formats (individual/group therapy, mentorship programmes and patient conferences). Reasons for wanting these services were grouped under two overarching themes, namely intrapersonal factors and interpersonal challenges.

Conclusions: Psychosocial challenges are part of the everyday lives of adults with CHD, yet they are rarely addressed as part of routine medical care. Patients themselves have clear opinions regarding the psychological services most appropriate to target their experiences of living with CHD.     

Posttraumatic growth following pregnancy termination for fetal abnormality: the predictive role of coping strategies and perinatal grief

Background: Research about termination for fetal abnormality (TFA) suggests that it is a traumatic event with potential negative psychological consequences. However, evidence also indicates that following traumatic events individuals may experience growth. Although TFA’s negative psychological outcomes are well documented, little is known of the potential for growth following this event. Therefore, the study’s objectives were to measure posttraumatic growth (PTG) post-TFA, examine the relationship between PTG, perinatal grief and coping, and determine the predictors of PTG.

Design: An online, retrospective survey was conducted with 161 women.

Methods: Eligible participants were women over 18 who had undergone TFA. Participants were recruited from a support organisation. They completed the Brief COPE, Short Perinatal Grief Scale and Posttraumatic Growth Inventory. Data were analysed using regression analyses.

Results: Moderate levels of PTG were observed for “relating to others,” “personal strengths” and “appreciation of life.” “Positive reframing” was a significant predictor of PTG. Despite using mainly “adaptive” coping strategies, women’s grief levels were high.

Conclusions: “Adaptive” coping strategies such as, “positive reframing” are relevant to TFA. They may act as protective factors against distress and as foundations for growth, implicating that interventions such as Cognitive Behavioural Therapy, which aim to reframe women’s experience, may be beneficial.     

Maternal Childhood Sexual Trauma and Early Parenting: Prenatal and Postnatal Associations

Existing research suggests that approximately 19% of females experience childhood sexual trauma (CST). Little is known, however, about the parenting behaviour of mothers who have experienced CST. Using propensity‐matched controls, the present study examines prenatal psychosocial distress, postnatal depressive symptomatology, and caregiving behaviours of women reporting CST at or before the age of 14. Data for these analyses were obtained from mother reports and from observational protocols from a longitudinal study of low‐income, rural families. Propensity score methodology was used to create a contrast group matched on family of origin variables in an effort to isolate and examine the long‐term associations of CST beyond the effects of other childhood adversities such as poverty. Study findings provide evidence that women with CST histories report greater prenatal psychosocial distress compared to women without trauma histories. Findings further provide evidence for a spillover process from prenatal distress to the broader caregiving system including less sensitive parenting through postnatal depressive symptoms for women with CST histories. These results highlight the importance of screening for CST and psychosocial distress and depression prenatally. Interventions for women with CST histories and directions for future study are proposed. Copyright © 2016 John Wiley & Sons, Ltd.     

Applying Motivational Interviewing in a Domestic Violence Shelter: A Pilot Study Evaluating the Training of Shelter Staff

ABSTRACT

This pilot study examined the use of motivational interviewing (MI) with 20 women receiving services at a domestic violence shelter. The experimental group (n = 10) received regular treatment services (RTS) from shelter counselors who were trained in MI; the control group (n = 10) received RTS only. Fisher's exact test showed that participants who received MI-enhanced RTS were significantly more motivated for change (p = .029), as measured through a dichotomous readiness for change motivational variable on the University of Rhode Island Change Assessment (URICA; Center on Alcoholism, Substance Abuse, &; Addiction Research Division, 1996 Center on Alcoholism, Substance Abuse, &; Addiction Research Division. 1996. University of Rhode Island Change Instrument (URICA) Scale, Albuquerque, NM: Author.  [Google Scholar]). Findings suggest that MI can be helpful in increasing the readiness for change in domestic violence survivors who contemplate leaving abusive relationships.     

Social relationships,stressful life events,and self-reported physical health: Genetic and environmental influences

Abstract

This study investigates how the associations between self-reported health, stressful life events, and social relationships are mediated by genetic and environmental influences and how much of the variance in health is in common with variation in these psychosocial factors. The analyses are based on questionnaire data from 576 pairs of twins reared apart and twins reared together. The data revealed that for men environmental influences were solely important for variation in the psychosocial measures and were the primary mediators of the relationship with health. For women, on the other hand, a substantial portion of the variance in the psychosocial factors was due to genetic influences and these influences also contributed to the bulk of the correlations with health. The gender differences for the relationships and their mediation indicate that what should be regarded as a psychosocial factor of importance for health might differ between genders.     

Effects of gender role self-discrepancies and self-perceived attractiveness on social anxiety for women across social situations

Background and objectives: Psychosocial factors, such as gender role norms, may impact how social anxiety disorder (SAD) is experienced and expressed in different social contexts for women. However to date, these factors have not been examined via experimental methodology. Design: This was a cross-sectional, quasi-experimental controlled study. Methods: The current study included 48 highly socially anxious (HSA) women (70.9% meeting criteria for SAD) and examined the relationships among psychosocial factors (i.e. gender role self-discrepancies and self-perceived physical attractiveness), self-perceived social performance, and state anxiety, across two in vivo social tasks (i.e. conversation and opinion speech). Results: On average, participants reported belief that they ought to be less feminine for the speech task and more masculine for both the conversation and speech tasks. Also, for the conversation task, only lower self-rated attractiveness predicted poorer self-perceived performance and greater post-task state anxiety, above gender role self-discrepancies and confederate gender. For the speech task, only greater self-discrepancy in prototypical masculine traits predicted poorer performance ratings, and it was related to greater state anxiety in anticipation of the task. Conclusion: For HSA women, psychosocial factors may play different roles in social anxiety across social contexts.     

Effects of group prenatal care on psychosocial risk in pregnancy: results from a randomised controlled trial

Few interventions have succeeded in reducing psychosocial risk among pregnant women. The objective of this study was to determine whether an integrated group prenatal care intervention already shown to improve perinatal and sexual risk outcomes can also improve psychosocial outcomes compared to standard individual care. This randomised controlled trial included pregnant women ages 14-25 from two public hospitals (N = 1047) who were randomly assigned to standard individual care, group prenatal care or integrated group prenatal care intervention (CenteringPregnancy Plus, CP+). Timing and content of visits followed obstetrical guidelines, from 18-week gestation through birth. Each 2-h group prenatal care session included physical assessment, education/skills building and support via facilitated discussion. Using intention-to-treat models, there were no significant differences in psychosocial function; yet, women in the top tertile of psychosocial stress at study entry did benefit from integrated group care. High-stress women randomly assigned to CP+ reported significantly increased self-esteem, decreased stress and social conflict in the third trimester of pregnancy; social conflict and depression were significantly lower 1-year postpartum (all p-values < 0.02). CP+ improved psychosocial outcomes for high-stress women. This 'bundled' intervention has promise for improving psychosocial outcomes, especially for young pregnant women who are traditionally more vulnerable and underserved.     

The Capacity for Emotional Growth

As the AIDS epidemic continues to spread throughout Australia, the incidence of infection is moving from the major risk group of middle-aged gay men to involve bisexual men, women, and youth. Because of their age, the latter group has unique problems lacking formal legal and social recognition and access to established institutions. The Albion Street Centre, a screening clinic for the AIDS virus, provides medical management and psychosocial services to infected youth. A major component of the psychosocial facilities is an emotional support group. This article reviews the literature relating to support groups and suggests why this therapeutic approach is especially useful for youth who have come into contact with the AIDS virus. The nature of the support group is detailed with particular reference to important issues and suggestions made for future developments during its operation.     

Group Psychotherapy and Rehabilitation of Long-Stay Patients

Abstract

Bulimia is a complex disorder that can significantly interfere with psychosocial functioning. It is a particularly significant problem among adolescents and young women in college and university settings. The preponderance of literature on group therapeutic approaches for this disorder is from a cognitive–behavioral perspective. In this paper, we present a psychodynamic group therapy approach for female university students, informed specifically by self psychological and relational frameworks. Through clinical illustrations, we demonstrate how the group provides selfobject experiences, including mirroring, idealizing, twinship, and adversarial experiences, and how the group becomes the arena through which group members can experience, express, and understand emotions. The interpersonal context of the group uniquely provides opportunities for members to examine their bulimic symptoms in relation to interactions that take place outside of or within the group.     

Perceptions of the roles of behaviour and genetics in disease risk: Are they associated with behaviour change attempts

Objective: We examined selected survivor characteristics to determine what factors might moderate the response to two psychosocial interventions.

Design: Seventy-one prostate cancer survivors (PCSs) were randomly assigned to either a telephone-delivered health education (THE) intervention or a telephone-delivered interpersonal counselling (TIP-C) intervention.

Measures: Psychological quality of life (QOL) outcomes included depression, negative and positive affect, and perceived stress.

Results: For three of the psychological outcomes (depression, negative affect and stress), there were distinct advantages from participating in THE. For example, more favourable depression outcomes occurred when men were older, had lower prostate specific functioning, were in active chemotherapy, had lower social support from friends and lower cancer knowledge. Participating in the TIP-C provided a more favourable outcome for positive affect when men had higher education, prostate specific functioning, social support from friends and cancer knowledge.

Conclusion: Unique survivor characteristics must be considered when recommending interventions that might improve psychological QOL in PCSs. Future research must examine who benefits most and from what components of psychosocial interventions to enable clinicians to recommend appropriate psychosocial care.     

The role of goal adjustment in symptoms of depression,anxiety and fatigue in cancer patients receiving psychosocial care: A longitudinal study

Objective: This study examined whether cancer patients reported increases in their goal adjustment capacities while receiving psychosocial care and whether these increases were related to changes in symptoms of depression, anxiety and fatigue. Goal adjustment was conceptualised as two independent capacities: goal disengagement (i.e. disengage from unattainable goals) and goal reengagement (i.e. reengage into new goals).

Design: This naturalistic, longitudinal study focused on 241 cancer patients receiving psychosocial care at one of the seven psycho-oncology institutions in the Netherlands. Data was collected before the start of psychosocial care (T1) and nine months thereafter (T2). Hierarchical regression analysis was used to examine the research questions.

Main Outcome Measures: Goal adjustment, symptoms of depression, anxiety and fatigue.

Results: At group level, patients reported small increases in goal disengagement (d = .22) but no significant change in goal reengagement (d = .09). At an individual level, 34% of cancer patients reported an increase in goal disengagement and 30% reported an increase in goal reengagement. Increases in goal reengagement were significantly associated with decreases in both depressive and anxiety symptoms, but not to changes in fatigue.

Conclusion: Findings indicate that particularly improvements in goal reengagement are beneficial for cancer patients’ psychological functioning.