Psychological Distress and Associated Factors Among a Sample of Pregnant Women in South Africa

We sought to identify the prevalence of psychological distress and associated factors among pregnant women who were patients at antenatal primary care clinics in a South Africa district. A cross-sectional study using systematic sampling was conducted among 1497 pregnant women (age range=18 to 47 years; mean age=26.6 years, SD=6.1; Black African=98%), with a mean gestational age of 6.5 months (SD=1.6). They completed the Kessler Psychological Distress Scale, a measure of psychological distress. Results showed high rates of severe psychological distress (26.5%). Increased distress was in multivariate analysis associated with having had an STI (other than HIV), being unhappy about current pregnancy, and HIV positive. Identification of pregnant women with psychological distress in public health clinics is crucial for effective and appropriate targeted interventions.     

HIV Testing Experience and Risk Behavior Among Sexually Active Black Young Adults: A CBPR-Based Study Using Respondent-Driven Sampling in Durham,North Carolina

African Americans are disproportionately affected by the HIV epidemic inclusive of men who have sex with men, heterosexual men, and women. As part of a community‐based participatory research study we assessed HIV testing experience among sexually active 18–30 year old Black men and women in Durham, NC. Of 508 participants, 173 (74 %) men and 236 (86 %; p = 0.0008) women reported ever being tested. Barriers to testing (e.g., perceived risk and stigma) were the same for men and women, but men fell behind mainly because a primary facilitator of testing—routine screening in clinical settings—was more effective at reaching women. Structural and behavioral risk factors associated with HIV infection were prevalent but did not predict HIV testing experience. Reduced access to health care services for low income Black young adults may exacerbate HIV testing barriers that already exist for men and undermine previous success rates in reaching women.     

Social Comparison in Medically High-Risk Pregnant Women1

The present study examined social comparison processes in 147 pregnant women at high risk of incurring an adverse birth outcome such as fetal loss or preterm delivery. These women typically undergo physical and psychological changes which elevate uncertainty and distress. Theoretically derived hypotheses concerning the impact of threat, self-esteem, perceived control, age, and gravidity (previous pregnancy) on social comparison were tested. Women experiencing low pregnancy-related threat and those with higher self-esteem were more likely to compare themselves favorably to other pregnant women. Younger women who had not been pregnant before compared most frequently; comparisons of physical state were more common than comparisons of emotional well-being or interpersonal relationships. Results are contrasted with social comparison processes in other populations facing stressful life events.     

Internal poverty and teen pregnancy

The subjects for the present study were drawn from the female students who participated in the National Education Longitudinal Study (NELS) initial eighth-grade data collection. Adolescent females who later became pregnant were matched on race, birth month, and birth year with adolescent females who did not report a pregnancy. The study examined selected predictor variables from the baseline 1988 wave of data in relation to the outcome variable of pregnancy status. Results indicated a statistically significant difference in locus of control between those females who later became pregnant and those who later did not experience a pregnancy during adolescence. Those who later became pregnant were much more likely to have an external locus of control (p = .0001). Females who later became pregnant were also more likely to have a poorer sense of personal efficacy (p = .0001). Finally, females who later experienced a teen pregnancy had more traditional occupational expectations (p = .006) and lower educational expectations (p = .001) than did those who did not later report a teen pregnancy.     

The impact of prenatal maternal stress and optimistic disposition on birth outcomes in medically high-risk women.

A sizable body of evidence indicates that prenatal maternal stress (PNMS) has an adverse impact on birth outcomes, including birth weight and gestational age at delivery. The authors hypothesized that effects of PNMS are attributable in part to dispositions such as pessimism that lead women to view their lives as stressful and that effects of PNMS and disposition on birth outcome are mediated by prenatal health behaviors. Using structural equations modeling procedures, the authors examined prospective impact of PNMS and dispositional optimism on birth weight and gestational age in a medically high-risk sample (N = 129), controlling for effects of risk and ethnicity. After its strong inverse association with optimism was accounted for, PNMS had no impact on birth outcomes. Women who were least optimistic delivered infants who weighed significantly less, controlling for gestational age. Optimists were more likely to exercise, and exercise was associated with lower risk of preterm delivery. Results suggest that chronic stress in pregnancy may be a reflection of underlying dispositions that contribute to adverse birth outcomes.     

Research Report: Antenatal HIV testing from the perspective of pregnant women and health clinic staff in South Africa—implications for pre- and post-test counselling

HIV testing is not routinely available at present in health clinics in Umtata, South Africa. However current statistics indicate that up to 25% of the population may be infected. Such findings imply that HIV testing and counselling should be introduced in health clinics as a means of promoting HIV prevention and reducing the risk of vertical transmission. However this would only be beneficial if staff are prepared to implement it and patients are willing to test. The issues are couched in a background of political activity surrounding HIV that may question approaches to HIV testing and a lack of availability of interventions to prevent mother to infant transmission. Furthermore the infrastructures of counselling training and provision may not be universally available, especially in pressured rural clinics. Therefore, a group of clinic staff and pregnant women, in rural and urban health centres in Umtata, were asked to participate in focus group discussions to elicit attitudes to HIV testing and counselling. In principal the majority of women, particularly in the rural clinic, were willing to have an HIV test, and strongly articulated the desire to test with their partners. Women who were reluctant to test emphasized their fear of receiving the result. The rural women appeared to be far more willing to disclose their HIV status to clinic staff, than urban women. Nevertheless, the discussions illustrated the impact of the stigma surrounding HIV, with clinic staff reporting cases where patients who were suspected to be positive were avoided by health workers. However staff in both clinics were willing to make the effort to implement HIV tests if they were to be made available. Despite the non-availability of rapid testing and interventions to reduce mother to child transmission most women saw advantages to HIV test provision. Pessimism and fear were underlying emotions associated with HIV for both staff and women. The implications for pre- and post-test counselling are discussed.     

Psychological adaptation and birth outcomes: the role of personal resources, stress, and sociocultural context in pregnancy.

Prenatal psychosocial predictors of infant birth weight and length of gestation were investigated in a prospective study of 120 Hispanic and 110 White pregnant women. Hypotheses specifying that personal resources (mastery, self-esteem, optimism), prenatal stress (state and pregnancy anxiety), and sociocultural factors (income, education, ethnicity) would have different effects on birth outcomes were tested using structural equation modeling. Results confirmed that women with stronger resources had higher birth weight babies (beta = .21), whereas those reporting more stress had shorter gestations (beta = -.20). Resources were also associated with lower stress (beta = -.67), being married, being White, having higher income and education, and giving birth for the first time. There was no evidence that resources buffered the effects of stress. The importance of personal resources in pregnancy is highlighted along with implications for understanding the etiology of adverse birth outcomes.     

Are Transgender Persons at Higher Risk for HIV Than Other Sexual Minorities? A Comparison of HIV Prevalence and Risks

SUMMARY

Recent studies have shown that transgender people are at high risk for HIV. Few studies, however, have directly compared the HIV risks and sexual health of transgender persons with that of other sexual minority populations. This study used baseline data of intervention studies targeting transgender persons, men who have sex with men, and women who have sex with women and men to compare their HIV risk behavior and sexual health. No significant differences were found between transgender persons and nontransgender men or women in consistent condom use or attitudes toward condom use. Transgender persons were less likely to have multiple partners and more likely to be monogamous than men who have sex with men; no differences were found between transgender persons and the women in this respect. When combining data on condom use, monogamy, and multiple partners, transgender persons did not differ from either nontransgender group in their overall risk for HIV. Transgender persons were less likely than the men or the women to have been tested for HIV. With regard to HIV prevalence, 17% of the men compared to only one transgender person and none of the women reported being HIV-positive. Transgender persons were also less likely than men who have sex with men to use drugs; no differences were found in the use of alcohol. However, with regard to mental health, transgender persons were more likely than the men to have experienced depression and more likely than men or women to have considered or attempted suicide. Finally, transgender persons reported the lowest levels of support from family and peers. Thus, in our sample, transgender persons appear to be at lower risk for HIV but at higher risk for mental health concerns than men who have sex with men. Remarkably few differences were found between transgender persons and women who have sex with women and men-a finding which might reflect the impact of social stigma on sexual health and have implications for the design of future HIV/STI prevention efforts.     

Adolescent pregnancy and sex roles

Traditional sex roles are related to the occurrence of adolescent pregnancy in this study. Sex-role orientation and related variables were measured by a questionnaire administered to 161 young women aged 13 to 18 years when they sought pregnancy tests or birth control information at one of several clinics. The hypothesis of the study, that adolescents who get pregnant are more likely than other sexually active young women to be traditional in sex-role orientation, receives some support from the findings. Pregnant adolescents, in comparison with birth control seeking adolescents, perceive themselves to be competent in more highly sex-typed activities, have lower aspirations and school grades, and have less sense of personal control over events in their lives. Pregnant teens do not seem to differ much from birth control seeking teens in sex-role values, and seem less likely to aspire to traditionally female occupations. Socioeconomic status (SES) is the strongest discriminator between pregnant teens and birth control seeking teens, with pregnant teens having lower SES. Pregnant adolescents, in comparison with those experiencing negative pregnancy tests, are younger and are more likely to rely on God to determine the course of their personal lives.Preliminary drafts of this article were prepared for the NSF-sponsored Chautauqua short course entitled The Psychology of the Female Experience, taught by Sharon Lord in 1980–1981, and the Pacific Sociological Association's Annual Meetings, Portland, Oregon, March 1981. The research upon which this article is based was partially supported by the Atkinson Research Fund, Willamette University. The author gratefully acknowledges the insightful comments of Chautauqua participants and staff members of the cooperating agencies.     

Repeat HIV Testing and HIV Transmission Risk Behaviors Among Sexually Transmitted Infection Clinic Patients

HIV testing and counseling expends considerable HIV prevention resources and offers great opportunities for HIV risk reduction. Individuals who are at risk for HIV and have not been HIV tested are the focus of current targeted testing campaigns and yet persons who are repeatedly tested for HIV often continue engaging in high-risk practices. This study examined HIV testing, risk behaviors, and other medical diagnostic testing practices of men (N = 231) and women (N = 86) attending an inner-city sexually transmitted infections (STI) clinic. Results showed that 75 (23%) participants had not yet been tested for HIV, 45 (14%) had been tested once, and 197 (63%) had been tested two or more times. Patients that had not been tested and those who were repeatedly tested were similar in their risk behaviors; both demonstrated significantly greater risks for HIV than persons tested just once, although repeat testers were more likely to have had a past STI. HIV testing history was minimally associated with other medical testing and health protective practices, such as testicular self-examination, mammography, and having had PAP tests. Results support targeting high-risk untested persons for HIV testing and suggest an urgent need for interventions to reduce risk behaviors among STI clinic patients who repeatedly test for HIV.     

Pregnant women's social status, stress, self-esteem, and their infants' sex ratio at birth

A reported association of social status of parents with infants' sex ratio at birth and of psychological stress (score on Beck Depression Inventory) with sex ratio were not supported by our analysis, but the possibility of an association between scores on the Rosenberg Self-esteem scale and sex ratio at birth for a sample of 385 pregnant women showed that women who have given birth to boys scored lower on self-esteem during pregnancy than those who have given birth to girls. Some explanations are reviewed to discuss this unforeseen association.     

Mothers' and fathers' changing perceptions of their male and female infants over the course of pregnancy

Twelve pregnant women and their spouses who had undergone ultrasonography and knew their child's gender were compared with 12 pregnant women and their spouses who had undergone ultrasonography but did not know their child's gender. Parents were interviewed (a) prior to receiving the ultrasound, (b) immediately after the ultrasound, and (c) following their infant's birth. Using the adjectives rating scales, and replicating the procedures developed by Rubin, Provenzano, and Luria (1974), parents' perceptions of their infants were measured. ANOVA results indicated that parents viewed their infants to be softer, finer, littler, cuddlier, easier, calmer, more inactive, more beautiful, more awkward, quieter, weaker, and somewhat more delicate following birth than during the preceding measurement period(s). Mothers viewed their infants to be softer, more nervous, more fussy, more excitable, and more noisy than did fathers. Supporting Rubin et al.'s (1974) findings, several differences emerged between parents' perceptions of boys and girls, particularly by the time the infants were born. Following birth, parents perceived girls to be finer, smaller, less coordinated, quieter, weaker, and more delicate than boys. No differences were found as a result of parents being informed of their infants' gender prior to birth.     

Parenting of low birth weight infants: A review of issues and interventions

Factors that may adversely affect parenting of low birth weight infants, including infant characteristics, parental emotional responses to premature birth, and patterns of parent-infant interaction, are reviewed. In addition, intervention studies designed to improve infant developmental outcomes through influencing parenting behaviors are examined. There was great diversity in theoretical frameworks, in timing of onset and frequency of interventions, and in measurement of outcomes. The interventions that were most effective in influencing behaviors and infant developmental outcomes were those in which there were multiple long-term contacts with parents and/or those that actively involved them in the intervention. The specific theoretical framework upon which the interventions were based appeared to be of less importance in influencing results. In order to increase our knowledge and ability to provide costeffective programs, there is a need to focus attention and data collection efforts on the process and intermediary steps of intervention as well as on outcome measures. There is also a need to improve our ability to recruit and retain those families who are most at risk for parenting and infant developmental problems including those with very low birth weight infants, those whose infants have serious perinatal complications, and those with indications of high social risk such as poverty-level incomes and problems of substance abuse.     

Measurement of Psychological Hardiness in Adolescents

Twelve pregnant women and their spouses who had undergone ultrasonography and knew their child's gender were compared with 12 pregnant women and their spouses who had undergone ultrasonography but did not know their child's gender. Parents were interviewed (a) prior to receiving the ultrasound, (b) immediately after the ultrasound, and (c) following their infant's birth. Using the adjectives rating scales, and replicating the procedures developed by Rubin, Provenzano, and Luria (1974), parents' perceptions of their infants were measured. ANOVA results indicated that parents viewed their infants to be softer, finer, littler, cuddlier, easier, calmer, more inactive, more beautiful, more awkward, quieter, weaker, and somewhat more delicate following birth than during the preceding measurement period(s). Mothers viewed their infants to be softer, more nervous, more fussy, more excitable, and more noisy than did fathers. Supporting Rubin et al.'s (1974) findings, several differences emerged between parents' perceptions of boys and girls, particularly by the time the infants were born. Following birth, parents perceived girls to be finer, smaller, less coordinated, quieter, weaker, and more delicate than boys. No differences were found as a result of parents being informed of their infants' gender prior to birth.     

Are students with disabilities suspended more frequently than otherwise similar students without disabilities?

Students with disabilities (SWD) have been reported to be disproportionately suspended from U.S. schools and so more likely to experience the “school-to-prison pipeline” through suspension's associations with lower academic achievement, dropout, juvenile delinquency, and adult criminality. Yet few studies have estimated SWD's risk of more frequent suspension while simultaneously controlling for potential confounds. Negative binomial regression modeling of suspension count data from a nationally representative and longitudinal sample (N = 6,740) indicated that males, those from lower resourced families, and students attending more economically segregated schools were more frequently suspended. On average, students who are Black received about 1.6 times as many suspensions by the end of 8th grade as otherwise similar White students. In contrast, having a disability by 1st grade was not a risk factor for more frequent suspension by the end of 8th grade while simultaneously accounting for other risk factors (e.g., gender, race/ethnicity, family SES, prior history of externalizing problem behaviors, being from a English-speaking household, school-level economic composition). Students with specific disability conditions (e.g., emotional disturbances, speech or language impairments) were not at increased risk for more frequent suspension. Students with disabilities who are Black, Hispanic, or of other race/ethnicity were not more frequently suspended than SWD who are White.     

Compliance,opposition, and behavior problems in toddlers born preterm or low birthweight

Although children born preterm or low birth weight (PT LBW) are more likely to exhibit behavior problems compared to children born at term, developmental and family processes associated with these problems are unclear. We examined trajectories of maternal depressive symptoms in relation to toddler compliance and behavior problems in families with PT LBW infants. A total of 177 infants (93 boys, 84 girls) and their mothers enrolled in the study during the infant's NICU stay. Data were collected at five time points across 2 years. Assessments of maternal depressive symptoms were conducted at all time points, and toddler compliance and opposition to maternal requests and behavior problems were assessed at 2 years. Toddlers born earlier with more health problems to mothers whose depressive symptoms increased over time exhibited the most opposition to maternal requests during a cleanup task at 24 months, consistent with multiple risk models. Mothers with elevated depression symptoms reported more behavior problems in their toddlers. The study has implications for family‐based early intervention programs seeking to identify PT LBW infants at highest risk for problem behaviors.     

Gender Roles,Power Strategies,and Precautionary Sexual Self-Efficacy: Implications for Black and Latina Women's HIV/AIDS Protective Behaviors

This cross-sectional study tested a conceptual model of women's HIV/AIDS protective behaviors using gender roles, relationship power strategies, and precautionary sexual self-efficacy as predictors in a predominantly Black and Latina community sample of heterosexual women (N = 125). Results revealed no support for the full model, but partial confirmation for several components of the model. Education significantly predicted gender roles, and gender roles and use of direct power strategies were significant predictors of sexual self-efficacy. Most of the participants were married or partnered and were unconcerned about contracting HIV, suggesting that if women perceive that they are at low or no risk, their gender roles, power strategies, and precautionary sexual self-efficacy will be inconsequential to their HIV/AIDS risk reduction practices.     

Movement patterns of persons with HIV receiving treatment in public clinics in the Southern Health Region,Puerto Rico

A survey conducted among 187 HIV-infected patients from publicly supported HIV clinics in the Puerto Rican Southern Health Region (SHR) failed to substantiate health planners' concern that this group travels frequently to the US to receive medical services. Respondents were questioned about all places of residence and all sites of HIV treatment in the past 12 months. Movement was defined as being anywhere outside of the SHR for 2 weeks or longer. 7% of the sample had moved at least once in the past year; 4% had moved outside the SHR but within Puerto Rico, while 3% had been in the continental US. Compared to the heterosexual risk group, intravenous drug users and men who have sex with men were 7-8 times more likely to have moved. The attainment of at least a high school education was also significantly and independently associated with increased probability of movement. Medical care was not identified by any of these respondents as the primary reason for travel. 58% indicated they were in their current place of residence to be near family, friends, and relatives. Both the small sample size and the low socioeconomic status of respondents may have limited the ability of this study to identify the so-called "air bridge," however.     

Ante-natal HIV testing: An observational study of HIV test discussion in maternity care

There has been a vociferous call for ante-natal HIV testing but low uptake persists in the UK despite DOH guidelines. The reasons for this are complex, with many studies examining intention, offer and uptake of HIV test but few observing the process to understand the nature of HIV discussion with pregnant women. A field observational study was undertaken where researchers attended 154 ante-natal consultations. These were selected in rotation during ante-natal visits by women at four London hospital based ante-natal clinics. A standardized checklist was utilized to monitor information on HIV. A mean of 1.73 minutes was spent discussing HIV infection and testing during ante-natal consultations which lasted for a mean of 33.1 minutes. Risk factors for HIV were mentioned infrequently. When mentioned they concentrated on sexual behaviour which was raised in 11.7% of the consultations. Potential interventions to reduce vertical transmission were discussed with no more than one in five women and possible adverse implications of HIV testing with fewer than one in ten, the only exception being the implications of a positive diagnosis for the baby. Discussion of interventions was associated with HIV test uptake, but risk discussion was not. The short time spent on discussing HIV testing, combined with paucity of mention of information relevant to pregnancy are issues for concern and probably help to explain the level of uptake in the UK.     

Claiming HIV Infection From Improbable Modes as a Possible Coping Strategy

Despite the extreme improbability of contracting HIV from oral intercourse, individuals continue to claim seroconversion via such behaviors. Among a sample of HIV‐positive men who have sex with men (MSM), those who attributed contracting HIV from oral intercourse or other non‐anal intercourse sexual behaviors were 5 times more likely to be a racial minority and 2 times more likely to be of lower socioeconomic status. Those believing less in a just world were 2 times more likely to attribute contracting HIV from non‐anal intercourse sexual behaviors. Attributing HIV contraction to improbable modes may be an attractive coping strategy to deflect the stigma more intensely felt among poorer, minority HIV‐positive MSM, and among men who are sensitive to fairness and justice.