Effect of the Healthy MOMs Lifestyle Intervention on Reducing Depressive Symptoms Among Pregnant Latinas

Depression during the prenatal and postpartum periods is associated with poor maternal, perinatal and child outcomes. This study examines the effectiveness of a culturally and linguistically tailored, social support-based, healthy lifestyle intervention led by trained community health workers in reducing depressive symptoms among pregnant and early postpartum Latinas. A sample of 275 pregnant Latinas was randomized to the Healthy MOMs Healthy Lifestyle Intervention (MOMs) or the Healthy Pregnancy Education (control) group. More than one-third of participants were at risk for depression at baseline. MOMs participants were less likely than control group participants to be at risk for depression at follow-up. Between baseline and 6 weeks postpartum, MOMs participants experienced a significant decline in depressive symptoms; control participants experienced a marginally significant decline. For MOMs participants, most of this decline occurred during the pregnancy intervention period, a time when no change occurred for control participants. The change in depressive symptoms during this period was greater among MOMs than control participants (“intervention effect”). From baseline to postpartum, there was a significant intervention effect among non-English-speaking women only. These findings provide evidence that a community-planned, culturally tailored healthy lifestyle intervention led by community health workers can reduce depressive symptoms among pregnant, Spanish-speaking Latinas.     

Beyond silence: working with Phoebe

This paper gives an account of a three-year period of silence that took place during the course of the intensive psychotherapy of a pre-adolescent girl with a diagnosis of ‘major depression’. The meaning and significance of silence in the therapeutic context is explored, as well as the importance of the ‘safety’ (Quinodoz, ‘The psychoanalytic setting as the instrument of the container function’, International Journal of Psycho-Analysis, 73: 627–35, 1992) and containing function of the setting that allows patients with a similar pathology a much needed regression, eventually enabling the birth and development of mature ‘verbal’ object relationships. Challenges and changes in the countertransference during a silent period in the course of psychotherapy are also discussed.     

Guilt as a Source of Narcissistic Gratification

This article takes as its starting point a paper by Hugo Bleichmar presented at the 2003 Joseph Sandler Research Conference on Depression. The author argues in favour of viewing depression in a broad perspective. The Freudian prototype of “guilty depression” represents only one of many pathways leading to depressive states. Psychoanalytic understanding of depression should represent a multidimensional approach, characterised by interacting determinants, both internal and external. In clinical practice, this would imply an attitude of greater freedom and flexibility in the analyst. The paper compares the psychoanalytic account of depression with that given by the cognitive approach. It is argued that within a diverse research field, where depression is studied from different angles—as a disorder of the brain and in terms of cognitive deficits—the contribution of psychoanalysis is that depression is most usefully studied at the level of psychological causation. The psychoanalytic understanding of depressive states in terms of unconscious interpretation and meaning of experience represents a distinct contribution. Implications of viewing depression as an “illness” are discussed.     

Family and Cultural Predictors of Depression Among Samoan American Middle and High School Students

This study investigated family intergenerational conflict and collective self‐esteem as predictors of depression in a sample of 128 Samoan middle and high school students. Simultaneous regression analyses revealed that each independent variable significantly contributed to an overall model that accounted for 13% of the variance in depression. Implications for counseling research and practice are discussed in terms of how schools may consider ways to promote these youth's cultural worth and positive family dynamics. Este estudio investigó el conflicto familiar intergeneracional y la autoestima colectiva como predictores de depresión en una muestra de 128 estudiantes samoanos de enseñanza media y secundaria. Los análisis simultáneos de regresión revelaron que cada variable independiente contribuyó de forma significativa a un modelo general que explicó un 13% de la varianza en depresión. Se discuten las implicaciones para la investigación y práctica de la consejería, en términos de cómo las escuelas pueden considerar formas de promover el valor cultural de estos jóvenes y una dinámica familiar positiva.     

Psychosocial consequences of recurrent vertigo

Abstract

Chronic vertigo is known to be associated with anxiety and depression in a significant proportion of patients, but there have been no systematic investigations into beliefs and behaviour related to recurrent vertigo. Twenty-three individuals with vertigo of various types were interviewed, generating over two thousand statements about vertigo and its psychosocial consequences. By means of progressive categorisation these were condensed into four tables of summary statements representing prevalent reactions to and effects of vertigo. Vertigo is viewed as intrinsically frightening and potentially stigmatising. In an attempt to avoid provoking attacks, particularly in public, subjects tended to impose restrictions on their activities and lifestyle which generated further feelings of helplessness and frustration. The statements obtained in this study provide an empirical basis for the development of a model that may be used to formulate predictions about the relationship between vertigo, handicap and distress, and the benefits of intervention.     

The distressed (Type D) personality mediates the relationship between remembered parenting and psychological distress in cardiac patients

Objective: Both the distressed (Type D) personality (i.e. the combination of negative affectivity and social inhibition traits) and dysfunctional parenting styles are associated with anxiety and depression. As parenting styles have been related to personality development, dysfunctional parenting styles may also be associated with Type D personality. We examined whether remembered parenting was associated with anxiety and depression in cardiac patients and whether Type D personality mediated this relationship.

Methods: Our sample comprised 435 patients treated with percutaneous coronary intervention (PCI) and 123 patients with congestive heart failure (CHF). Patients completed the Hospital Anxiety and Depression Scale, Type D Scale (DS14), and Remembered Relationship with Parents (RRP¹⁰) scale.

Results: Remembered parenting was significantly associated with higher anxiety and depression levels and Type D personality. In multivariable linear regression analyses, Type D personality accounted for 25–29% of the variance in anxiety and 23–46% of the variance in depression, while remembered parenting was no longer significantly associated with these domains. Sobel tests and bootstrapping indicated that Type D personality mediated the relationship between remembered parenting and anxiety and depression.

Conclusion: Type D personality mediated the relationship between remembered parenting and anxiety and depression in both PCI and CHF patients.     

Social comparison,coping and depression in people with spinal cord injury

The present study among 70 people with spinal cord injury examined the prevalence and correlates of identification (seeing others as a potential future) and contrast (seeing others in competitive terms) in social comparison as related to coping and depression. The most prevalent social comparison strategy was downward contrast (a positive response to seeing others who were worse-off), followed by upward identification (a positive response to perceiving better-off others as a potential future), downward identification (a negative response to perceiving worse-off others as a potential future), and upward contrast (a negative response to seeing others who were better-off). Those with less severe lesions reported the highest levels of upward contrast, coping through blaming others, and depression. Downward contrast was particularly related to constructive coping, and upward identification to wishful thinking. The less adaptive social comparison strategies, i.e., upward contrast and downward identification, were quite strongly related to wishful thinking and blaming others. Particularly upward contrast, i.e., feeling bad as response to seeing that others are better-off, was related to depression.     

Symptoms,impairment and illness intrusiveness–their relationship with depression in women with CFS/ME

Chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME) is an illness in which physiological and psychological factors are believed to interact to cause and maintain CFS/ME in an individual predisposed to it. The various symptoms and impairments associated with CFS/ME have a large impact on quality of life. The purpose of the present study was to identify the extent to which the core symptoms and impairments associated with CFS/ME relate to depression in women with CFS/ME, and to discover whether these relationships were mediated by illness intrusiveness. CFS/ME was found to be a highly intrusive illness, intruding into more life domains and to a greater degree than other illnesses. The effects of both symptoms and impairment on depression were, in part, mediated by illness intrusiveness. Although symptoms severity and impairment had both direct and indirect effects on depression, illness intrusiveness was the strongest predictor of depression.     

Quality-of-life assessment in HIV-infected psychiatric outpatients: Perceived health,functional status,symptoms, and preferences for cardiopulmonary resuscitation

Abstract

The current study had two purposes: (1) to describe the reliability and validity of a measure of quality of life (QOL) in HIV-infected psychiatric outpatients, and (2) to predict cardiopulmonary resuscitation (CPR) preferences from disease stage, depression, and other QOL factors. We studied 63 patients, who were seen in one year at an HIV/AIDS psychiatry clinic. The results provide evidence for the validity of our instrument as a measure of health status in an HIV-infected psychiatric population. Overall symptoms were the strongest associates of functional limitations. disability, and perceived health, but depression was also significantly associated with all measures of QOL. Twenty-two patients (35.5%) would not have wanted to be revived if their heart stopped beating the day of the study. Disease stage and poor mental health were independent predictors of this preference, but severity of depression, social support, fatigue, perceived health, functional limitations, and life satisfaction were not.     

Work strain and the post-discharge adjustment of patients following a heart attack

Abstract

The role of work characteristics in determining return to work after an acute coronary event was examined. One hundred and forty nine patients were enrolled. One year post-discharge, 74 had returned to work. Work characteristics (decision latitude, and opportunity for social interaction at work), together with age, depression, and medical prognosis, correctly classified work status in 78% of cases. At 12 months post-discharge, patients who had not returned to work recorded significantly poorer levels of adjustment compared to those who had returned to work. A better quality of life is associated with a lower level of depression pre-hospitalization, ownership of a larger home, being male, and having a more positive work environment. The findings suggest that the pre-illness work environment of the patient is a factor influencing return to work, which needs to be considered in rehabilitation programmes.