%0 Journal Article %J Women Health %D 2013 %T Views and experiences of suicidal ideation during pregnancy and the postpartum: findings from interviews with maternal care clinic patients. %A Tabb, Karen M %A Gavin, Amelia R %A Guo, Yuqing %A Huang, Hsiang %A Debiec, Kate %A Katon, Wayne %K Adult %K Depression %K Depression, Postpartum %K Female %K Follow-Up Studies %K Humans %K Interviews as Topic %K Maternal Health Services %K Mothers %K Postpartum Period %K Pregnancy %K Pregnancy Complications %K Risk Factors %K Stress, Psychological %K Suicidal Ideation %K Surveys and Questionnaires %K Young Adult %X

INTRODUCTION: Perinatal suicidality (i.e., thoughts of death, suicide attempts, or self-harm during the period immediately before and up to 12 months after the birth of a child) is a significant public health concern. Few investigations have examined the patients' own views and experiences of maternal suicidal ideation.

METHODS: Between April and October 2010, researchers identified 14 patient participants at a single university-based medical center for a follow-up, semi-structured interview if they screened positive for suicidal ideation on the Patient Health Questionnaire-9 (PHQ-9) short form. In-depth interviews followed a semi-structured interview guide. Researchers transcribed all interviews verbatim and analyzed transcripts using thematic network analysis.

RESULTS: Participants described the experience of suicidality during pregnancy as related to somatic symptoms, past diagnoses, infanticide, family psychiatric history (e.g., completed suicides and family member attempts), and pregnancy complications. The network of themes included the perinatal experience, patient descriptions of changes in mood symptoms, illustrations of situational coping, and reported mental health service use.

IMPLICATIONS: The interview themes suggested that in this small sample, pregnancy represented a critical time period to screen for suicide and to establish treatment for the mothers in the study. These findings may assist health care professionals in the development of interventions designed to identify, assess, and prevent suicidality among perinatal women.

%B Women Health %V 53 %P 519-35 %8 2013 %G eng %N 5 %R 10.1080/03630242.2013.804024 %0 Journal Article %J Gen Hosp Psychiatry %D 2012 %T Depression in pregnancy is associated with preexisting but not pregnancy-induced hypertension. %A Katon, Wayne J %A Russo, Joan E %A Melville, Jennifer L %A Katon, Jodie G %A Gavin, Amelia R %K Adult %K Antidepressive Agents %K Depression %K Female %K Humans %K Hypertension %K Pregnancy %K Pregnancy Complications %K Prospective Studies %K Regression Analysis %K Surveys and Questionnaires %K Young Adult %X

BACKGROUND: The aim was to examine whether depression is associated with preexisting hypertension or pregnancy-induced hypertension in a large sample of women attending a university-based obstetrics clinic.

METHODS: In this prospective study, participants were 2398 women receiving ongoing prenatal care at a university-based obstetrics clinic from January 2004 through January 2009. Prevalence of depression was measured using the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition criteria based on the Patient Health Questionnaire-9 as well as the self-reported use of antidepressant medication. Evidence of preexisting hypertension, pregnancy-induced hypertension and preeclampsia/eclampsia was determined by obstetrician International Classification of Diseases, Ninth Revision codes. Logistic regression was used to quantify the association between hypertension in pregnancy and antenatal depression.

RESULTS: After adjusting for sociodemographic variables, chronic medical conditions, smoking and prior pregnancy complications, women with preexisting hypertension had an increased risk of any depression (minor, major, use of antidepressants) [odds ratio (OR)=1.55, 95% confidence interval (CI) 1.08-2.23) and major depression and/or use of antidepressants (OR=1.65, 95% CI 1.10-2.48) compared to women without hypertension. No differences were seen in risk of depression in women with pregnancy-induced hypertension or preeclampsia/eclampsia compared to those without hypertension.

CONCLUSION: Women with preexisting hypertension, but not pregnancy-induced hypertension, are more likely to meet criteria for an antenatal depressive disorder and/or to be treated with antidepressants and could be targeted by obstetricians for screening for depression and enhanced treatment.

%B Gen Hosp Psychiatry %V 34 %P 9-16 %8 2012 Jan-Feb %G eng %N 1 %R 10.1016/j.genhosppsych.2011.09.018 %0 Journal Article %J Prev Sci %D 2012 %T Maternal early life risk factors for offspring birth weight: findings from the add health study. %A Gavin, Amelia R %A Thompson, Elaine %A Rue, Tessa %A Guo, Yuqing %K Adolescent %K Child Abuse %K Depression %K Factor Analysis, Statistical %K Female %K Humans %K Infant, Low Birth Weight %K Infant, Newborn %K Longitudinal Studies %K Mothers %K Risk Factors %K Smoking %K Social Class %K Substance-Related Disorders %X

The aim of this study was to examine the pathways that link mothers' early life socio economic status (SES) and mothers' experience of childhood maltreatment with birth weight among their later born offspring. Data were drawn from a nationally representative longitudinal survey of school-aged respondents, initially enrolled during adolescence in Wave I (1994-1995) and Wave II (1996) of the National Longitudinal Study of Adolescent Health and followed-up in adulthood in Wave III (2001-2002). Data on offspring birth weight were obtained from nulliparous females (N = 1,897) who had given birth between Waves II and III. Analyses used structural equation modeling to examine the extent to which early life maternal risk predicted offspring birth weight, and demonstrated that maternal childhood SES and maternal childhood maltreatment predicted offspring birth weight through several mediated pathways. First, maternal adolescent substance use and prenatal cigarette use partially mediated the association between maternal childhood SES and offspring birth weight. Second, maternal adolescent depressive symptoms and adult SES partially mediated the association between maternal childhood SES and offspring birth weight. Third, adult SES partially mediated the association between maternal childhood SES and offspring birth weight. Fourth, maternal adolescent substance use and prenatal cigarette use partially mediated the association between maternal childhood maltreatment and offspring birth weight. Finally, maternal adolescent depressive symptoms and adult SES partially mediated the association between maternal childhood maltreatment and offspring birth weight. To our knowledge, this is the first study to identify maternal childhood maltreatment as an early life risk factor for offspring birth weight among a nationally representative sample of young women, and to demonstrate the mechanisms that link childhood SES and maltreatment to offspring birth weight. These findings suggest the importance of designing and implementing prevention and intervention strategies to address early life maternal social conditions in an effort to improve inter generational child health at birth.

%B Prev Sci %V 13 %P 162-72 %8 2012 Apr %G eng %N 2 %R 10.1007/s11121-011-0253-2 %0 Journal Article %J J Womens Health (Larchmt) %D 2012 %T Mediators of adverse birth outcomes among socially disadvantaged women. %A Gavin, Amelia R %A Nurius, Paula %A Logan-Greene, Patricia %K Adolescent %K Adult %K Cohort Studies %K Diagnostic and Statistical Manual of Mental Disorders %K Female %K Gestational Age %K Health Behavior %K Healthcare Disparities %K Humans %K Insurance Coverage %K Mental Disorders %K Middle Aged %K Pregnancy %K Pregnancy Outcome %K Pregnant Women %K Prenatal Care %K Prospective Studies %K Social Class %K Stress, Psychological %K Substance-Related Disorders %K Surveys and Questionnaires %K United States %K Vulnerable Populations %X

BACKGROUND: Numerous studies find that socially disadvantaged women are more likely than socially advantaged women to deliver infants that weigh less than normal and/or are born weeks prior to their due date. However, little is known about the pathways that link maternal social disadvantage to birth outcomes. Using data from a prospective cohort study, we examined whether antenatal psychosocial stress, substance use, and maternal health conditions in pregnancy mediated the pathway between maternal social disadvantage and birth outcomes.

METHODS: Analyses used structural equation modeling to examine data from a community clinic-based sample (n=2168) of pregnant women who completed questionnaires assessing psychosocial functioning and health behaviors as well as sociodemographic characteristics, which were matched with subsequent birth outcome data.

RESULTS: Analyses revealed maternal social disadvantage predicted poorer birth outcomes through a mediated pathway including maternal health conditions in pregnancy.

CONCLUSIONS: The findings demonstrate that maternal social disadvantage is associated with poor health status in pregnancy, which in turn adversely affects birth outcomes. Results argue for more systematic attention to the roles of social disadvantage, including life course perspectives that trace social disadvantage prior to and through pregnancy.

%B J Womens Health (Larchmt) %V 21 %P 634-42 %8 2012 Jun %G eng %N 6 %R 10.1089/jwh.2011.2766 %0 Journal Article %J J Womens Health (Larchmt) %D 2011 %T Diabetes and depression in pregnancy: is there an association? %A Katon, Jodie G %A Russo, Joan %A Gavin, Amelia R %A Melville, Jennifer L %A Katon, Wayne J %K Adult %K Attitude to Health %K Cohort Studies %K Comorbidity %K Cross-Sectional Studies %K Depression %K Diabetes, Gestational %K Female %K Humans %K Pregnancy %K Pregnancy in Diabetics %K Prenatal Care %K Prevalence %K Prospective Studies %K Quality of Life %K Risk Factors %K United States %K Women's Health %K Young Adult %X

BACKGROUND: Prior studies have reported inconsistent findings regarding the association of antenatal depression with pregnancy-related diabetes. This study examined the association of diabetes and antenatal depression.

METHODS: We conducted a cross-sectional analysis of baseline data from a prospective cohort study of pregnant women receiving prenatal care at a single University of Washington Medical Center clinic between January 2004 and January 2009. The primary exposure was diabetes in pregnancy (no diabetes, preexisting diabetes, or gestational diabetes [GDM]). Antenatal depression was defined by the Patient Health Questionnaire-9 (PHQ-9) score or current use of antidepressants. Antenatal depression was coded as (1) any depression (probable major or minor depression by PHQ-9 or current antidepressant use) and (2) major depression (probable major depression by PHQ-9 or current antidepressant use). Logistic regression was used to quantify the association between diabetes in pregnancy and antenatal depression.

RESULTS: The prevalences of preexisting diabetes, GDM, any antenatal depression, and major antenatal depression were 9%, 18%, 13.6%, and 9.8%, respectively. In the unadjusted analysis, women with preexisting diabetes had 54% higher odds of any antenatal depression compared to those without diabetes (odds ratio [OR] 1.54, 95% confidence interval [CI] 1.08-2.21). After adjusting for important covariates the association was attenuated (OR 1.16, 95% CI 0.79-1.71). Results were similar for antenatal major depression. GDM was not associated with increased odds for any antenatal depression or antenatal major depression.

CONCLUSIONS: Neither preexisting diabetes nor GDM was independently associated with increased risk of antenatal depression.

%B J Womens Health (Larchmt) %V 20 %P 983-9 %8 2011 Jul %G eng %N 7 %R 10.1089/jwh.2010.2662 %0 Journal Article %J Women Health %D 2011 %T The prevalence and correlates of depressive symptoms among adolescent mothers: results from a 17-year longitudinal study. %A Gavin, Amelia R %A Lindhorst, Taryn %A Lohr, Mary Jane %K Adolescent %K Adult %K Cohort Studies %K Depression %K Female %K Humans %K Logistic Models %K Longitudinal Studies %K Male %K Marital Status %K Mothers %K Parity %K Pregnancy %K Pregnancy in Adolescence %K Prevalence %K Public Health %K Sexual Partners %K Smoking %K Social Welfare %K Spouse Abuse %K Young Adult %X

The objective of the authors in this study was to examine the prevalence and correlates of elevated depressive symptoms in a 17-year cohort study of 173 women who were unmarried, pregnant adolescents between June 1988 and January 1990. Multiple logistic regression was used to estimate the associations between correlates and elevated depressive symptoms during five distinct developmental periods of the life course. Depressive symptoms were measured by the Brief Symptom Inventory depression subscale. The prevalence of elevated depressive symptoms in adolescent mothers significantly increased over the 17 years of the study from 19.8% to 35.2%. In adjusted analyses, antenatal depressive symptoms were positively and significantly associated with elevated depressive symptoms at every developmental period. Intimate partner violence was positively and significantly associated with elevated depressive symptoms during all but one developmental period. Other significant correlates of elevated depressive symptoms included welfare receipt, smoking, and parity, all of which were significant at some, but not other, developmental periods. Antenatal depressive symptoms and intimate partner violence were positively and significantly associated with elevated depressive symptoms. Given the public health consequences associated with maternal depression, clinical and community-based interventions should be developed to identify and to treat adolescent mothers at-risk for antenatal depression and intimate partner violence.

%B Women Health %V 51 %P 525-45 %8 2011 Aug 31 %G eng %N 6 %R 10.1080/03630242.2011.606355 %0 Journal Article %J Arch Womens Ment Health %D 2011 %T Prevalence and correlates of suicidal ideation during pregnancy. %A Gavin, Amelia R %A Tabb, Karen M %A Melville, Jennifer L %A Guo, Yuqing %A Katon, Wayne %K Adult %K Attitude to Health %K Comorbidity %K Confidence Intervals %K Cross-Sectional Studies %K Depression %K Ethnic Groups %K Female %K Humans %K Logistic Models %K Odds Ratio %K Pregnancy %K Pregnancy Complications %K Prenatal Care %K Prevalence %K Quality of Life %K Risk Factors %K Suicidal Ideation %K United States %K Young Adult %X

Data are scarce regarding the prevalence and risk factors for antenatal suicidal ideation because systematic screening for suicidal ideation during pregnancy is rare. This study reports the prevalence and correlates of suicidal ideation during pregnancy. We performed cross-sectional analysis of data from an ongoing registry. Study participants were 2,159 women receiving prenatal care at a university obstetric clinic from January 2004 through March 2010. Multiple logistic regression identified factors associated with antenatal suicidal ideation as measured by the Patient Health Questionnaire. Overall, 2.7% of the sample reported antenatal suicidal ideation. Over 50% of women who reported antenatal suicidal ideation also reported major depression. In the fully adjusted model antenatal major depression (OR = 11.50; 95% CI 5.40, 24.48) and antenatal psychosocial stress (OR = 3.19; 95% CI 1.44, 7.05) were positively associated with an increased risk of antenatal suicidal ideation. We found that being non-Hispanic White was associated with a decreased risk of antenatal suicidal ideation (OR = 0.51; 95% CI 0.26-0.99). The prevalence of antenatal suicidal ideation in the present study was similar to rates reported in nationally representative non-pregnant samples. In other words, pregnancy is not a protective factor against suicidal ideation. Given the high comorbidity of antenatal suicidal ideation with major depression, efforts should be made to identify those women at risk for antenatal suicidal ideation through universal screening.

%B Arch Womens Ment Health %V 14 %P 239-46 %8 2011 Jun %G eng %N 3 %R 10.1007/s00737-011-0207-5 %0 Journal Article %J Gen Hosp Psychiatry %D 2011 %T Racial differences in the prevalence of antenatal depression. %A Gavin, Amelia R %A Melville, Jennifer L %A Rue, Tessa %A Guo, Yuqing %A Dina, Karen Tabb %A Katon, Wayne J %K Adult %K Depression %K Female %K Health Status Disparities %K Humans %K Logistic Models %K Pregnancy %K Prenatal Care %K Surveys and Questionnaires %K United States %K Young Adult %X

OBJECTIVE: This study examined whether there were racial/ethnic differences in the prevalence of antenatal depression based on Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, diagnostic criteria in a community-based sample of pregnant women.

METHOD: Data were drawn from an ongoing registry of pregnant women receiving prenatal care at a university obstetric clinic from January 2004 through March 2010 (N =1997). Logistic regression models adjusting for sociodemographic, psychiatric, behavioral and clinical characteristics were used to examine racial/ethnic differences in antenatal depression as measured by the Patient Health Questionnaire.

RESULTS: Overall, 5.1% of the sample reported antenatal depression. Blacks and Asian/Pacific Islanders were at increased risk for antenatal depression compared to non-Hispanic White women. This increased risk of antenatal depression among Blacks and Asian/Pacific Islanders remained after adjustment for a variety of risk factors.

CONCLUSION: Results suggest the importance of race/ethnicity as a risk factor for antenatal depression. Prevention and treatment strategies geared toward the mental health needs of Black and Asian/Pacific Islander women are needed to reduce the racial/ethnic disparities in antenatal depression.

%B Gen Hosp Psychiatry %V 33 %P 87-93 %8 2011 Mar-Apr %G eng %N 2 %R 10.1016/j.genhosppsych.2010.11.012 %0 Journal Article %J J Adolesc Health %D 2011 %T The role of maternal early-life and later-life risk factors on offspring low birth weight: Findings from a three-generational study. %A Gavin, Amelia R %A Hill, Karl G %A Hawkins, J D %A Maas, Carl %K Adolescent %K Adolescent Behavior %K Adult %K Alcohol Drinking %K Birth Weight %K Child Abuse %K Child of Impaired Parents %K Depression %K Female %K Humans %K Infant, Low Birth Weight %K Infant, Newborn %K Intergenerational Relations %K Longitudinal Studies %K Male %K Obesity %K Risk Factors %K Smoking %K Social Class %X

PURPOSE: This study examined three research questions: (1) Is there an association between maternal early-life economic disadvantage and the birth weight of later-born offspring? (2) Is there an association between maternal abuse in childhood and the birth weight of later-born offspring? (3) To what extent are these early-life risks mediated through adolescent and adult substance use, mental and physical health status, and adult socioeconomic status (SES)?

METHODS: Analyses used structural equation modeling to examine data from two longitudinal studies, which included three generations. The first generation (G1) and the second generation (G2) were enrolled in the Seattle Social Development Project (SSDP), and the third generation (G3) was enrolled in the SSDP Intergenerational Project. Data for the study (N = 136) focused on (G2) mothers enrolled in the SSDP and their children (G3).

RESULTS: Analyses revealed that G2 low childhood SES predicted G3 offspring birth weight. Early childhood abuse among G2 respondents predicted G3 offspring birth weight through a mediated pathway including G2 adolescent substance use and G2 prenatal substance use. Birth weight was unrelated to maternal adult SES, depression, or obesity.

CONCLUSIONS: To our knowledge, this is the first study to identify the effect of maternal early-life risks of low childhood SES and child maltreatment on later-born offspring birth weight. These findings have far-reaching effects on the cumulative risk associated with early-life economic disadvantage and childhood maltreatment. Such findings encourage policies and interventions that enhance child health at birth by taking the mother's own early-life and development into account.

%B J Adolesc Health %V 49 %P 166-71 %8 2011 Aug %G eng %N 2 %R 10.1016/j.jadohealth.2010.11.246 %0 Journal Article %J J Psychosom Res %D 2010 %T The association between obesity, depression, and educational attainment in women: the mediating role of body image dissatisfaction. %A Gavin, Amelia R %A Simon, Greg E %A Ludman, Evette J %K Adult %K Aged %K Body Image %K Body Weight %K Depression %K Depressive Disorder %K Educational Status %K Female %K Health Status %K Health Surveys %K Humans %K Logistic Models %K Middle Aged %K Obesity %K Prospective Studies %K Psychiatric Status Rating Scales %K Surveys and Questionnaires %K Women %X

OBJECTIVE: We examine the mediating role of body image dissatisfaction (BID) on the association between obesity and depression and the variation of this association as a function of years of education among a population-based sample of women aged 40-65 years.

METHODS: A series of sample-weighted logistic regression models were used to estimate the associations between obesity, BID, and depression, stratified by educational attainment. Data were obtained from a structured telephone interview of 4543 female health plan enrollees, including self-reported height and weight, the Patient Health Questionnaire assessment of depression, and a single-item measure of BID.

RESULTS: Among those with <16 years of education, in both the unadjusted and adjusted models, obesity and BID were significantly associated with depression. Similarly, among those with ≥ 16 years of education, obesity and BID were significantly associated with depression in the unadjusted models. However, in the adjusted model, only BID was associated with depression. A formal test for mediation suggests that the association between obesity and depression was mediated by BID regardless of level of education.

CONCLUSIONS: Our data suggest that BID-mediated the obesity-depression association. In addition, obesity and BID may be salient risk factors for depression among middle-aged women as a function of the level of education.

%B J Psychosom Res %V 69 %P 573-81 %8 2010 Dec %G eng %N 6 %R 10.1016/j.jpsychores.2010.05.001 %0 Journal Article %J Public Health Rep %D 2010 %T Racial/ethnic differences in the association between obesity and major depressive disorder: findings from the Comprehensive Psychiatric Epidemiology Surveys. %A Gavin, Amelia R %A Rue, Tessa %A Takeuchi, David %K Adult %K Age Distribution %K Comorbidity %K Depressive Disorder, Major %K Emigrants and Immigrants %K Female %K Health Surveys %K Humans %K Logistic Models %K Male %K Middle Aged %K Obesity %K Prevalence %K Risk Factors %K Sex Distribution %K United States %X

OBJECTIVES: This study examined whether the association between obesity and 12-month prevalence of major depressive disorder (MDD) varied according to racial/ethnic status and nativity in representative national samples of black, Latino, Asian, and non-Hispanic white people.

METHODS: We used data from the Comprehensive Psychiatric Epidemiology Surveys.

RESULTS: In analyses by gender, obesity was associated with an elevated risk of MDD among non-Hispanic white women (adjusted odds ratio [AOR] = 1.73; 95% confidence interval [CI] 1.27, 2.35; p = 0.001). Formal test for interaction revealed significant variation by race present between non-Hispanic white women and black, Latin, and Asian women. No significant differences were evident among men. In analyses by nativity, the association between obesity and MDD was significant among U.S.-born non-Hispanic white women (AOR=1.62; 95% CI 1.16, 2.27; p = 0.001) and U.S.-born black women (AOR = 1.29; 95% CI 1.01, 1.66; p = 0.041). Significant interactions were present among U.S.-born white and black women, Latin women, and Asian women. No significant interactions were evident among foreign-born women. Similarly, no significant differences were present among native-born or foreign-born men.

CONCLUSIONS: The findings suggest that the association between obesity and MDD varies according to racial/ethnic status and nativity. Understanding the link between obesity and depression may be imperative to designing interventions to address body weight maintenance and reduction strategies among women.

%B Public Health Rep %V 125 %P 698-708 %8 2010 Sep-Oct %G eng %N 5