%0 Journal Article %J Depress Anxiety %D 2012 %T Impact of childhood trauma on the outcomes of a perinatal depression trial. %A Grote, Nancy K %A Spieker, Susan J %A Lohr, Mary Jane %A Geibel, Sharon L %A Swartz, Holly A %A Frank, Ellen %A Houck, Patricia R %A Katon, Wayne %K Adult %K Adult Survivors of Child Abuse %K Depressive Disorder %K Female %K Humans %K Poverty %K Pregnancy %K Pregnancy Complications %K Psychotherapy, Brief %K Risk Factors %K Treatment Outcome %X

BACKGROUND: Childhood abuse and neglect have been linked with increased risks of adverse mental health outcomes in adulthood and may moderate or predict response to depression treatment. In a small randomized controlled trial treating depression in a diverse sample of nontreatment-seeking, pregnant, low-income women, we hypothesized that childhood trauma exposure would moderate changes in symptoms and functioning over time for women assigned to usual care (UC), but not to brief interpersonal psychotherapy (IPT-B) followed by maintenance IPT. Second, we predicted that trauma exposure would be negatively associated with treatment response over time and at the two follow-up time points for women within UC, but not for those within IPT-B who were expected to show remission in depression severity and other outcomes, regardless of trauma exposure.

METHODS: Fifty-three pregnant low-income women were randomly assigned to IPT-B (n = 25) or UC (n = 28). Inclusion criteria included ≥ 18 years, >12 on the Edinburgh Postnatal Depression Scale, 10-32 weeks gestation, English speaking, and access to a phone. Participants were evaluated for childhood trauma, depressive symptoms/diagnoses, anxiety symptoms, social functioning, and interpersonal problems.

RESULTS: Regression and mixed effects repeated measures analyses revealed that trauma exposure did not moderate changes in symptoms and functioning over time for women in UC versus IPT-B. Analyses of covariance showed that within the IPT-B group, women with more versus less trauma exposure had greater depression severity and poorer outcomes at 3-month postbaseline. At 6-month postpartum, they had outcomes indicating remission in depression and functioning, but also had more residual depressive symptoms than those with less trauma exposure.

CONCLUSIONS: Childhood trauma did not predict poorer outcomes in the IPT-B group at 6-month postpartum, as it did at 3-month postbaseline, suggesting that IPT including maintenance sessions is a reasonable approach to treating depression in this population. Since women with more trauma exposure had more residual depressive symptoms at 6-month postpartum, they might require longer maintenance treatment to prevent depressive relapse.

%B Depress Anxiety %V 29 %P 563-73 %8 2012 Jul %G eng %N 7 %R 10.1002/da.21929 %0 Journal Article %J Aging Ment Health %D 2010 %T Barriers to treatment and culturally endorsed coping strategies among depressed African-American older adults. %A Conner, Kyaien O %A Copeland, Valire Carr %A Grote, Nancy K %A Rosen, Daniel %A Albert, Steve %A McMurray, Michelle L %A Reynolds, Charles F %A Brown, Charlotte %A Koeske, Gary %K Adaptation, Psychological %K African Americans %K Aged %K Aged, 80 and over %K Aging %K Culture %K Depression %K Female %K Health Knowledge, Attitudes, Practice %K Health Services Accessibility %K Humans %K Interviews as Topic %K Male %K Mental Health Services %K Patient Acceptance of Health Care %K Pennsylvania %K Prejudice %K Qualitative Research %X

OBJECTIVE: Older adults are particularly vulnerable to the effects of depression, however, they are less likely to seek and engage in mental health treatment. African-American older adults are even less likely than their White counterparts to seek and engage in mental health treatment. This qualitative study examined the experience of being depressed among African-American elders and their perceptions of barriers confronted when contemplating seeking mental health services. In addition, we examined how coping strategies are utilized by African-American elders who choose not to seek professional mental health services.

METHOD: A total of 37 interviews were conducted with African-American elders endorsing at least mild symptoms of depression. Interviews were audiotaped and subsequently transcribed. Content analysis was utilized to analyze the qualitative data.

RESULTS: Thematic analysis of the interviews with African-American older adults is presented within three areas: (1) Beliefs about Depression Among Older African-Americans; (2) Barriers to Seeking Treatment for Older African-Americans; and (3) Cultural Coping Strategies for Depressed African-American Older Adults.

CONCLUSION: Older African-Americans in this study identified a number of experiences living in the Black community that impacted their treatment seeking attitudes and behaviors, which led to identification and utilization of more culturally endorsed coping strategies to deal with their depression. Findings from this study provide a greater understanding of the stigma associated with having a mental illness and its influence on attitudes toward mental health services.

%B Aging Ment Health %V 14 %P 971-83 %8 2010 Nov %G eng %N 8 %R 10.1080/13607863.2010.501061 %0 Journal Article %J Am J Geriatr Psychiatry %D 2010 %T Mental health treatment seeking among older adults with depression: the impact of stigma and race. %A Conner, Kyaien O %A Copeland, Valire Carr %A Grote, Nancy K %A Koeske, Gary %A Rosen, Daniel %A Reynolds, Charles F %A Brown, Charlotte %K African Americans %K Aged %K Aged, 80 and over %K Attitude to Health %K Depression %K European Continental Ancestry Group %K Female %K Humans %K Male %K Mental Health Services %K Middle Aged %K Patient Acceptance of Health Care %K Stereotyping %X

OBJECTIVE: Stigma associated with mental illness continues to be a significant barrier to help seeking, leading to negative attitudes about mental health treatment and deterring individuals who need services from seeking care. This study examined the impact of public stigma (negative attitudes held by the public) and internalized stigma (negative attitudes held by stigmatized individuals about themselves) on racial differences in treatment-seeking attitudes and behaviors among older adults with depression.

METHOD: Random digit dialing was utilized to identify a representative sample of 248 African American and white older adults (older than 60 years) with depression (symptoms assessed by the Patient Health Questionnaire-9). Telephone-based surveys were conducted to assess their treatment-seeking attitudes and behaviors and the factors that impacted these behaviors.

RESULTS: Depressed older adult participants endorsed a high level of public stigma and were not likely to be currently engaged in or did they intend to seek mental health treatment. Results also suggested that African American older adults were more likely to internalize stigma and endorsed less positive attitudes toward seeking mental health treatment than their white counterparts. Multiple regression analysis indicated that internalized stigma partially mediated the relationship between race and attitudes toward treatment.

CONCLUSION: Stigma associated with having a mental illness has a negative influence on attitudes and intentions toward seeking mental health services among older adults with depression, particularly African American elders. Interventions to target internalized stigma are needed to help engage this population in psychosocial mental health treatments.

%B Am J Geriatr Psychiatry %V 18 %P 531-43 %8 2010 Jun %G eng %N 6 %R 10.1097/JGP.0b013e3181cc0366 %0 Journal Article %J Arch Gen Psychiatry %D 2010 %T A meta-analysis of depression during pregnancy and the risk of preterm birth, low birth weight, and intrauterine growth restriction. %A Grote, Nancy K %A Bridge, Jeffrey A %A Gavin, Amelia R %A Melville, Jennifer L %A Iyengar, Satish %A Katon, Wayne J %K Cross-Cultural Comparison %K Depressive Disorder %K Female %K Fetal Growth Retardation %K Humans %K Infant, Low Birth Weight %K Infant, Newborn %K Mass Screening %K Obstetric Labor, Premature %K Pregnancy %K Pregnancy Complications %K Prospective Studies %K Risk %K Socioeconomic Factors %X

CONTEXT: Maternal depressive symptoms during pregnancy have been reported in some, but not all, studies to be associated with an increased risk of preterm birth (PTB), low birth weight (LBW), and intrauterine growth restriction (IUGR).

OBJECTIVE: To estimate the risk of PTB, LBW, and IUGR associated with antenatal depression.

DATA SOURCES AND STUDY SELECTION: We searched for English-language and non-English-language articles via the MEDLINE, PsycINFO, CINAHL, Social Work Abstracts, Social Services Abstracts, and Dissertation Abstracts International databases (January 1980 through December 2009). We aimed to include prospective studies reporting data on antenatal depression and at least 1 adverse birth outcome: PTB (<37 weeks' gestation), LBW (<2500 g), or IUGR (<10th percentile for gestational age). Of 862 reviewed studies, 29 US-published and non-US-published studies met the selection criteria.

DATA EXTRACTION: Information was extracted on study characteristics, antenatal depression measurement, and other biopsychosocial risk factors and was reviewed twice to minimize error.

DATA SYNTHESIS: Pooled relative risks (RRs) for the effect of antenatal depression on each birth outcome were calculated using random-effects methods. In studies of PTB, LBW, and IUGR that used a categorical depression measure, pooled effect sizes were significantly larger (pooled RR [95% confidence interval] = 1.39 [1.19-1.61], 1.49 [1.25-1.77], and 1.45 [1.05-2.02], respectively) compared with studies that used a continuous depression measure (1.03 [1.00-1.06], 1.04 [0.99-1.09], and 1.02 [1.00-1.04], respectively). The estimates of risk for categorically defined antenatal depression and PTB and LBW remained significant when the trim-and-fill procedure was used to correct for publication bias. The risk of LBW associated with antenatal depression was significantly larger in developing countries (RR = 2.05; 95% confidence interval, 1.43-2.93) compared with the United States (RR = 1.10; 95% confidence interval, 1.01-1.21) or European social democracies (RR = 1.16; 95% confidence interval, 0.92-1.47). Categorically defined antenatal depression tended to be associated with an increased risk of PTB among women of lower socioeconomic status in the United States.

CONCLUSIONS: Women with depression during pregnancy are at increased risk for PTB and LBW, although the magnitude of the effect varies as a function of depression measurement, country location, and US socioeconomic status. An important implication of these findings is that antenatal depression should be identified through universal screening and treated.

%B Arch Gen Psychiatry %V 67 %P 1012-24 %8 2010 Oct %G eng %N 10 %R 10.1001/archgenpsychiatry.2010.111