Comparison of Stress, Social Support, and Depression Across the Trimesters in a Multiethnic Population

Abstract

Objective To describe the differences in stress, social support, and depression across three trimesters in a group of White, African‐American, and Hispanic women. Design A midpoint analysis in a prospective, longitudinal multicenter trial. Analysis consisted of t‐tests, repeated measures analysis of variance, and descriptive statistics. Setting Multicenter. Sample The sample (n = 299) consisted of African‐American (n = 45), Hispanic (n = 54), and White (n = 200) pregnant women with singleton gestation. Methods Women completed a psychosocial assessment during each trimester. Depressive symptoms, stress, and social support were measured using valid instruments (Edinburg, Everyday Stressors [ESS], and Autonomy and Relatedness Inventory [ARI]). Results Depressive symptoms (Edinburgh). In the first trimester, Hispanic and African‐American women had significantly higher depressive symptom scores (DSS) compared to White women (p < .001, respectively). In the second trimester, only African‐American women had significantly higher DDS compared to White women. In the third trimester, no significant racial differences existed in DSS. In African‐American and Hispanic women, DDS significantly decreased (p = .05, and <.001, respectively) from first to third trimesters, whereas White women had a slight increase. Self‐reported stress (ESS). Among all groups, women consistently reported highest stress in the first trimester, with significantly lower stress in the third trimester (p < .001, respectively). African‐American women had the highest mean stress scores, with White women reporting the least amount of stress throughout pregnancy. Social support (ARI). In the first trimester, significant social support differences existed among all groups, with Hispanic women having the lowest mean scores and White women reporting the highest support (98.74, 106.47, and 113.35). In the second to third trimesters, Hispanic woman consistently reported less support than African‐American and White women (p < .001, respectively). No differences in social support existed between African‐American and White women in the second or third trimester. Conclusion/Implications for Nursing Practice Depression during pregnancy has been associated with poor pregnancy outcomes. Many risk factors have been identified to increase a women's risk of depression during pregnancy, including stress and lack of social support. There is limited research comparing stress, social support, and depression throughout pregnancy among different ethnic groups. Clear psychosocial differences exist among races and vary across trimesters. High stress, low social support, and depression negatively affect pregnancy outcome. Culturally sensitive and psychosocial‐specific interventions delivered in the first trimester may improve pregnancy outcomes. To describe the differences in stress, social support, and depression across three trimesters in a group of White, African‐American, and Hispanic women. A midpoint analysis in a prospective, longitudinal multicenter trial. Analysis consisted of t‐tests, repeated measures analysis of variance, and descriptive statistics. Multicenter. The sample (n = 299) consisted of African‐American (n = 45), Hispanic (n = 54), and White (n = 200) pregnant women with singleton gestation. Women completed a psychosocial assessment during each trimester. Depressive symptoms, stress, and social support were measured using valid instruments (Edinburg, Everyday Stressors [ESS], and Autonomy and Relatedness Inventory [ARI]). Depressive symptoms (Edinburgh). In the first trimester, Hispanic and African‐American women had significantly higher depressive symptom scores (DSS) compared to White women (p < .001, respectively). In the second trimester, only African‐American women had significantly higher DDS compared to White women. In the third trimester, no significant racial differences existed in DSS. In African‐American and Hispanic women, DDS significantly decreased (p = .05, and <.001, respectively) from first to third trimesters, whereas White women had a slight increase. Self‐reported stress (ESS). Among all groups, women consistently reported highest stress in the first trimester, with significantly lower stress in the third trimester (p < .001, respectively). African‐American women had the highest mean stress scores, with White women reporting the least amount of stress throughout pregnancy. Social support (ARI). In the first trimester, significant social support differences existed among all groups, with Hispanic women having the lowest mean scores and White women reporting the highest support (98.74, 106.47, and 113.35). In the second to third trimesters, Hispanic woman consistently reported less support than African‐American and White women (p < .001, respectively). No differences in social support existed between African‐American and White women in the second or third trimester. Depression during pregnancy has been associated with poor pregnancy outcomes. Many risk factors have been identified to increase a women's risk of depression during pregnancy, including stress and lack of social support. There is limited research comparing stress, social support, and depression throughout pregnancy among different ethnic groups. Clear psychosocial differences exist among races and vary across trimesters. High stress, low social support, and depression negatively affect pregnancy outcome. Culturally sensitive and psychosocial‐specific interventions delivered in the first trimester may improve pregnancy outcomes.