Depression In Low-income Women Research Articles

How Income Inequality and Race Concentrate Depression in Low-Income Women in the US; 2005-2016.

Aim: To estimate the association between income and depressive symptoms in adult women, ages 20 years and older. Methods: Data for this study came from the 2005–2016 National Health and Nutrition Examination Survey (NHANES). We measured the presence of depressive symptoms by using a 9-item PHQ (Public Health Questionnaire, PHQ-9) and the Poverty to Income Ratio (PIR) as a proxy for income. We employed Negative Binomial Regression (NBRG) and logistic regression models in a sample of 11,420 women. We adjusted models by age, racial/ethnic groups, marital status, education, health insurance, comorbidity, and utilization of mental health professionals. We calculated the Gini Coefficient (GC) as a measure of income inequality, using PIR. Results: Between 2005 and 2016, 20.1% of low-PIR women suffered from depression (PHQ ≥10) compared with 12.0% of women in medium-PIR and 5.0% in high-PIR. The highest probabilities of being depressed were in Black Non-Hispanics (BNH) and Hispanics (12.0%), and then in White NH (WNH; 9.1%). The results of NBRG have shown that women in medium-PIR (0.90 [CI: 0.84–0.97]) and high-PIR 0.76 (CI: 0.70–0.82) had a lower incidence-rate ratio than women in low-PIR. The logistic regression results showed that income is protective in High-PIR groups (OR = 0.56, CI [0.43–0.73]). Conclusion: Policies to treat depression should prioritize the needs of low-income women of all racial groups and women.

Treatment for Depression in Low-Income Women: A Systematic Review and Meta-Analysis

Previous articleNext article FreeTreatment for Depression in Low-Income Women: A Systematic Review and Meta-AnalysisJacqueline Corcoran, Anao Zhang, Lydia Watson-Lewis, and Tatiana JohnsonJacqueline Corcoran Search for more articles by this author , Anao Zhang Search for more articles by this author , Lydia Watson-Lewis Search for more articles by this author , and Tatiana Johnson Search for more articles by this author PDF Add to favoritesDownload CitationTrack CitationsPermissionsReprints Share onFacebookTwitterLinkedInRedditEmail SectionsMoreDetailsFiguresReferencesCited by Journal of the Society for Social Work and Research Just Accepted Published for the Society for Social Work and Research Article DOIhttps://doi.org/10.1086/715212 Views: 96 HistoryAccepted August 21, 2020 Crossref reports no articles citing this article.

Perinatal Depression in Low-Income Women: A Literature Review and Innovative Screening Approach.

This paper reviews literature on perinatal depression prevalence, consequences, and screening among low-income women and women of color. We introduce the Warm Connections program's innovative perinatal depression screening protocol and explore perinatal depression patterns among WIC participants. Perinatal depression negatively impacts maternal and child outcomes. Research shows mixed findings of perinatal depression prevalence rates among low-income women and women of color. The Warm Connections program supports the ability of WIC staff to administer the EPDS to WIC participants. Perinatal depression rates appeared lower in the Warm Connections program than in studies using less specific perinatal depression screening instruments with similar samples. Future research should continue to explore perinatal depression patterns among low-income women and women of color. Partnering with community-based settings such as WIC provides innovative opportunities to provide screening, referral, and treatment for low income women and women of color.

Brief Interpersonal Psychotherapy for depression during pregnancy in a low-income population: A randomized controlled trial

BackgroundDepression is common in low-income pregnant women, and treatments need to be fitted to meet their needs. We conducted a randomized controlled trial comparing brief Interpersonal Psychotherapy (brief-IPT) to enhanced treatment as usual (ETAU) for perinatal depression in low-income women. The brief-IPT model is designed to better engage low-income women by utilizing an engagement session, providing flexible delivery of sessions, and pragmatic case management. MethodsPregnant women, aged ≥18, between 12 and 30 weeks gestation were recruited from an urban prenatal clinic. Women scoring ≥10 on the Edinburgh Depression Scale and meeting depressive disorder criteria were randomized to either brief-IPT (n=21) or ETAU (n=21). We assessed treatment outcomes, acceptability, and feasibility of the intervention (measured by session attendance). ResultsDepression scores significantly decreased in both brief-IPT and ETAU. Brief-IPT participants reported significant improvements in social support satisfaction as compared to ETAU participants, even after controlling for concurrent depressive symptoms. Brief-IPT participants reported high satisfaction with the program. However, many participants did not participate in the full 9-session course of treatment (average sessions attended =6, range 0–17). LimitationsSmall sample size, use of self-report measures, and lack of an active psychotherapy control group limits interpretation of study results. ConclusionsBrief-IPT for perinatal depression is acceptable to low-income women and is helpful for improving depressive symptoms and social support. However, feasibility of the treatment was limited by relatively low session attendance in spite of efforts to maximize treatment engagement. Additional modifications to meet the needs of low-income women are discussed.

Depression Affects Emotional Eating and Dietary Intake and Is Related to Food Insecurity in a Group of Multiethnic, Low-income Women

Both depression and obesity are prevalent among low-income, food insecure women. Though a causal relationship between depression and obesity has been suggested, research has not extensively investigated dietary intake and eating behavior attributes in relation to depression in low-income women. This study examined symptoms of depression in a cross-sectional group of urban, low-income women (n = 330) and the relationship to food insecurity, dietary intake, weight status, and emotional eating. Results showed that depressed women were more food insecure, had higher caloric intake, and consumed more servings of discretionary foods, such as fat and sugar, which appeared to be partially mediated through the increased emotional eating among depressed participants and may contribute to increased weight overtime.

Economic Stress, Social Support, and Maternal Depression: Is Social Support Deterioration Occurring?

Maternal depression in low-income women is a significant problem because of its negative consequences for both mothers and their children. Economic stress increases risk for depression; however, mechanisms linking economic stress and depression are not well understood. The social support deterioration model suggests that chronic stressors can exert effects on psychological well-being directly) and, also, indirectly when stressors undermine social support. The analysis presented in this article tested the relationships suggested by the social support deterioration model by examining the direct and indirect links among economic stress, social support, and depressive symptoms in a sample of 336 mothers with children in mental health care. Structural equation modeling was used to examine the hypothesized paths depicted by this model and the relevant demographic variables. Economic stress was associated with depressive symptoms and appeared to exert part of its influence by reducing social support. Future research should consider social support and economic stress as potential targets for prevention of and intervention regarding maternal depression. KEY WORDS: economic stress; maternal depression; mental health; social support; socioeconomic status ********** Maternal depression is a significant public mental health problem that can negatively affect mothers and children. Besides the direct negative effects that mothers can experience, such as lowered quality of life and potential deficits in workplace and home settings (Druss, Rosenheck, & Sledge, 2000; Judd et al., 2000; Stewart, Ricci, Chee, Hahn, & Morganstein, 2003), children of depressed mothers are at greater risk for behavioral and emotional problems (Ashman, Dawson, & Panagiotides, 2008; Weissman et al., 2006). Although the mechanisms linking mothers' and children's behavioral health outcomes are not yet clearly understood, it appears that parenting is negatively affected by the symptoms of depression and that children may also model cognitions, behaviors, and affect consistent with the illness (S. H. Goodman, 2007; S. H. Goodman & Gotlib, 1999). Understanding the role of factors that may contribute to maternal depression is an important task to ultimately developing treatment and preventive strategies to alleviate this problem. This article examines the effects of economic stress and social support on maternal depressive symptoms in a group of predominantly low-income mothers whose children are receiving mental health care. A number of important studies have documented the link between economic stress and depressive illness. Since Brown, Bhrolchain, and Harris's (1975) study of psychiatric symptoms in working-class and middle-class women, research has continued to accumulate linking economic stress and the risk of experiencing depressive illness. In a meta-analysis of 60 studies examining socioeconomic inequalities and depression, individuals in the lowest socioeconomic status (SES) group were nearly twice as likely to experience a current depressive episode as those in the highest SES group (Lorant et al., 2003). Longitudinal studies have also confirmed that sustained economic stress increases the risk of experiencing depressive symptoms (Dearing, Taylor, & McCartney, 2004; Lynch, Kaplan, & Shema, 1997). The alarming rate of depressive symptoms in low-income community samples of mothers also suggests a link between economic stress and depression. In a variety of studies specific to low-income mothers, 35% to 52% of women were found to be at risk for clinical depression (Coiro, 2001; Kalil, Born, Kunz, & Caudill, 2001; Pascoe, Stolfi, & Ormond, 2006). Despite the detrimental impact of economic stress, it appears that social support may provide some protection from maternal depression. Studies specifically addressing social support and maternal depression have confirmed that high levels of social support are associated with significantly lower levels of depressive symptoms and a lower risk of depressive illness (Cairney, Boyle, Offord, & Racine, 2003; Siefert, Bowman, Heflin, Danziger, W Surkan, Peterson, Hughes, & Gottlieb, 2006). …

Statistical Approaches to Modeling: Multiple Outcomes in Psychiatric Studies

Increasingly, multiple outcomes are collected in order to characterize treatment effectiveness or to evaluate risk factors. These outcomes tend to be correlated because they are measuring related quantities in the same individuals. While the analysis of outcomes measured in the same scale (commensurate outcomes) can be undertaken with standard statistical methods, outcomes measured in different scales (non-commensurate outcomes), such as mixed binary and continuous outcomes, present more difficult challenges.In this paper we contrast some statistical approaches to analyze non-commensurate multiple outcomes. We discuss the advantages of a multivariate method for the analysis of non-commensurate outcomes including situations of missing data. A real data example from a clinical trial, comparing different treatments for depression in low-income women, is used to illustrate the differences between the statistical approaches.

Cost-Effectiveness of a Primary Care Treatment Program for Depression in Low-Income Women in Santiago, Chile

Cost-Effectiveness of a Primary Care Treatment Program for Depression in Low-Income Women in Santiago, Chile

Reduction of maternal depression: much remains to be done

In today's Lancet, Graciela Rojas and colleagues report a randomised trial in primary care for the reduction of maternal depression in low-income women in Santiago, Chile.1 The intervention tested had several components: training of primary-care physicians in the management of depression followed by weekly psychiatric supervision lasting an hour; psychoeducational groups for mothers; pharmacotherapy if needed; and support from trained non-medical staff to boost adherence. 230 women participated in the trial, 114 of those were allocated to the multi component intervention.

Prevention of Postpartum Depression in Low-Income Women: Development of the Mamás y Bebés/Mothers and Babies Course

A prenatal intervention designed to prevent the onset of major depressive episodes (MDEs) during pregnancy and postpartum was pilot tested at a public sector women’s clinic. The Mamás y Bebés/Mothers and Babies Course is an intervention developed in Spanish and English that uses a cognitive-behavioral mood management framework, and incorporates social learning concepts, attachment theory, and socio-cultural issues. The four goals of this project were to develop the intervention, assess its acceptability, test the feasibility of conducting a randomized trial with public sector patients, and obtain estimates of its effect size. Forty-one pregnant women at high risk for developing MDEs were randomized to the Mothers and Babies Course ( n = 21) or a comparison condition ( n = 20). Assessments occurred during pregnancy and at 1, 3, 6, and 12 months postpartum. Differences in terms of depression symptom levels or incidence of MDEs between the two groups did not reach statistical significance in this pilot trial. However, the MDE incidence rates of 14% for the intervention condition versus 25% for the comparison condition represent a small effect size ( h = 0.28) that will be further examined in a larger scale study. The intervention was well received by the participants and implementation of a randomized trial appeared quite feasible as indicated by our follow-up rate of 91% at 12 months. Implications for the continuing development of preventive interventions for perinatal depression are discussed.

Cost-Effectiveness of a Primary Care Treatment Program for Depression in Low-Income Women in Santiago, Chile

The authors compared the incremental cost-effectiveness of a stepped-care, multicomponent program with usual care for the treatment of depressed women in primary care in Santiago, Chile. A cost-effectiveness study was conducted of a previous randomized controlled trial involving 240 eligible women with DSM-IV major depression who were selected from a consecutive sample of adult women attending primary care clinics. The patients were randomly allocated to usual care or a multicomponent stepped-care program led by a nonmedical health care worker. Depression-free days and health care costs derived from local sources were assessed after 3 and 6 months. A health service perspective was used in the economic analysis. Complete data were determined for 80% of the randomly assigned patients. After we adjusted for initial severity, women receiving the stepped-care program had a mean of 50 additional depression-free days over 6 months relative to patients allocated to usual care. The stepped-care program was marginally more expensive than usual care (an extra 216 Chilean pesos per depression-free day). There was a 90% probability that the incremental cost of obtaining an extra depression-free day with the intervention would not exceed 300 pesos (1.04 US dollars). The stepped-care program was significantly more effective and marginally more expensive than usual care for the treatment of depressed women in primary care. Small investments to improve depression appear to yield larger gains in poorer environments. Simple and inexpensive treatment programs tested in developing countries might provide good study models for developed countries.

Cost-Effectiveness of a Primary Care Treatment Program for Depression in Low-Income Women in Santiago, Chile

Objective: The authors compared the incremental cost-effectiveness of a stepped-care, multicomponent program with usual care for the treatment of depressed women in primary care in Santiago, Chile. Method: A cost-effectiveness study was conducted of a previous randomized controlled trial involving 240 eligible women with DSM-IV major depression who were selected from a consecutive sample of adult women attending primary care clinics. The patients were randomly allocated to usual care or a multicomponent stepped-care program led by a nonmedical health care worker. Depression-free days and health care costs derived from local sources were assessed after 3 and 6 months. A health service perspective was used in the economic analysis. Results: Complete data were determined for 80% of the randomly assigned patients. After we adjusted for initial severity, women receiving the stepped-care program had a mean of 50 additional depression-free days over 6 months relative to patients allocated to usual care. The stepped-care program was marginally more expensive than usual care (an extra 216 Chilean pesos per depression-free day). There was a 90% probability that the incremental cost of obtaining an extra depression-free day with the intervention would not exceed 300 pesos ($1.04 U.S.). Conclusions: The stepped-care program was significantly more effective and marginally more expensive than usual care for the treatment of depressed women in primary care. Small investments to improve depression appear to yield larger gains in poorer environments. Simple and inexpensive treatment programs tested in developing countries might provide good study models for developed countries.

Culturally Relevant Psychotherapy for Perinatal Depression in Low-Income Ob/Gyn Patients

To minimize barriers to care, ameliorate antenatal depression, and prevent postpartum depression in low-income women, we propose that a culturally relevant version of brief interpersonal psychotherapy (IPT-B) may be an effective approach. IPT-B is a modified form of Interpersonal Psychotherapy (IPT), an efficacious treatment for depression that we have altered to address the needs of women who have difficulty adhering to longer courses of psychotherapy. Culturally relevant additions to IPT-B include (1) a pre-treatment engagement strategy consisting of an ethnographic interview accompanied by psychoeducation to engage women in treatment; (2) convenient delivery of IPT-B in a public care Ob/Gyn clinic where the women receive prenatal services; (3) flexible scheduling of treatment sessions at the clinic or on the phone; and 4) facilitation of access to social services.

Treating depression in primary care in low-income women in Santiago, Chile: a randomised controlled trial

Depression in women is one of the commonest problems encountered in primary care. We aimed to compare the effectiveness of a stepped-care programme with usual care in primary-care management of depression in low-income women in Santiago, Chile. In a randomised controlled trial, in three primary-care clinics in Chile, 240 adult female primary-care patients with major depression were allocated stepped care or usual care. Stepped care was a 3-month, multicomponent intervention led by a non-medical health worker, which included a psychoeducational group intervention, structured and systematic follow-up, and drug treatment for patients with severe depression. Data were analysed on an intention-to-treat basis. The primary outcome measure was the Hamilton depression rating scale (HDRS) administered at baseline and at 3 and 6 months after randomisation. About 90% of randomised patients completed outcome assessments. There was a substantial between-group difference in all outcome measures in favour of the stepped-care programme. The adjusted difference in mean HDRS score between the groups was -8.89 (95% CI -11.15 to -6.76; p<0.0001). At 6-months' follow-up, 70% (60-79) of the stepped-care compared with 30% (21-40) of the usual-care group had recovered (HDRS score <8). Despite few resources and marked deprivation, women with major depression responded well to a structured, stepped-care treatment programme, which is being introduced across Chile. Socially disadvantaged patients might gain the most from systematic improvements in treatment of depression.

Primary Prevention in the New Millennium: The Challenge of Translating Knowledge into Action

In a thoughtful essay on prevention, Leon S. Robertson (1998) recently observed that constructing elaborate theoretical models of disease is intellectually appealing to academics and other scientists, but if resources are used mainly to further specify causal paths rather than to test the effectiveness of preventive interventions, considerable unnecessary harm may occur in the interim. Robertson notes that multifactorial analysis of causal pathways does not necessarily lead to prevention, and can even interfere with prevention by becoming an excuse to do nothing. He further points out that one needs only to identify a necessary condition for a disorder and eliminate it to prevent the disorder from occurring, regardless of whether or not the “web of causes” is fully understood. Moreover, although we have identified a number of technical strategies to control known hazards to health, such as guns, tobacco, and adverse work conditions, the most effective approaches are those undertaken at the government or corporate level, and they are infrequently implemented (Robertson, 1998). Although policy interventions and environmental changes have greater impact, the emphasis has been on preventive actions at the individual level (Brownson, Newschaffer, and Ali-Abarghoui, 1997). A major challenge for primary prevention in the new millennium is to translate what we know about the deleterious influences of poverty, discrimination, and other social inequalities into effective preventive interventions. Consider, for example, the relationship between poverty and major depression in low-income women. Major depression is highly prevalent among women, and is associated with significant impairment in functioning, including parenting (Weissman and Olfson, 1995). Women are overrepresented among the poor, and higher rates of depression have consistently been found among both Black women and White women of lower socioeconomic status (Blazer et al., 1994; Williams et al., 1992). Bruce et al. (1991)