Childhood and adulthood trauma exposure: Associations with perinatal mental health and psychotherapy response.

Trauma exposure is strongly linked to maternal posttraumatic stress disorder (PTSD) and depressive symptoms during the perinatal period; however, childhood trauma exposure is often assessed without accounting for adult exposure. This study tested the unique impacts of childhood and adulthood trauma exposure on PTSD and depressive symptoms among pregnant women (N = 107, 82.9% Latina) enrolled in a nonrandomized intervention study. Regression analyses at baseline showed positive associations between trauma exposure and PTSD symptoms irrespective of trauma timing, childhood: B = 1.62, t(91) = 2.11, p = .038; adulthood: B = 2.92, t(91) = 3.04, p = .003. However only adulthood trauma exposure, B = 1.28, t(94) = 2.94, p = .004, was positively associated with depressive symptoms. Mixed-effects analyses of variance revealed interaction effects of time and adulthood trauma exposure, indicating that women with high degrees of adulthood trauma exposure had higher baseline levels of PTSD, F(1, 76.4) = 6.45, p = .013, and depressive symptoms, F(1, 87.2) = 4.88, p = .030, but showed a more precipitous decrease posttreatment than women with lower levels of adulthood trauma exposure. These findings support the clinical relevance of assessing both childhood and adulthood trauma exposure during the perinatal period given their impacts on baseline symptoms and psychotherapy response.

Viewpoint: Challenges and strategies for engaging participants in videoconferencing appointments.

There are unique challenges that arise from participating in remote clinical trials. Broadly, findings suggest that participants enrolled in digital intervention trials are more likely to disengage or prematurely dropout than participants in face-to-face trials. Thus, optimizing contact with participants via video-conferencing platforms to build rapport and encourage commitment to the study is critical. Still, challenges with video-conferencing visits can pose challenges. Some of these challenges include a lack of clarity about study requirements, difficulties demonstrating staff engagement and building rapport, and the technical challenges of using video-conferencing software. These challenges can affect participant retention, study validity, and the willingness of underserved groups to participate in research. In the context of a remote randomized clinical trial evaluating a digital intervention for prenatal insomnia, we discuss strategies used to counteract these challenges, including the use of virtual orientation sessions, and practical recommendations to improve staff engagement with participants. These findings are relevant to research teams conducting remote clinical trials, especially those seeking to recruit and retain participants from populations currently and historically underrepresented in research.

Pandemic-Related Stress and Resilience Among Latinx Mothers with a History of Depression: Differences by Immigration Status.

This study explores the impact of the COVID-19 pandemic on low-income, Latinx mothers in Southern California with a history of depression, including undocumented mothers and members of mixed status families. Drawing participants from a parent study that provided a maternal depression intervention to Head Start mothers (n = 119), this mixed method study integrates qualitative and quantitative data in a convergent design. Thirty-four mothers completed semi-structured qualitative interviews and standardized questionnaires in the fall of 2020. Mothers shared overwhelming economic difficulties, with the majority reporting that their family income decreased and half reporting that they were unable to pay for housing. Stressors were compounded for undocumented mothers and members of mixed-status families who were excluded from major relief programs. Stress affected maternal mental health, and mothers with precarious status reported differences in functioning. Mothers also identified positive ways that they coped with adversity. Results show that Latinx mothers with a history of depression, particularly mothers with precarious immigration status, continue to suffer considerable economic, social, and emotional impacts of the COVID-19 pandemic. Social workers can support the human rights of this population by advocating for financial relief, food assistance, and the expansion of medical-legal partnerships and physical and mental health services.

Exposure therapy acceptability among pregnant Latinas with anxiety: A qualitative content analysis.

OBJECTIVE: Exposure therapy is the frontline treatment for anxiety among adults but is underutilized during pregnancy. We qualitatively assess the prospective acceptability of exposure therapy among pregnant Latinas with elevated anxiety, a group that experiences mental health disparities. METHOD: Pregnant Latinas (N = 25) with elevated anxiety were interviewed regarding their acceptability of exposure therapy following the receipt of an informational clinical video vignette. Interviews were analyzed using deductive content analysis guided by the Theoretical Framework of Acceptability to understand pregnant Latinas' views about exposure therapy. RESULTS: Nineteen themes were identified across seven theoretically driven subdomains of acceptability. Women expressed acceptability enhancing factors for exposure therapy including feeling hopeful about its effects, a belief that treatment could benefit their broader family, and a preference for treatment during pregnancy as opposed to the postpartum period. Women also expressed challenges to exposure therapy acceptability such as managing family reactions to prenatal psychotherapy, conflict with cultural conceptions of the maternal role, and perceived difficulty using exposure for avoidance related to prenatal health. CONCLUSION: Identified themes provide insights about exposure acceptability among pregnant women and can be used to bettter engage Latinas in anxiety interventions, ultimately improving clinical outcomes. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Addressing Adverse Childhood and Adult Experiences During Prenatal Care.

Adverse childhood and adult experiences can affect health outcomes throughout life and across generations. The perinatal period offers a critical opportunity for obstetric clinicians to partner with patients to provide support and improve outcomes. This article draws on stakeholder input, expert opinion, and available evidence to provide recommendations for obstetric clinicians' inquiry about and response to pregnant patients' past and present adversity and trauma during prenatal care encounters. Trauma-informed care is a universal intervention that can proactively address adversity and trauma and support healing, even if a patient does not explicitly disclose past or present adversity. Inquiry about past and present adversity and trauma provides an avenue to offer support and to create individualized care plans. Preparatory steps to adopting a trauma-informed approach to prenatal care include initiating education and training for practice staff, prioritizing addressing racism and health disparities, and establishing patient safety and trust. Inquiry about adversity and trauma, as well as resilience factors, can be implemented gradually over time through open-ended questions, structured survey measures, or a combination of both techniques. A range of evidence-based educational resources, prevention and intervention programs, and community-based initiatives can be included within individualized care plans to improve perinatal health outcomes. These practices will be further developed and improved by increased clinical training and research, as well as through broad adoption of a trauma-informed approach and collaboration across specialty areas.

Anxiety in pregnancy and length of gestation: Findings from the healthy babies before birth study.

OBJECTIVES: Anxiety is prevalent in pregnancy and predicts risk of adverse birth outcomes. Many instruments measure anxiety in pregnancy, some of which assess pregnancy anxiety defined as maternal concerns about a current pregnancy (e.g., baby, childbirth). The present study examined covariance among four anxiety or distress measures at two times in pregnancy and tested joint and individual effects on gestational length. We hypothesized that the common variance of the measures in each trimester would predict earlier delivery. METHOD: Research staff interviewed 196 women in first and third trimester utilizing a clinical screener of anxiety severity/impairment, two instruments measuring pregnancy anxiety, and one on prenatal distress. Birth outcomes and medical risk factors were obtained from medical records after birth. Structural equation modeling fit latent factors for each trimester from the four measures. Subsequent models tested whether the latent factors predicted gestational length, and unique effects of each measure. RESULTS: The third-trimester pregnancy anxiety latent factor predicted shorter gestational length adjusting for mother's age, education, parity, and obstetric risk. Scores on a four-item pregnancy-specific anxiety measure (PSAS) in third trimester added uniquely to prediction of gestational length. In first trimester, scores on the clinical screener (OASIS) uniquely predicted shorter gestational length whereas the latent factor did not. CONCLUSION: These results support existing evidence indicating that pregnancy anxiety is a reliable risk factor for earlier birth. Findings point to possible screening for clinically significant anxiety symptoms in the first trimester, and pregnancy-specific anxiety thereafter to advance efforts to prevent earlier delivery. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Psychological Interventions for Prenatal Anxiety in Latinas and Black Women: A Scoping Review and Recommendations.

Anxiety symptoms are common among pregnant women worldwide. In the United States, prenatal anxiety symptoms tend to be elevated among Black and Latin American women as compared to non-Latina White women. Despite the high prevalence of anxiety and associations with adverse maternal and offspring outcomes, interventions have not been developed or tailored sufficiently to Black women or Latinas who need efficacious treatment. This article provides a scoping review of articles published since 2017 that test the effects of randomized and non-randomized psychological interventions designed to reduce prenatal anxiety in samples comprised primarily of ethnic/racial minority women. We also review published protocols of planned psychological interventions to reduce prenatal anxiety in order to highlight novel approaches. In addition to summarizing intervention efficacy and participant acceptability, we highlight gaps in the literature which, if addressed, could improve perinatal mental health equity. Finally, we discuss future directions in prenatal anxiety intervention science beginning preconception including intervention design and prevention models.

Discrimination and Internalizing Symptoms in Rural Latinx Adolescents: The Protective Role of Family Resilience.

OBJECTIVE: There is a well-documented relationship between discrimination and increases in internalizing symptoms among rural Latinx youth. Among numerous assets in these adolescents' lives, family resilience emerges as a culturally relevant and robust protective factor. However, it is still unclear whether family resilience is equally protective across different internalizing symptom clusters and whether this buffering effect is independent of other interconnected resilience sources. METHOD: Latinx adolescents from an underserved rural community (n = 444; Mage = 15.74, SDage = 1.22; 51% male) reported on their internalizing symptoms, experiences of discrimination, and sources of resilience. We examined whether perceived family resilience moderated the association between perceived discrimination and self-reported depressive, somatic, and anxiety symptoms over and above adolescents' sex, self-reported level of acculturation, as well as perceived individual and contextual resilience. RESULTS: Analyses showed that perceived discrimination experiences were robustly associated with higher levels of self-reported internalizing symptoms, while perceived family resilience was related to lower self-reported symptomatology. Closer examination revealed that perceived family resilience buffered the negative effects of perceived discrimination on self-reported depression and somatic symptoms, but not anxiety symptoms. CONCLUSIONS: This study addresses a gap in the literature by identifying differential protective effects of family resilience that might be explained by cultural values and practices in rural Latinx families. Findings suggest that interventions that incorporate family members and promote supportive family environments may benefit rural Latinx youth with a broad range of internalizing symptoms.

Cognitive behavioral stress management effects on prenatal anxiety among low-income women.

OBJECTIVE: Few studies have tested cognitive behavioral therapy to reduce prenatal anxiety despite substantial empirical support among individuals seeking treatment for anxiety symptoms. We examined whether a brief cognitive behavioral intervention delivered to low-income pregnant women would be efficacious for reducing prenatal anxiety. METHOD: A sample of 100 primarily ethnic and racial minority pregnant women with subclinical anxiety (74% Latina, 18% Black; Mage = 26.5) were randomized to an 8-week cognitive behavioral stress management (CBSM) intervention (n = 55), or to an attentional control condition (n = 45). Two forms of anxiety (state and pregnancy-specific) were measured at baseline, post-treatment, and at follow-up in the postpartum using the State-Trait Personality Inventory-State and the Pregnancy Related Anxiety scale, respectively. Intent-to-treat (ITT) and completer analyses were conducted using linear mixed models to test mean differences in both forms of anxiety by group assignment and by intervention completion (< 7 vs. ≥ 7 sessions) at post-treatment and follow-up timepoints. RESULTS: ITT results revealed no intervention Group × Time interactions for state, F(3, 356) = .51, p = .68, or pregnancy-specific anxiety, F(2, 184.39) = .75, p = .47, indicating no intervention effect post-treatment or at follow-up. Completer analyses showed that women who received all intervention content (34.5%) had significantly less state anxiety at post-treatment compared to women who had not completed the intervention, (65.5%; Msessions = 3.62); F(6, 270.67) = 2.35, p = .03, and those in the control condition. CONCLUSIONS: While we did not find support for the use of CBSM to treat prenatal anxiety among low-income women, those who received a full dose benefited in state anxiety immediately postintervention. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Considerations of diversity, equity, and inclusion in mental health apps: A scoping review of evaluation frameworks.

Mental health applications or apps are a promising approach to reduce the pervasive unmet mental health need observed among marginalized groups. However, these groups face unique challenges to engage in and benefit from these interventions, and apps that consider issues of diversity, equity, and inclusion (DEI) may be better positioned to reach them. App evaluation frameworks emerge as crucial tools for researchers, clinicians, and users to select evidence-based apps. Nevertheless, it is unclear the extent to which existing assessment tools capture DEI factors. The present scoping review identified 68 studies that employed one or more assessment tools to evaluate a mental health app, leading to 44 unique app evaluation frameworks. Results showed that most frameworks were developed after 2015, and only 58% of them considered at least one DEI criterion. Frameworks that performed exceptionally well were those that combined multiple standardized and validated measures. This lack of consideration for DEI variables may limit the ability of app-based interventions to serve marginalized communities, or even worse, create new disparities. Therefore, we provide recommendations to improve current app evaluation frameworks' cultural robustness and clinical utility, maximizing their effectiveness when working with individuals from marginalized communities.

Altered Thalamocortical Connectivity in 6-Week-Old Infants at High Familial Risk for Autism Spectrum Disorder.

Converging evidence from neuroimaging studies has revealed altered connectivity in cortical-subcortical networks in youth and adults with autism spectrum disorder (ASD). Comparatively little is known about the development of cortical-subcortical connectivity in infancy, before the emergence of overt ASD symptomatology. Here, we examined early functional and structural connectivity of thalamocortical networks in infants at high familial risk for ASD (HR) and low-risk controls (LR). Resting-state functional connectivity and diffusion tensor imaging data were acquired in 52 6-week-old infants. Functional connectivity was examined between 6 cortical seeds-prefrontal, motor, somatosensory, temporal, parietal, and occipital regions-and bilateral thalamus. We found significant thalamic-prefrontal underconnectivity, as well as thalamic-occipital and thalamic-motor overconnectivity in HR infants, relative to LR infants. Subsequent structural connectivity analyses also revealed atypical white matter integrity in thalamic-occipital tracts in HR infants, compared with LR infants. Notably, aberrant connectivity indices at 6 weeks predicted atypical social development between 9 and 36 months of age, as assessed with eye-tracking and diagnostic measures. These findings indicate that thalamocortical connectivity is disrupted at both the functional and structural level in HR infants as early as 6 weeks of age, providing a possible early marker of risk for ASD.

Lack of neural evidence for implicit language learning in 9-month-old infants at high risk for autism.

Word segmentation is a fundamental aspect of language learning, since identification of word boundaries in continuous speech must occur before the acquisition of word meanings can take place. We previously used functional magnetic resonance imaging (fMRI) to show that youth with autism spectrum disorder (ASD) are less sensitive to statistical and speech cues that guide implicit word segmentation. However, little is known about the neural mechanisms underlying this process during infancy and how this may be associated with ASD risk. Here, we examined early neural signatures of language-related learning in 9-month-old infants at high (HR) and low familial risk (LR) for ASD. During natural sleep, infants underwent fMRI while passively listening to three speech streams containing strong statistical and prosodic cues, strong statistical cues only, or minimal statistical cues to word boundaries. Compared to HR infants, LR infants showed greater activity in the left amygdala for the speech stream containing statistical and prosodic cues. While listening to this same speech stream, LR infants also showed more learning-related signal increases in left temporal regions as well as increasing functional connectivity between bilateral primary auditory cortex and right anterior insula. Importantly, learning-related signal increases at 9 months positively correlated with expressive language outcome at 36 months in both groups. In the HR group, greater signal increases were additionally associated with less severe ASD symptomatology at 36 months. These findings suggest that early differences in the neural networks underlying language learning may predict subsequent language development and altered trajectories associated with ASD risk.

Electrophysiological signatures of visual statistical learning in 3-month-old infants at familial and low risk for autism spectrum disorder.

Visual statistical learning (VSL) refers to the ability to extract associations and conditional probabilities within the visual environment. It may serve as a precursor to cognitive and social communication development. Quantifying VSL in infants at familial risk (FR) for Autism Spectrum Disorder (ASD) provides opportunities to understand how genetic predisposition can influence early learning processes which may, in turn, lay a foundation for cognitive and social communication delays. We examined electroencephalography (EEG) signatures of VSL in 3-month-old infants, examining whether EEG correlates of VSL differentiated FR from low-risk (LR) infants. In an exploratory analysis, we then examined whether EEG correlates of VSL at 3 months relate to cognitive function and ASD symptoms at 18 months. Infants were exposed to a continuous stream of looming shape pairs with varying probability that the shapes would occur in sequence (high probability-deterministic condition; low probability-probabilistic condition). EEG was time-locked to shapes based on their transitional probabilities. EEG analysis examined group-level characteristics underlying specific components, including the late frontal positivity (LFP) and N700 responses. FR infants demonstrated increased LFP and N700 response to the probabilistic condition, whereas LR infants demonstrated increased LFP and N700 response to the deterministic condition. LFP at 3 months predicted 18-month visual reception skills and not ASD symptoms. Our findings thus provide evidence for distinct VSL processes in FR and LR infants as early as 3 months. Atypical pattern learning in FR infants may lay a foundation for later delays in higher level, nonverbal cognitive skills, and predict ASD symptoms well before an ASD diagnosis is made.

Postpartum depressive symptoms in low-income Latinas: Cultural and contextual contributors.

OBJECTIVE: Using a conceptual model of postpartum depression risk in Latinas including both contextual and cultural stressors, we tested contributions to depressive symptom levels and trajectories over the course of 1 year following birth in a community sample of Latinas. METHOD: A multisite sample of low-income U.S.-born and foreign-born Latinas (n = 537; M age = 25.70) was interviewed on many topics including measures of stress and maternal health at 1, 6, and 12 months postpartum. Nested multilevel growth curve models were implemented to test associations of contextual stressors (poverty, domestic violence) with trajectories of depressive symptoms, adjusting for confounds. This model was compared to 1 that added cultural stress variables (everyday discrimination, foreign-born status, language preference, age at immigration) measured 1-month postpartum. RESULTS: The best fitting model provided evidence for the independent effects of cultural and contextual stressors. Discrimination (ß = .13 SE = .02, p = < .001) and domestic violence (ß = .39 SE = .09, p = < .001) predicted trajectories with higher levels of depressive symptoms 1 month postpartum, but not linear change in symptoms over the year. CONCLUSIONS: The present study provides evidence that discrimination, a cultural factor, and domestic violence, a contextual factor, each predict higher levels of early postpartum depressive symptoms. Interventions addressing discrimination and maternal safety are recommended. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Trauma Exposure and Mental Health Symptoms in Rural Latinx Adolescents: The Role of Family Processes.

Previous research suggests that rural Latinx youth are more likely to experience traumatic events and are at higher risk for developing subsequent psychopathology compared to non-Latinx white youth. The aim of this study is to understand how family processes and values affect risk for internalizing and externalizing symptoms among rural Latinx youth (N = 648, mage = 15.7 (SD = 1.2)) who are exposed to trauma. Multiple mediation analyses were performed to understand if family variables such as familism and family conflict explain the relationship between trauma exposure and psychopathology. Results suggest that familism partially mediates the relationship between trauma exposure and internalizing and externalizing symptoms, whereas family conflict partially mediates the relationship between trauma exposure and externalizing symptoms. These findings show that family variables are differentially impacted by trauma and have a separate and unique impact on mental health outcomes among rural Latinx youth. Specifically, our findings suggest that familial support or closeness may constitute a nonspecific protective factor for psychopathology among Latinx youth, whereas family conflict creates a stressful home environment that may deter adolescent trauma recovery and lead specifically to externalizing symptoms.

Psychological interventions for depression and anxiety in pregnant Latina and Black women in the United States: A systematic review.

Black women and Latinas have more symptoms of depression and anxiety during pregnancy than do their non-Latina White counterparts. Although effective interventions targeting internalizing disorders in pregnancy are available, they are primarily tested with White women. This article reviews randomized controlled trials and non-randomized studies to better understand the effectiveness of psychological interventions for anxiety and depression during pregnancy in Latinas and Black women. Additionally, this review summarizes important characteristics of interventions such as intervention format, treatment modality, and the use of cultural adaptations. Literature searches of relevant research citation databases produced 68 studies; 13 of which were included in the final review. Most studies were excluded because their samples were not majority Latina or Black women or because they did not test an intervention. Of the included studies, three interventions outperformed a control group condition and showed statistically significant reductions in depressive symptoms. An additional two studies showed reductions in depressive symptoms from pretreatment to post-treatment using non-controlled designs. The remaining eight studies (seven randomized and one non-randomized) did not show significant intervention effects. Cognitive behavioral therapy was the modality with most evidence for reducing depressive symptoms in pregnant Black and Latina women. No intervention was found to reduce anxiety symptoms, although only two of the 13 measured anxiety as an outcome. Five studies made cultural adaptations to their treatment protocols. Future studies should strive to better understand the importance of cultural modifications to improve engagement and clinical outcomes with pregnant women receiving treatment for anxiety and depression.

Urban Latinx parents' attitudes towards mental health: Mental health literacy and service use.

Latinx youth report elevated internalizing symptomatology as compared to their non-Latinx White counterparts and are less likely to access mental health care for these problems. This qualitative study examined the knowledge, beliefs and perceptions that Latinx parents (86% foreign-born; 66.7% monolingual Spanish speakers) living in urban communities have about mental health and service use for anxiety and depression in children. We used thematic analysis to analyze interview data from 15 Latinx parents who expressed concerns about their child's (age 6-13) worry or sadness. Analyses revealed that Latinx parents often have difficulty identifying mental health problems, report stigma about mental health problems and help-seeking and want more information about how they can help their children. Although Latinx parents report significant mental health and treatment-seeking stigma, the majority were open to seeking mental health services for their children or were already receiving services. Findings suggest that stigma although prevalent, may not deter service utilization for some Latinx families. Implications for community health and future research are discussed.

Altered lateralization of dorsal language tracts in 6-week-old infants at risk for autism.

Altered structural connectivity has been identified as a possible biomarker of autism spectrum disorder (ASD) risk in the developing brain. Core features of ASD include impaired social communication and early language delay. Thus, examining white matter tracts associated with language may lend further insight into early signs of ASD risk and the mechanisms that underlie language impairments associated with the disorder. Evidence of altered structural connectivity has previously been detected in 6-month-old infants at high familial risk for developing ASD. However, as language processing begins in utero, differences in structural connectivity between language regions may be present in the early infant brain shortly after birth. Here we investigated key white matter pathways of the dorsal language network in 6-week-old infants at high (HR) and low (LR) risk for ASD to identify atypicalities in structural connectivity that may predict altered developmental trajectories prior to overt language delays and the onset of ASD symptomatology. Compared to HR infants, LR infants showed higher fractional anisotropy (FA) in the left superior longitudinal fasciculus (SLF); in contrast, in the right SLF, HR infants showed higher FA than LR infants. Additionally, HR infants showed more rightward lateralization of the SLF. Across both groups, measures of FA and lateralization of these pathways at 6 weeks of age were related to later language development at 18 months of age as well as ASD symptomatology at 36 months of age. These findings indicate that early differences in the structure of language pathways may provide an early predictor of future language development and ASD risk.

Family factors mediate discrimination related stress and externalizing symptoms in rural Latino adolescents.

INTRODUCTION: Externalizing disorders are more prevalent in rural than urban settings and account for disproportionately high mental health service costs for rural adolescents. Although cultural stressors such as discrimination have been associated with externalizing problems in ethnic minority youth broadly, this relationship is understudied in Latinos, particularly those in rural settings. Further, though the associations of family processes such as familism and family conflict have been studied in relation to youth externalizing symptoms, whether these processes change in the face of adolescent discrimination stress remains unknown. METHODS: A moderated multiple mediation model was used to examine the association between perceived discrimination, externalizing symptoms, and the indirect effect of family factors (familism, and family conflict) in a large sample (n = 455) of rural Latino youth. We also evaluated whether indirect and direct effects of discrimination on externalizing symptoms differed in boys versus girls. RESULTS: Familism and family conflict each independently mediated the relationship between discrimination related stress and externalizing symptoms. However, discrimination had a direct effect on externalizing symptoms for boys only. In girls, this association held only when family factors were accounted for. Post-hoc analyses reveal that the moderating effect of sex on discrimination is driven by differences in rule-breaking behavior, as opposed to aggressive behavior. CONCLUSION: Findings suggest that discrimination is associated with changes in the family environment which in turn invoke elevated risk for externalizing problems. Further, family-focused interventions that address externalizing problems may be especially effective for adolescent girls.