Potential impact of trauma on the ability to prevent depression among low-income mothers.

BACKGROUND: Violent trauma is common in urban communities. We explored the hypothesis that past trauma could moderate the effect of a cognitive behavioral intervention designed to prevent depression among urban, low-income mothers. METHODS: Synthesis of two pilot randomized trials of problem solving education (PSE) among 93 mothers of children hospitalized in the neonatal intensive care unit or enrolled in community-based Early Intervention programs. Outcomes included depressive symptoms, perceived stress, and social functioning. Results were adjusted for baseline depressive symptoms, then stratified according to subjects' trauma history. RESULTS: Fifteen of the 44 PSE subjects (34%) experienced a moderately severe depressive symptom episode during the 3-month follow-up period, as opposed to 21 of 45 control subjects (47%), for a nearly significant adjusted odds ratio (aOR) of 0.36 (95% CI: 0.13, 1.02). Among mothers without trauma histories, far fewer PSE mothers (5 of 24; 21%) experienced an episode of moderately severe depressive symptoms than control mothers (12 of 26; 46%) for a significant aOR of 0.15 (95% CI: 0.03, 0.79). Conversely, among mothers with trauma histories, a similar proportion of PSE mothers (10 of 19; 53%) experienced an episode of moderately severe depressive symptoms as control mothers (9 of 19; 47%). Similar trends held for perceived stress and social functioning. CONCLUSIONS: PSE may be more effective at preventing depression among mothers without trauma histories. Our results are consistent with the depression treatment literature, but are novel because they support the principle of intervention moderation in risk prevention, as opposed to treatment, paradigm.

"Just be straight with me:" an exploration of Black patient experiences in initial mental health encounters.

It is advantageous for a clinician to understand how patients feel about their initial encounters, but it can be difficult to discern what is and what is not working. This qualitative, exploratory study is guided by the question, "What happens during an initial mental health encounter between a Black patient and a non-Black provider that leads the patient to describe it as a good or poor experience?" The findings are based on face-to-face, postintake interviews with 14 Black patients seen by 11 non-Black providers as part of the Patient-Provider Encounter Study. The objective is to explore the initial interpersonal interactions between Black patients and their non-Black mental health providers and to better understand how patients come to describe the encounter as good (favorable) or poor (unfavorable). A framework inclusive of 5 specific elements is introduced that maps the patient's conceptualization process about how judgments are made about the encounter. Owing to the naturalistic and exploratory nature of the study, a research hypothesis was not established. Instead, we observed how patients scanned the interaction with the provider, made assessments about their provider, and determined whether their experience was positive or negative. The implications of these findings will help to improve the interactions in mental health settings between minority patients and their providers.