Depression screening may not capture significant sources of prenatal stress for Black women.

Exposure to stress during pregnancy, including depression, has a significant impact on maternal health. Black women experience varied stressors that impact pregnancy outcomes. Although the move to engage in universal screening of women for depression is a positive step toward improving women's health, it has been deployed without a comprehensive examination of its utility for capturing exposure to other stressors with known associations with perinatal and neonatal health problems for Black women such as discrimination stress. In the present study, we examine the overlap between several sources of stress and a positive screen on the Edinburgh Postnatal Depression Scale (EPDS) in Black pregnant women. Data were gathered from a study examining the effects of stress on prenatal health (N = 168). Discrimination stress, structural and systemic racism stress, perceived stress, and partner abuse were measured using standardized questionnaires during pregnancy. Using a score of ≥ 13 to indicate probable depression the sensitivity of the EPDS to identify women who experienced high levels of discrimination stress (41.7%), structural and systemic racism (39.5%), perceived stress (63.4%), and partner abuse (45.2%) was suboptimal. Lowering the threshold for a positive screen on the EPDS to a score of 10 improved sensitivity but did not solve the problem of under-identification of women whose health is at risk. The focus on depression screening for pregnant women should be re-considered. A screening toolkit that more rigorously and broadly assesses risk and need for support and intervention is needed to improve perinatal health outcomes for Black women.

Social connectedness and well-being among Black women who experienced adolescent sexual trauma.

OBJECTIVE: Sexual violence disproportionately impacts Black girls and women in the United States. The literature documents the long-term mental health outcomes of childhood sexual trauma, but research on resilience-promoting factors for Black women survivors of such trauma is sparse. The present study tests hypotheses about the influence of Black girls' social connectedness (e.g., with mothers, peers, and racial/ethnic community) on the association between adolescent sexual trauma and early adulthood well-being. METHOD: Participants included 850 Black girls from the Pittsburgh Girls Study. Girls reported prospectively and retrospectively on experiences of sexual trauma between ages 13 and 17. Annual assessments of social connectedness comprised reports of closeness with mother, peer social self-worth, and belonging/affirmation in racial/ethnic identity. In early adulthood (ages 18-21), participants reported on psychological flourishing. RESULTS: Approximately 10% (N = 83) of participants reported having experienced sexual trauma during adolescence. Hierarchical linear regression analyses revealed that adolescent sexual trauma predicted lower psychological flourishing, whereas peer social self-worth and belonging in racial/ethnic identity predicted higher psychological flourishing in early adulthood. Tests of moderation revealed no significant effects of social connectedness on the association between adolescent sexual trauma and later psychological flourishing. CONCLUSIONS: Findings suggest that Black women survivors of adolescent sexual trauma may experience lower psychological flourishing than those without histories of such trauma and support the importance of multiple domains of social connectedness for Black adolescent girls, in general. However, further research is needed on race- and gender-specific contextual factors that enable Black women survivors of sexual trauma to thrive. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Community Violence Exposure and Adolescent Pregnancy in Chicago.

This study examined the association between community violence exposure (CVE), sex without contraception, and adolescent pregnancy in Chicago. A self-administered, online survey was conducted among 15- to 19-year-old girls from the South and West sides of Chicago from October to March 2018. Participants were recruited via community organization partnerships and social media advertising. The survey included questions about CVE, sexual behaviors, and covariates that are known to contribute to sexual risk taking. CVE was measured via a validated index of seven questions that measured individual experiences with violence. Multivariable and logistic regression analyses were performed to examine the association between CVE, penile-vaginal intercourse without contraception, and ever being pregnant. The final sample included 644 girls. Levels of CVE were high: 62.87% of girls reported that a close friend or relative died because of violence and 41.60% were a victim of violence. Nearly half (48.69%) of girls had penile-vaginal intercourse and 6.01% had been pregnant. For each standard deviation increase in CVE score, the odds of penile-vaginal intercourse without contraception (odds ratio [OR] = 1.69, 95% confidence interval [CI] = [1.27, 2.25]) and the odds of ever being pregnant (OR = 1.87, 95% CI = [1.36, 2.57]) increased. These results remained significant when adjusting for demographic, psychosocial, institutional, and interpersonal factors. Findings suggest that girls in Chicago who are exposed to higher levels of community violence have an increased likelihood of experiencing penile-vaginal intercourse without contraception and teenage pregnancy, even when adjusting for other predictors to teenage pregnancy.

The Impact of Adolescent Sexual Harassment Experiences in Predicting Sexual Risk-Taking in Young Women.

Early sexual behavior plays a vital role in female reproductive health. Victimization experiences such as sexual harassment may have a unique impact on girls' sexual health. We examined the prospective associations between sexual harassment during adolescence and high-risk sexual activity in early adulthood. Using mixed-effects logistic regression models, we tested associations between sexual harassment at ages 13 to 15 years and sexual risk behaviors at ages 16 to 20 years, controlling for depression and peer victimization. We used a community sample in Pittsburgh, PA. Through the Pittsburgh Girls Study, 2,450 girls were recruited when they were between the ages of 5 and 8 years, with approximately equal numbers in each of the four age groups. Approximately half of the girls sampled were African American (52%), and 41% were European American. The remaining girls were described as multiracial or representing another race. Data were collected via an annual nonclinician administered interview. Results indicated that participants who experienced sexual harassment as adolescents (21%) were more likely to have multiple sexual partners and more likely to have contracted a sexually transmitted infection (STI) in early adulthood. Sexually active 16-year-olds who had been sexually harassed were over 3 times more likely to have had two or more partners in the past 30 days. These effects were maintained controlling for other types of peer victimization and depression. Sexual harassment was not significantly associated with birth control use. These results suggest that sexual harassment has downstream effects on women's health.

Resident Well-Being Before and During the COVID-19 Pandemic.

BACKGROUND: Preliminary studies reveal challenges posed by the COVID-19 pandemic to the well-being of health care workers. Little is known about the effects of the pandemic on the well-being of graduate medical education (GME) residents or about protective factors and post-traumatic growth. Through deeper examination of resident well-being during this unique crisis, we can identify trends and associated lessons to apply broadly to resident well-being. OBJECTIVE: To characterize resident burnout, resilience, and loneliness before and during the COVID-19 pandemic. METHODS: All residents in any specialty at a single institution were anonymously surveyed semiannually for 2 years (2019-2020), including the time period of the COVID-19 pandemic. Surveys included demographics, the 10-item Connor-Davidson Resilience Scale, the Maslach Burnout Inventory, and the UCLA Loneliness Scale. RESULTS: Overall response rates were 53% (508 of 964) in spring 2019, 55% (538 of 982) in fall 2019, 51% (498 of 984) in spring 2020, and 57% (563 of 985) in fall 2020. The overall rates of burnout were stable across all time periods and did not change during the COVID-19 pandemic. Among frontline residents, burnout rates were higher than other resident populations in both the pre- and post-COVID-19 pandemic time periods. Resilience and loneliness measures were similar for frontline and non-frontline residents and remained stable during the pandemic. CONCLUSIONS: Initial data from this single institution survey of all GME residents in the first 8 months of the COVID-19 pandemic demonstrated burnout and loneliness did not increase and resilience was preserved.

Evaluation of a trauma-informed and gender-responsive intervention for women in drug treatment.

There is growing recognition of the complex needs of women with dual diagnoses of substance abuse and mental health disorders. Recent research indicates that 55% to 99% of women with co-occurring disorders have experienced trauma from abuse and that abused women tend to engage in self-destructive behaviors. These women often are not well served by the services found in their communities, which separate substance abuse and mental health programs, despite the fact that research shows that integrated, trauma-informed treatment services will increase the success of their recovery. A recent study examined the use of two gender-responsive, trauma-informed curricula presented in a residential facility for women, 55% of whom had criminal histories. Helping Women Recover and Beyond Trauma are both manualized programs founded on research and clinical practice and are grounded in the theories of addiction, trauma, and women's psychological development. This treatment model is named "Women's Integrated Treatment" (WIT). Women who successfully completed the programs were assessed at several points in time on several scales, including trauma symptomology, depression, and substance use before and after the programs. The findings indicated less substance use, less depression, and fewer trauma symptoms (p < or = .05)--including anxiety, sleep disturbances, and dissociation--after participation in the WIT curricula.