Changes in mental health symptoms and sociocultural factors across the COVID-19 pandemic in mothers of Mexican descent.

Latinos have been disproportionately affected by the COVID-19 pandemic in the US. Little is known about the lasting effects on mental health, particularly among mothers of young children, who historically report high levels of depression and anxiety. We examined if anxiety and depression symptoms worsened for mothers of Mexican descent across the pandemic and identified the role of sociocultural risk and protective factors on these changes. Mothers of Mexican descent (n = 141) with young children (ages 0-7) were administered surveys on mental health symptoms (anxiety and depression), stress-related sociocultural factors (perceived discrimination) before (pre-pandemic), within 3 months (early pandemic), and 18 months after the COVID-19 stay-at-home order (late pandemic). Another sociocultural factor, acculturative stress, was only measured pre-pandemic while during the later phase of the pandemic mothers reported their levels of loneliness, optimism, and coping styles. Repeated measures (RM) ANOVA demonstrated that depressive and anxiety symptoms as well as perceived discrimination increased from pre to early months of the COVID-19 pandemic and slightly lowered in late-COVID but did not return to pre-COVID levels. Two-way RM ANOVA showed that acculturative stress and perceived discrimination predicted worse mental health trajectories across the pandemic while moderations revealed that optimism buffered against, and avoidant coping increased the adverse effects of sociocultural factors on mental health. The effects of the COVID pandemic on mental health are lingering in mothers of young children; however, optimism may be a protective factor. The results also highlight the damaging effects of external factors, such as discrimination, on maternal mental health during times of crisis.

Feasibility and impact of a remote moderate-intensity yoga intervention on stress and executive functioning in working adults: a randomized controlled trial.

The feasibility of a moderate-intensity yoga intervention, delivered remotely via supervised and unsupervised sessions, and its psychosocial and cognitive effects have not been thoroughly investigated. This randomized controlled trial assessed feasibility and preliminary efficacy of an 8-week moderate-intensity yoga intervention (3×/week, 50 min) delivered remotely (vs. a waitlist control arm), on stress and cognitive functioning. Participants (n = 86) were low active, full-time working adults (81.40% female; Mage = 41 years) with symptoms of stress. Feasibility was assessed via adherence, enjoyment, and safety; stress and anxiety via self-report questionnaires; and executive functioning via neuropsychological tests. Overall attendance was 75.1%, 100% of participants enjoyed the intervention, and only one adverse event was reported. At follow-up, the yoga group had significantly lower stress and anxiety, and higher accuracy on working memory tasks. Remote moderate intensity yoga practice proved safe, enjoyable, and may reduce stress and improve cognitive functioning. This study was pre-registered on ClinicalTrials.gov (NCT04740229).

The Price of Pre-adolescent Abuse: Effects of Sexual Abuse on Perinatal Depression and Anxiety.

INTRODUCTION: Childhood abuse is a major public health concern and a risk factor for subsequent poor maternal mental health. This study of 176 racially diverse women explored the associations between the histories of childhood sexual abuse and depression and anxiety during pregnancy, at six weeks postpartum, and 12 weeks postpartum. METHODS: Data on depressive and anxiety symptoms were gathered during pregnancy, at six weeks postpartum, and 12 weeks postpartum. Sociodemographic data were collected during pregnancy, while data on childhood sexual abuse were gathered during the 12-week postpartum period. Bivariate analyses and repeated mixed-effects linear regression with bootstrapping were used to assess the association between childhood sexual abuse and perinatal depressive and anxiety symptoms. RESULTS: Childhood sexual abuse was significantly associated with depressive symptoms (ß = 2.52, 95% CI 1.72, 3.32, p < .001) and anxiety symptoms (ß = 4.44, 95% CI 3.70, 5.81, p < .001) over time, while controlling for demographic characteristics and lifetime major depression and anxiety. Depressive and anxiety symptoms decreased over the perinatal period and were highest during pregnancy. Black women were more likely to report higher depressive symptoms (ß = 1.35, 95% CI 0.51, 2.19, p = .002) and anxiety symptoms (ß = 3.29 95% CI 1.72, 4.87, p < .001) over time compared to White women. DISCUSSION: The results highlight the importance of assessing the long-term effects of childhood sexual abuse on perinatal depressive and anxiety symptoms to help inform the development of interventions for women, particularly Black women.

A Systematic Review of Technology-Based Prevention and Treatment Interventions for Perinatal Depression and Anxiety in Latina and African American Women.

INTRODUCTION: Latina and African American women have elevated risk for perinatal depression and anxiety but have low rates of treatment engagement. Amid significant improvements in narrowing the digital divide, the number of technology-based mental health interventions has increased. A technology-based mode of delivery is important to consider because it can increase patient engagement and should inform program development. This review aimed to assess the mode of technology used for preventing and/or treating perinatal depression and anxiety in Latina and African American women, examine symptom management, and describe participant satisfaction. METHODS: We used PubMed, CINAHL, PsycINFO, PsycARTICLES, EBSCO, and Social Services Abstracts to identify studies that used technology (e.g., smartphones) to prevent and/or treat depression and/or anxiety in Latina and/or African American perinatal women. To be eligible for inclusion, studies must have had at least 50% Latina and/or African American samples. The review was conducted between November 2018 and October 2019, with no set publication start date. RESULTS: Of 152 studies reviewed, six met the inclusion criteria. Four studies included African American women; two studies had samples that were mostly composed of Latina women. Three studies used telephone/smartphone (e.g., text messaging) and three implemented internet-based interventions. All studies addressed depression; one focused on anxiety. The findings demonstrated participant satisfaction and promise for symptom management. DISCUSSION: Despite the limited number of studies that used technology to engage Latina and African American perinatal women, the results suggest that these women were willing to participate in digital interventions to address perinatal depression and anxiety.

A systematic review of cultural orientation and perinatal depression in Latina women: are acculturation, Marianismo, and religiosity risks or protective factors?

Latinas in the USA and Spanish-speaking countries experience elevated rates of perinatal depression (PND) because of high psychosocial stressors. Latinas are heterogeneous and have varying cultural practices. It is unclear whether specific cultural orientations have differential risks for PND. This systematic review aimed to determine whether degree of acculturation, Marianismo, and religiosity are risks or protective factors for PND in Latina women living in the USA, Latin America, and other countries. The review included PubMed, CINAHL, PsycINFO, PsycARTICLES, Academic Search Ultimate (EBSCO), and Social Services Abstracts, and used Boolean combined keywords. English and Spanish language articles were considered. The review was conducted between July 2017 and February 2018, with no boundaries on publication dates. Ten studies were selected for inclusion. Of those, two studies were conducted in Mexico and most studies conducted in the USA included women of Mexican descent. Degree of acculturation (adoption of mainstream values) was inconsistently directly associated with PND; evidence suggest indirect associations. Marianismo, the traditional female role of virtue, passivity, and priority of others over oneself, was inconsistently correlated with risk for depression in pregnancy, but significantly and indirectly associated with postpartum depression. Two of three studies found religiosity to be protective postpartum. Further research on protective and risk factors of specific cultural orientations, particularly degree of acculturation and Marianismo, for PND in Latinas in the USA and abroad is needed. Attention to specific perinatal periods is necessary given the inconsistent findings.

Exploring associations between perinatal depression, anxiety, and urinary oxytocin levels in Latinas.

Perinatal depression has been associated with lower oxytocin (OT) levels. However, few studies have explored this topic in relation to Latinas who are at high risk of perinatal depression. The objective of this study was to explore these associations in Latinas. A total of 108 Latinas in the third trimester of pregnancy participated in the study. Depression and urinary OT levels were assessed in pregnancy and 6 weeks postpartum. Nonparametric tests were implemented to test the proposed associations. Results revealed that 28% of the participants had probable depression in pregnancy, and 23% at 6 weeks postpartum. OT levels significantly decreased from prenatal to postpartum in the whole sample; however, participants with probable prenatal depression did not exhibit a significant change in OT levels. Participants who were depressed or anxious at 6 weeks postpartum exhibited persistently higher mean OT levels over time. A distinct pattern of higher levels of OT in depressed Latinas suggests that OT levels may be an important neuroendocrine factor contributing to depressive and anxious symptoms.

Pilot Study Exploring Migration Experiences and Perinatal Depressive and Anxiety Symptoms in Immigrant Latinas.

INTRODUCTION: Migration-related experiences can increase Latinas' risk of perinatal depression and anxiety. Few studies have investigated these associations among Latinas due to a lack of survey instruments explicitly assessing migration experiences. This study assessed the feasibility and acceptability of the Migration Experiences Survey (MES), a newly-developed measure of migration and deportation fears and explored associations between those experiences and mental health in a sample of immigrant Latinas in the perinatal period. METHODS: This cross-sectional study recruited women from community health clinics in Chapel Hill, NC between July 2013 and 2014. Twenty-five immigrant women were enrolled in the study during their third trimester of pregnancy. Women were interviewed in English or Spanish during pregnancy and at 8 weeks postpartum. The Edinburgh Postnatal Depression Scale was used to assess depressive symptoms and the Spielberger State-Trait Anxiety Inventory was used to determine anxiety symptoms. The MES was administered at 8 weeks postpartum. Nonparametric tests were conducted to determine associations between deportation fears and maternal mood. RESULTS: Results show that the MES is acceptable for collecting data on migration experiences and assessing deportation fears among immigrant Latinas, regardless of depressive or anxiety symptoms. More than 40% had migration safety concerns and fears of deportation. Self or family-related fears of deportation were significantly associated with prenatal state anxiety and trait anxiety (p < .05). No significant associations between deportation fears and depressive symptoms were observed. DISCUSSION: The MES is a useful tool for gathering information about migration experiences associated with perinatal anxiety.

Maternal and Neonatal Hair Cortisol Levels and Psychological Stress Are Associated With Onset of Secretory Activation of Human Milk Production.

BACKGROUND: Several factors can influence the production of mothers' own milk. PURPOSE: To assess the influence of maternal psychological stress, maternal cortisol levels, and neonatal hair cortisol levels on timing of secretory activation. METHODS: A prospective study was conducted at 2 public health centers in Andalusia, Spain. Participants were 60 pregnant women and their 60 neonates. Hair cortisol levels and psychological stress (pregnancy-specific stress [Prenatal Distress Questionnaire, PDQ] and perceived stress [Perceived Stress Scale, PSS]) were evaluated during the third trimester and the postpartum period. This study was part of the GESTASTRESS cohort study on the effects of stress during pregnancy. RESULTS: Higher PDQ and PSS scores (P < .05) in the third trimester were associated with later onset of secretory activation. Higher postpartum maternal hair cortisol levels were associated with a delayed secretory activation of mother's own milk (P < .05). IMPLICATIONS FOR RESEARCH: Future studies should look at the influence of psychological stress and cortisol levels on hormones involved in mother's own milk production. IMPLICATIONS FOR PRACTICE: Neonatal nurses and other healthcare providers should be familiar with levels of neonates' exposure to maternal prenatal stress prior to birth.

Traumatic events: exploring associations with maternal depression, infant bonding, and oxytocin in Latina mothers.

BACKGROUND: Childhood and adulthood traumatic experiences negatively impact maternal-infant bonding and increase risk of postpartum depression (PPD). Lower oxytocin levels have also been associated with PPD and compromised mother-infant bonding. Despite advances in these areas of investigation, much of the research has not included Latinas, who are important because they have high rates of fertility, traumatic events, and PPD. METHODS: To address gaps identified in the literature, we explored associations between traumatic life events, PPD, and bonding subscale scores (e.g., Impaired Bonding, Rejection and Anger, Anxiety about Care) in a sample of 28 Latinas. We also examined associations between these factors and oxytocin (OT). Wilcoxon signed-rank tests were employed to examine differences in subscale scores over time. Kruskal-Wallis one-way analysis of variance was used to examine differences in bonding subscale scores and OT by maternal depression status and traumatic events. We also explored interaction effects of traumatic events and OT AUC on bonding subscale scores. RESULTS: Women with PPD at 8 weeks had significantly higher Rejection and Anger subscale scores (p = 0.054) than non-PPD women, where higher scores represent more compromised bonding. Significant differences in Rejection and Anger (p = 0.042) and Anxiety about Care (p = 0.005) by adulthood traumatic histories were observed at 8 weeks postpartum. There was also a significant difference in Anxiety about Care scores at 4 weeks postpartum (p = 0.024) and Impaired Bonding at 8 weeks postpartum (p = 0.041) by trauma events involving an infant. There was a significant interaction between OT and childhood sexual abuse on Impaired Bonding (p = 0.038). CONCLUSION: We observed differential responses in bonding subscale scores by traumatic histories. Women who experienced a trauma involving an infant had higher compromised bonding scores, whereas those with adulthood traumatic histories, such as intimate partner violence, had lower scores. We also found an interaction between childhood trauma and oxytocin levels on bonding scores, suggesting a physiological response to early abuse that can have implications on mothers' bonding perceptions. These preliminary results suggest the need for additional research on the long-term emotional and physiological effects of traumatic events occurring prior to parturition.

Diabetes, Prenatal Depression, and Self-Rated Health in Latina Mothers.

BACKGROUND: Latinas in the United States have elevated rates of diabetes and prenatal depression (PND). The presence of diabetes and PND can also have a negative effect on women's self-rated health (SRH), a commonly used indicator of health that is consistent with objective health status and is a predictor of mortality. However, the associations between PND, diabetes, and SRH have not been tested, particularly among Latinas, who have elevated risk of both medical conditions. To address this gap, this pilot study tested the association between PND and diabetes using data from Latinas enrolled during their third trimester of pregnancy and explored whether these health conditions were associated with SRH in these women. METHODS: For this study, the Edinburgh Postnatal Depression Scale was used to determine PND status, self-reported medical history to determine diabetes status, and SRH before and during the current pregnancy in a sample of 34 prenatal Latinas. Participants were invited to take part in the study in their third trimester of pregnancy. Bivariate analyses and logistic regressions were used to test associations between demographic variables, PND, diabetes, and SRH. RESULTS: There was no significant association between PND and diabetes status in this sample of Latinas. There was a significant difference in SRH from pre-pregnancy to pregnancy, with worse ratings reported during pregnancy. Furthermore, women with PND or diabetes reported worse SRH, even after controlling for pre-pregnancy SRH. CONCLUSION: SRH is an important and robust variable associated with PND and diabetes in prenatal Latinas, making it an important factor to assess when treating this high-risk group.

Perinatal depression treatment preferences among Latina mothers.

The study described here was designed to determine treatment preferences among Latinas to identify treatment options that meet their needs and increase their engagement. Focus group interviews were conducted with 22 prenatal and postpartum Latinas at risk for depression. The group interviews were conducted in Spanish and English using a standardized interview protocol. Focus group transcripts were analyzed to identify themes regarding perinatal depression coping strategies, preferred approaches to treating perinatal depression, and recommendations for engaging perinatal Latinas in treatment. The results suggest that Latinas' treatment preferences consist of a pathway (i.e., hierarchical) approach that begins with the use of one's own resources, followed by the use of formal support systems (e.g., home-visiting nurse), and supplemented with the use of behavioral therapy. Antidepressant use was judged to be acceptable only in severe cases or after delivery. The data indicate that to increase health-seeking behaviors among perinatal Latinas, practitioners should first build trust.

Demographic and COVID-19-Related Factors Associated with Depressive and Anxiety Symptoms Among African American and Latina Women in a Midwestern State.

PURPOSE: The COVID-19 pandemic exacerbated racial and ethnic disparities among Latina and African American (AA) women, including risk factors for depression and anxiety. This study sought to identify demographic- and pandemic-related factors associated with depressive and anxiety symptoms in adult AA and Latina women living in a Midwestern state. METHODS: Data for this secondary analysis of 1037 AA and Latina women were collected in May 2020 and June/July 2020. Participants completed an online survey about their demographic characteristics, job changes due to COVID-19, general concern about COVID-19, concern about the effects COVID-19 on their mental health, and whether they prayed to cope with COVID-19. Linear regressions with bootstrapping were conducted to determine associations. RESULTS: Latinas had significantly higher depressive and anxiety symptoms than AA women. Older age was a buffer against depressive and anxiety symptoms. Women who anticipated a reduction in work hours or job loss had significantly higher depressive and anxiety symptoms than those with no job changes. A reduction in work hours was also a risk for higher depressive symptoms. General and specific concerns about the impact of COVID-19 were positively associated with higher depressive and anxiety symptoms. Race/ethnicity moderated the effect of praying to cope with COVID-19 on depressive symptoms. CONCLUSIONS: As the pandemic continues, mental health resources should be allocated to help AA and Latina women who experienced or anticipate reductions in paid hours and those concerned about its effects. Research is needed to identify how praying increased depressive symptoms in adult Latina women early in the pandemic.

Solutions From Mexican-Descent Perinatal Women To Pandemic-Related Food, Mental Health, And Health And Safety Stressors.

Latina women in the US were disproportionately affected by the COVID-19 pandemic because of structural racism, including discrimination, reduced care access, and elevated risk for illness and death. Although several US policies were implemented to offset the economic toll of the pandemic, few addressed complex stressors, particularly those among Mexican-descent mothers. This qualitative study with thirty-eight perinatal women and mothers of young children who were of Mexican descent sought to identify pandemic-related stressors and solicit recommendations for addressing them during future large-scale crises. Identified stressors included food access issues, mental health needs, and health and safety concerns. The women's recommendations revealed feasible and actionable strategies, including increased access to behavioral and health care services and accessible information about food-related resources. The findings highlight the critical need for responsive policies and programs to ensure the well-being of Mexican-descent perinatal women and mothers of young children during large-scale crises.

Latino youth's internalising behaviours: links to immigrant status and neighbourhood characteristics.

OBJECTIVES: Latinos are the fastest-growing immigrant group in the U.S.A. Yet, little is known about the emotional well-being of this population, such as the links among family, neighbourhood context and Latino immigrant youth mental health. Understanding this link will help determine which contexts negatively impact Latino immigrant youth mental health. DESIGN: Drawing data from the Project on Human Development in Chicago Neighbourhoods collected in 1994-1995 and 1997-1999, this study examined links between Latino youth's internalising behaviours, based on the Child Behavior Checklist (CBCL), and neighbourhood characteristics as a function of immigrant status. The sample included 1040 (aged 9-17) Latino immigrant youth seen twice over three years and identified as first, second or third generation. In this study, neighbourhoods are made up of two to three census tracts that reflect similar racial/ethnic and socioeconomic composition. Using hierarchical linear regression models, the study also explored links between internalising behaviours and neighbourhood characteristics, including concentrated disadvantage, immigrant concentration and residential stability. RESULTS: First- and second-generation youth had higher internalising behaviour scores (i.e., worse mental health) than third-generation youth after controlling for youth internalising behaviours at Wave 1, maternal depression and family characteristics. First- and second-generation youth were more likely to live in high immigrant-concentrated neighbourhoods and first-generation youth were more likely to live in residentially unstable neighbourhoods. Controlling for neighbourhood clusters eliminated the immigrant-generation internalising association. However, second-generation Latino youth living in neighbourhoods with higher residential stability had higher levels of internalising behaviour problems compared to first- and third-generation youth living in similar neighbourhoods. CONCLUSIONS: We found that the interaction between immigrant generation and neighbourhood context helps to explain differences observed in the mental health of second-generation immigrant youth, a result that may help other communities in the USA and other countries better understand the factors that contribute to immigrant youth well-being.

Predictors of Food and Water Stockpiling During the COVID-19 Pandemic Among Latinos and Non-Latino Black People.

OBJECTIVE: The study examined factors associated with food and water stockpiling (FWS) during the COVID-19 pandemic. METHODS: A secondary analysis of online survey data collected in two waves: April 2020 (wave 1) and June/July 2020 (wave 2), was conducted through REDCap web application. A total of 2,271 Non-Latino Black and Latino adults (mean age: 36.8 years (SD = 16.0); 64.3% female) living in Illinois were recruited. Participants self-reported if they stockpiled food and/or water (FWS) seven days prior to survey completion because of the pandemic. Logistic regression was used to determine if each variable was associated with the odds of reporting FWS. RESULTS: Nearly a quarter (23.3%) of participants reported FWS. The adjusted model revealed that odds of FWS increase as the number of household members increased (OR: 1.21; 95% CI: 1.05-1.41). Odds of FWS were lower among participants who were not self-quarantining compared to those self-quarantining all the time (OR: 0.32; 95% CI: 0.17 - 0.62). Furthermore, individuals with lower levels of concern about COVID-19 had lower odds of FWS than those extremely concerned. CONCLUSIONS: Household size, self-quarantine status, and concern about COVID-19 were significantly associated with FWS. These findings highlight the need to address the concerns of marginalized individuals to promote healthy behaviors.

COVID-19-Related Risk, Resilience, and Mental Health Among Mexican American Mothers Across the First Year of the Pandemic.

BACKGROUND: Latina mothers have been especially affected by the pandemic and historically exhibit high rates of depression and anxiety. However, few longitudinal studies have assessed the effect of the pandemic on this vulnerable population. We hypothesized that COVID-19-related stressors would associate with psychological distress among Latina mothers across the first year of the pandemic. METHODS: We investigated COVID-19-related impact, stigma, and fears across two critical time points and changes in these measures in relation to changes in maternal anxiety and depression among mothers of Mexican descent living in Southern California (n=152). Surveys were administered within 5-16 weeks of the March 19, 2020 stay-at-home COVID-19 order in California and again between June to December 2021. RESULTS: High proportions of women reported moderate to severe impacts of COVID-19 early in the pandemic, which reduced modestly a year later, e.g., reduced family incomes (55.9% 2020 Lockdown vs 32.7% 1-year follow-up). Anticipatory stigma was high across the first year, e.g., worrying at least some of the time that a family member will be deported (33.1% 2020 Lockdown vs. 14.1% 1-year follow-up), or they would not be able to care for their children (88.5% 2020 lockdown vs 82.2% 1-year follow-up). COVID-19 stigma, impact, and fears were significantly associated with higher levels of anxiety and depressive symptoms at both time points (p<0.003), and changes in COVID-19 impact were associated with changes in depression (p=0.0004). CONCLUSION: Findings emphasize the adverse socioeconomic and psychological effects of the pandemic for Latina mothers.

A mixed-method approach to understanding the experiences of non-deployed military caregivers.

Given the unprecedented operational tempo of the Afghanistan and Iraq wars and the heavy involvement of the Reserve and National Guard, the stress that military families are exposed to is distinct from stress in earlier conflicts, with little empirical data to inform the impact on non-deployed military caregivers or "home caregivers." The study seeks to examine the experiences of home caregivers during deployments, with a focus on the impact of deployment on the caregiver's well-being. We conducted 50 qualitative interviews and 1,337 survey interviews with home caregivers who experienced at least one deployment. The structured qualitative interview focused on caregiver experiences during deployment. The quantitative data centered on caregiver well-being and household and relationship hassles. The qualitative interview notes were the unit of analysis and traditional methods were used to analyze the data. The quantitative data were analyzed using regression models. The qualitative data revealed key deployment-related household challenges that caregivers experience and the effect of those challenges on caregivers. Multivariate analyses of the quantitative data explored differences in caregivers' emotional well-being, household and relationship hassles. The results showed important component and deployment experience differences. Caregivers affiliated with the National Guard and those with more months of deployment reported significantly poorer emotional well-being, and more household and relationship hassles. Given the important role that maternal well-being has on child and family functioning, it is critical to understand how the stress of deployment is affecting mothers in their daily routines, especially during potentially high stress periods.

Activity Settings and Daily Routines in Preschool Classrooms: Diverse Experiences in Early Learning Settings for Low-Income Children.

This paper examines activity settings and daily classroom routines experienced by 3- and 4-year-old low-income children in public center-based preschool programs, private center-based programs, and family child care homes. Two daily routine profiles were identified using a time-sampling coding procedure: a High Free-Choice pattern in which children spent a majority of their day engaged in child-directed free-choice activity settings combined with relatively low amounts of teacher-directed activity, and a Structured-Balanced pattern in which children spent relatively equal proportions of their day engaged in child-directed free-choice activity settings and teacher-directed small- and whole-group activities. Daily routine profiles were associated with program type and curriculum use but not with measures of process quality. Children in Structured-Balanced classrooms had more opportunities to engage in language and literacy and math activities, whereas children in High Free-Choice classrooms had more opportunities for gross motor and fantasy play. Being in a Structured-Balanced classroom was associated with children's language scores but profiles were not associated with measures of children's math reasoning or socio-emotional behavior. Consideration of teachers' structuring of daily routines represents a valuable way to understand nuances in the provision of learning experiences for young children in the context of current views about developmentally appropriate practice and school readiness.

Change in Employment Status Due to the COVID-19 Pandemic, SNAP Participation, and Household Food Insecurity among Black and Latino Adults in Illinois.

The onset of the COVID-19 pandemic resulted in record-high unemployment rates. Black and Latino adults experienced disproportionately higher rates of unemployment. We aimed to examine associations between pandemic-related employment status change and household food insecurity among an economically diverse sample of Black and Latino adults in Illinois during the early months of the COVID-19 pandemic. Furthermore, we evaluated the significance of Supplemental Nutrition Assistance Program (SNAP) participation to determine if it modified associations. We analyzed cross-sectional data collected from 1,809 Black and Latino adults in two waves: May 2020 and June/July 2020. Participants listed their change in employment status as "lost job entirely", "employed, but paid hours reduced", "employed, but anticipate job lost", or "no change". Participants self-reported their SNAP status and completed the USDA's six item U.S. Food Security Module to report household food security status. We used logistic regression to assess the significance of associations after controlling for socio-demographics. Approximately 15.5% of participants lost their job entirely, 25.2% were SNAP participants, and 51.8% reported low food security (LFS). All changes in employment were significantly associated with increased odds of LFS after adjusting for socio-demographics. SNAP participants who lost their job had higher odds of LFS (OR: 4.69; 95% CI: 2.69-8.17) compared to non-participants who lost their job (OR: 2.97; 95%: 1.95-4.52). In summary, we observed strong associations between changes in employment and household food insecurity, particularly among SNAP participants, which underscores the pandemic's impact on low-income and minority populations.

Prenatal Depressive Symptoms, Self-Rated Health, and Diabetes Self-Efficacy: A Moderated Mediation Analysis.

BACKGROUND: Diabetes leads to risk for pregnant persons and their fetuses and requires behavioral changes that can be compromised by poor mental health. Poor self-rated health (SRH), a reliable predictor of morbidity and mortality, has been associated with depressive symptoms and lower self-efficacy in patients with diabetes. However, it is unclear whether SRH mediates the association between depressive symptoms and self-efficacy in pregnant patients with diabetes and whether the healthcare site moderates the mediation. Thus, we sought to test these associations in a racially and ethnically diverse sample of pregnant individuals diagnosed with diabetes from two clinical settings. MATERIALS AND METHODS: This was an observational, cross-sectional study of 137 pregnant individuals diagnosed with diabetes at two clinical study sites. Participants self-administered a demographic questionnaire and measures designed to assess depressive symptoms, SRH in pregnancy, and diabetes self-efficacy. A moderated mediation model tested whether these indirect effects were moderated by the site. RESULTS: The results show that SRH mediated the association between depressive symptoms and diabetes self-efficacy. The results also showed the site moderated the mediating effect of SRH on depressive symptoms and diabetes self-efficacy. CONCLUSIONS: Understanding the role of clinical care settings can help inform when and how SRH mediates that association between prenatal depressive symptoms and self-efficacy in diabetic patients.