Psychological Factors that Link Socioeconomic Status to Depression/Anxiety in Patients with Systemic Lupus Erythematosus.

Our analyses examined whether reserve capacity factors would explain the relationship between socioeconomic status (SES) and symptoms of depression/anxiety in patients with systemic lupus erythematosus (SLE). We assessed disease activity, depression/anxiety symptoms, and intrapersonal and interpersonal reserve capacity measures in 128 patients with SLE. Multiple meditational analyses revealed that intrapersonal and interpersonal psychosocial aspects of reserve capacity fully mediated the relationship between SES and depression/anxiety. Lower SES was indirectly associated with higher symptoms of depression and anxiety through the effects of psychosocial resilience. Interventions aimed at improving modifiable reserve capacity variables, such as self-esteem and optimism, may improve anxious/depressive symptomatology in patients with SLE.

Psychosocial Characteristics of Adult Daughters of Breast Cancer Patients: Comparison of Clinic and Community Caregivers Samples.

OBJECTIVE: The long-term psychosocial impact of adult daughters caring for their mothers with breast cancer has been recognized but understudied. The objectives of this study were to characterize the psychosocial functioning of women who served as informal caregivers during their mothers. treatment for breast cancer in two distinct samples, community and high risk clinic, and to determine differences in psychosocial functioning between the two samples. METHODS: Using a cross-sectional design, a sample of mostly married, Caucasian and college educated women (N = 59) were administered a battery of questionnaires assessing socio-demographic and psychosocial factors (i.e. coping, caregiving tasks and difficulty, social support, spirituality, mental distress, depressive symptoms). RESULTS: Using descriptive analysis, chi-square and T tests, results demonstrated significant differences between the two samples in time since caregiving, with the community sample reporting few years since the caregiving episode (e.g. 2.1 versus 15.1 years); coping strategies, with the clinic sample reporting higher scores on active coping, behavioral disengagement, planning, and self-blame; support type care tasks difficulty, with the clinic sample reporting higher scores on emotional support and tangible support, and all domains of spirituality (e.g. peace, meaning, faith), with higher levels being reported by the community sample. Although participants did not exhibit clinically significant levels of emotional distress, almost 25% of the community sample and 10% of the clinic sample had clinically significant depressive symptoms. CONCLUSIONS: Findings underscore the need for interventions tailored for caregivers to consider the unique psychosocial characteristics of caregivers across settings.

The influence of prenatal trauma, stress, social support, and years of residency in the US on postpartum maternal health status among low-income Latinas.

This study examined the associations of prenatal psychosocial factors, including depressive symptoms, post-traumatic stress disorder symptoms, trauma exposure including intimate partner violence, perceived stress, and social support, with perceived postpartum health status. Low-income Latinas (N = 203) were recruited from two health plans within the first 12 weeks of their pregnancies and followed through 3 months after birth. Participants completed semi-structured interviews conducted in English or Spanish within the first 12 weeks of pregnancy, and again at 12 weeks postpartum. Perceived health status was measured by the SF-12. Participants with complete follow-up data (n= 193) were used in data analysis. Women were mostly foreign-born (75%) with low-incomes (59%) and reported postpartum health status in the average range (M = 102.5; SD = 12.2). Overall health status was positively associated with decreased levels of perceived stress (P < .0001), being foreign-born and having resided in the US <10 years (P = .003). Emotional well-being was positively linked with being foreign-born and having resided in the US <10 years (P = .002), increased levels of social support (P = .01), and decreased levels of perceived stress (P < .001). Exposure to non-specific IPV trauma (P = .01) and health problems experienced during pregnancy or delivery (P = .05) were negatively associated with physical health status. Prenatal psychosocial factors and length of residency in the US are differentially predictive of overall postpartum health status and emotional well-being, and have less impact on physical well-being after birth. Health professionals are encouraged to assess these factors in early pregnancy.

The contributions of socioeconomic status, perceived stress, and depression to disability in adults with systemic lupus erythematosus.

Purpose: Psychological and sociodemographic factors contribute to disability in systemic lupus erythematosus. Yet the pathways by which these factors influence disability remain unclear. The objective of this study was to evaluate a model examining socioeconomic status (SES), perceived stress, and depressive symptoms as determinants of lupus-related disability.Methods: The sample included 134 patients receiving treatment at an academic hospital. Structural equation modeling examined the direct and indirect effects of SES (income, education, and subjective social status), perceived stress (Perceived Stress Scale), and depressive symptoms (Hospital Depression Anxiety Scale depression subscale) on disability (Lupus Patient-Reported Outcome measure Physical Health and Pain-Vitality subscales).Results: Structural equation modeling confirmed that the model fit the data well. The SES exerted a direct negative effect on perceived stress (ß = -0.40, p < 0.001). In turn, perceived stress predicted higher levels of depression (ß = 0.72, p < 0.001), which ultimately contributed to greater disability (ß = 0.53, p < 0.001). The influence of SES on disability was indirect (mediated by perceived stress and depression).Conclusions: Findings support the socioeconomic gradient in disability as mediated by perceived stress and depression, such that lower SES contributed to lupus-related disability via perceived stress and depressive symptoms.Implications for RehabilitationLow socioeconomic status, perceived stress, and depression are prognostic factors for the disability in systemic lupus erythematosus.Study findings indicate that perceived stress and depression fully mediate (account for) the negative impact of low socioeconomic status on lupus-related disability.Screening for and addressing psychological distress may enhance management of disability in lupus patients.This research demonstrates the value of a conceptual framework for identifying potentially modifiable risk factors for disability in lupus and other chronic disabling diseases.

On the outside looking in: promoting HIV/AIDS research initiated by African American investigators.

People of color are disproportionately affected by HIV/AIDS, yet African American HIV/AIDS researchers are in short supply. Complex historical, structural, sociocultural, and personal barriers can prevent African Americans from becoming well-trained biomedical, behavioral, and social HIV/AIDS researchers. Institutional factors that influence the numbers of African Americans conducting HIV/AIDS research include the limitation of early-career decisions and a lack of exposure to research, research socialization, and mentoring. Two individual-level factors that influence the submission of federally funded research proposals are the limited availability of support for culturally congruent HIV research and African Americans' negative perceptions of their own competence and ability to contribute to society. We discuss progress toward eliminating disparities experienced by African American HIV/AIDS researchers at the individual, academic institution, and sociopolitical levels.

Intimate partner violence and community service needs among pregnant and postpartum Latina women.

Health care providers are advised to refer abused women to needed community services. However, little is known about abused women's perceived need for services, particularly among Latina women. We examined the relationship between intimate partner violence (IPV) and perceived needs for legal, social, and job services among a prospective cohort of 210 pregnant Latinas. IPV was associated with needing social and legal services at most time points. Women with recent IPV experiences reported greater service needs than women with more remote IPV experiences, who in turn reported greater need than women without IPV experiences. We conclude that IPV may be associated with ongoing perceived needs for social and legal services among Latina perinatal patients.

Correlates of relationship, psychological, and sexual behavioral factors for HIV risk among Indian women.

The rate of HIV/AIDS among women in India is expected to rise yet few studies have examined factors related to HIV risk among Indian women. The objective of this prospective, cross-sectional study was to characterize similarities and differences in the relationships, psychological well-being, and sexual behaviors among Indian women (N=459). Both HIV positive (N=216) and negative (N=243) women from urban and rural areas in India were included in this study. Chi-square, analysis of variance, and logistic regression analyses revealed that in both geographic groups, HIV-positive women were significantly more likely to report marital dissatisfaction, a history of forced sex, domestic violence, depressive symptoms and husband's extra marital sex when compared to the HIV-negative women. Findings also indicate that specific factors related to the quality of the marital relationship such as domestic violence, martial dysfunction, and depressive symptoms may be related to HIV-related risks for women. Implications for future research and culturally relevant interventions are discussed.

Major Depression Comorbid with Medical Conditions: Analysis of Quality of Life, Functioning, and Depressive Symptom Severity.

Background: The presence of Major Depressive Disorder (MDD) is often comorbid in patients with a variety of general medical conditions (GMCs) which could lead to less favorable outcomes. Objective: The goal of this analysis is to examine functional outcomes of QOL and functioning before and after antidepressant treatment among patients with MDD with and without GMCs. Methods: We performed a secondary analysis based on the STAR*D database. The analysis included two patient groups from the STAR*D trial: 1,198 patients comorbid with MDD and GMCs (MDD + GMC) and 1,082 patients with MDD and no GMCs (MDDnoGMC), as defined by the Cumulative Illness Rating Scale. We analyzed depressive symptom severity, functioning and quality of life (QOL) before and after level 1 treatment with citalopram. Results: At baseline, the MDD + GMC group had significantly lower QOL (p < 0.001) and functioning (p = 0.001) than the MDDnoGMC group, although depressive symptom severity was not significantly different. Following antidepressant treatment, QOL, functioning and depressive symptom severity significantly improved for both MDD + GMC and MDDnoGMC groups. However, patients with MDD + GMC were more likely to experience severe impairments in QOL in (56.8% vs. 43.5% for MDDnoGMC, p < 0.001) and functioning (42.5% vs. 29.3% for MDDnoGMC, p < 0.001) following treatment. The remission rate was significantly lower for MDD + GMC (30.6% vs. 41.1% for MDDnoGMC, p < 0.001). Conclusions: Our findings suggest that antidepressant treatment had a positive impact on patients with and without GMCs. However, those with GMCs experienced not only a lower remission rate, but also continued to experience more significantly severe impairments in QOL and functioning.

Role of psychosocial reserve capacity in anxiety and depression in patients with systemic lupus erythematosus.

AIM: To examine the relationship between reserve capacity measures and anxiety/depression among patients with systemic lupus erythematosus (SLE) from Southern California (SoCal), United States and Manila, Philippines. METHODS: A total of 235 participants with SLE completed self-reported scales to assess anxiety/depression and psychosocial reserve capacity measures (self-esteem, optimism, personal mastery/coping skills, social support), socioeconomic status (SES) data, and Mexican SLE Disease Activity Index. Statistical analyses included independent sample t-tests, Chi-square, and point-biserial and Pearson correlations. RESULTS: Overall, participants from Manila reported lower SES than SoCal participants. Over half of Manila and SoCal participants (69% and 59.1%, respectively) reported high anxiety scores. SoCal participants had higher depression scores than Filipinos (66%, 27%, respectively, P < 0.001) despite appearing to be more resilient by exhibiting higher scores for all reserve capacity measures (P < 0.001). Participants with low self-esteem scores from both groups had higher anxiety and depression scores. SoCal participants who reported lower optimism, lower personal mastery and lower social support were more anxious and depressed, while Filipinos low on these three variables reported less depressive symptoms. CONCLUSION: Reduced psychosocial reserve capacity in individuals leads to vulnerabilities that may ultimately result in greater disease burden and psychological distress. Low self-esteem, optimism, coping and social support were associated with depression and low self-esteem was associated with anxiety for both groups. Despite the Filipino cohort's lower reserve capacity and SES, Filipino patients exhibited less depression than their SoCal counterparts, suggesting that other factors may protect them from experiencing depression.

Spinal cord stimulation: Subjective pain intensity and presurgical correlates in chronic pain patients.

OBJECTIVES: This study determined the changes in pain intensity prior to and after permanent placement of spinal cord stimulation (SCS), as measured by the Visual Analog Scale (VAS) and, examined associations of presurgical characteristics to both pre- and post-SCS VAS scores. MATERIALS AND METHODS: Demographic, disease, and psychological data were extracted from the medical charts of chronic pain patients (N = 58) being treated at a Hospital in IL, USA. Most patients were diagnosed with complex regional pain syndrome (51.9%) and low back pain (33.3%). The majority were White (72.5%), male (60%), married (72%), and temporary disabled or receiving worker's compensation (40%). Study objectives were tested with correlational and univariate analysis. RESULTS: A significant reduction between pre (M = 6.87; SD = 1.38) and Post-(M = 4.11; SD = 1.54) SCS pain intensity scores was observed (p < .000). Pre-SCS pain intensity scores were associated with medical diagnosis (p < .01), marital status (p < .05), and catastrophizing (p < .05). Post-SCS pain intensity scores were associated with body mass index (p < .05), medical diagnosis (p < .05), employment status (p < .05), bodily concern (p < .05), marital status (p < .05), and race (p < .05). CONCLUSIONS: Results strengthen support for the short-term effectiveness of SCS and demonstrate the differential associations of presurgical factors on pain intensity.

Violence prevention among HIV-positive women with histories of violence: healing women in their communities.

Experiences of past and current gender-based violence are common among HIV-positive women in the United States, who are predominantly from ethnic minority groups. However, culturally congruent, feasible interventions for HIV-positive women who have experienced past and/or current violence are not widely available. The Office on Women's Health Gender Forum has made several recommendations for responding to the National HIV/AIDS Strategy Implementation Plan, including recommendations to incorporate gender-based violence prevention into a comprehensive, gender-responsive national strategy. This paper draws on an example of a community-based project for HIV-positive women, the Healing Our Women Project, to illustrate how violence prevention can be achieved within peer-led and community-based programming. Strong community partnerships, responsiveness to community needs and local cultural norms, a trained workforce, and culturally competent care are programmatic cornerstones of gender-responsive services. HIV-positive women with histories of gender-based violence and risk factors for current and future violence deserve the highest quality gender-responsive services to ensure that they can address their health needs within contexts of safety and respect.

Intimate partner violence and maternal depression during the perinatal period: a longitudinal investigation of Latinas.

This study assessed the course of perinatal depression among 210 Latinas who were and were not affected by intimate partner violence (IPV) and identified associated psychosocial factors. Peak depression prevalence occurred prenatally among 45.7% of IPV-exposed and 24.6% of non-IPV-exposed Latinas. At each assessment, depression was significantly higher for IPV-exposed compared to non-IPV-exposed mothers. Mastery and social support were associated with lower depression, whereas history of IPV, perceived stress, and avoidant coping behaviors were associated with higher depression. Findings support recommendations for routine depression and IPV screening of Latinas in perinatal clinical settings.

Trauma and psychosocial predictors of substance abuse in women impacted by HIV/AIDS.

The purpose of this study was to estimate the relative contributions of trauma, chronic stress burden, depression, anxiety, social support, and social undermining in predicting alcohol and drug abuse, and whether ethnicity moderated these relationships. A multi-ethnic sample of 288 HIV-positive and HIV-negative women was recruited. Multiple group path analysis indicated that greater drug dependence was associated with being HIV+, more depression, and higher chronic burden. Trauma was related only to anxiety. Also, greater alcohol dependence was associated with more depression and more social undermining, and these effects were moderated by ethnicity. African American and Latina women evidenced different relationships between depression, social support and social undermining. Depression, social support and social undermining served as intervening variables in influencing the relationships between the other psychosocial variables and drug and alcohol dependence. The implications of these findings for alcohol and drug abuse research and services are discussed.