Experiences and perceptions of perinatal depression among new immigrant Chinese parents: a qualitative study.

BACKGROUND: Immigrant status, acculturation level, race and ethnicity have been found to contribute to the utilization of mental health services in the perinatal period. This study explored perinatal experiences and perceptions among Chinese immigrant mothers and their spouses, as well as the possible barriers and facilitators that affect their health care utilization. METHODS: We recruited 13 women ages 18-35 years born in mainland China, living in Rochester, New York, and residing less than 5 years in the United States. Participants primary language was Mandarin Chinese and all had given birth to at least one live infant within the past 7 years. Participants' age was at least 18 years old at the time of delivery. Five spouses also participated. We divided women in two focus groups and held one focus group for men, with data collection including demographic questionnaires and semi-structured focus group questions conducted in December 2014. Data were analyzed following thematic analysis. RESULTS: Four themes emerged: experiences of perinatal depression; perceptions of perinatal depression; general preventive and coping strategies; and attitudes toward the supportive use social media applications (apps) and text messaging during the perinatal period. Participants had limited knowledge of perinatal depression and had difficulty distinguishing between normal perinatal mood fluctuations and more severe symptoms of depression. They discussed immigrant-related stress, conflicts with parents/in-laws while "doing the month", the perceived gap between the ideal of "perfect moms" and reality, and challenges with parenting as the causes of perinatal depression. Women approved of screening for the condition but were conservative about follow-up interventions. As for the management of perinatal depression, participants preferred to deal with the problem within the family before seeking external help, due to potential stigma as well as Chinese traditional culture. They were receptive to obtaining pertinent health information from anonymous social media apps, preferring these to personal text messages. CONCLUSION: The recent immigrant Chinese parents to the United States in the study had limited knowledge of perinatal depression and did not make full use of mental health services for support due to language and cultural barriers. Screening for perinatal depression is only the first step. Future research should explore what interventions may serve as an acceptable approach to overcoming these gaps.

Couple Interventions for Chronic Pain: A Systematic Review.

OBJECTIVE: Couple interventions for chronic pain have been shown to more effectively reduce pain intensity for individuals with chronic pain (ICPs) than individual behavioral interventions or usual care. This systematic review identified randomized controlled trials of couple interventions to highlight strategies that could be incorporated into psychotherapy with ICPs and their romantic partners. METHODS: The authors identified articles reporting randomized controlled trials of couple interventions for chronic pain. Three databases were searched (ie, PubMed, Embase, and PsycInfo), resulting in 18 studies and 22 articles. RESULTS: Couple interventions resulted in statistically significant improvements in pain intensity compared with other conditions in 8% to 40% of the studies depending on the comparator group (i.e., control, individual intervention, another couple intervention), and in statistically significant improvements on a pain-related outcome compared with other conditions in 31% to 50% of the studies depending on the comparator group (ie, control, individual intervention, another couple intervention). Educating couples about pain was the most common strategy (83%). Jointly administered relaxation or meditation skills were included in nearly half of the interventions (48%). Many interventions taught cognitive-behavioral skills jointly to couples (39%) or to the ICP with partner encouragement (30%). Teaching couples how to request and provide assistance (30%), and encouraging partners to avoid reinforcing pain behaviors (39%), occurred frequently. ICPs and their partners were often asked to set goals (30%). DISCUSSION: This review outlined strategies included in couple interventions for chronic pain that are derived from the cognitive-behavioral therapy, acceptance and commitment therapy, and operant behavioral traditions, but delivered relationally. Therapists working with ICPs and their partners may integrate these strategies into their practice to help couples who are managing chronic pain.

Material Hardship and Mental Health Symptoms Among a Predominantly Low Income Sample of Pregnant Women Seeking Prenatal Care.

Introduction Although poverty is an established correlate of poorer mental health for pregnant women, limited research has examined the mental health effects of material hardship (i.e., difficulties meeting basic needs such as for food, transportation, or stable housing) during pregnancy. Methods The current research examined rates of material hardship among pregnant women seeking prenatal care and the relationships of both income and material hardship with depression and anxiety during pregnancy. Pregnant women (N = 892) responded to self-report measures of mental health symptoms, annual household income, and current material hardship in the waiting areas of community-based obstetrics/gynecology practices serving primarily financially disadvantaged patients. Results About 56% of the sample reported some form of material hardship. About 19% of the sample reported elevated depression, and 17% reported elevated anxiety. Both depression and anxiety were uniquely associated with lower income and greater material hardship, even after controlling for age, race/ethnicity, relationship status, and number of children in the home. Furthermore, material hardship partially mediated the effect of income on mental health symptoms. Discussion The physical, emotional, and social effects of deprivation of basic daily needs may contribute to pregnant women's experiences of mental health symptoms. These results converge with the broader literature focused on the social determinants of physical and mental health. When symptoms of depression and anxiety reflect distress related to material hardship, addressing unmet social needs may be more effective than mental health treatment.

Reproductive Coercion by Male Sexual Partners: Associations With Partner Violence and College Women's Sexual Health.

Reproductive coercion (RC) involves indirect and direct partner behaviors that interfere with effective contraceptive use. RC has been identified as a correlate of intimate partner violence (IPV) among ethnically diverse women sampled from urban health clinics or shelters. Research is needed to determine whether RC is experienced more generally by young women and, if so, whether RC is associated with IPV, multiple indicators of sexual health, or both. In the present study, sexually active undergraduate women ( N = 223, 80% Caucasian/White) provided self-report data on their sexual health and behaviorally specific lifetime experiences of both RC and partner physical violence. About 30% reported experiencing RC from a male sexual partner. Most commonly, RC involved condom manipulation or refusal within an adolescent dating relationship. Experiences of RC and partner violence were not independent; half of the women who reported RC also reported experiencing partner physical violence. Women with a history of RC reported a significantly reduced rate of contraceptive use during last vaginal sex and lower contraceptive and sexual self-efficacy. Additional research on the sociocultural and relational contexts of RC is needed.

Randomized controlled trial of interpersonal psychotherapy versus enhanced treatment as usual for women with co-occurring depression and pelvic pain.

OBJECTIVE: Our study assessed the effectiveness of Interpersonal Psychotherapy (IPT) tailored for biomedical patients with depression and pain. IPT was compared to enhanced treatment as usual (E-TAU) among women with co-occurring depression and chronic pain presenting for care at a women's health or family medicine practice. We hypothesized that women presenting to urban medical practices with depression and chronic pain would benefit from IPT tailored to address their needs to a greater degree than from E-TAU. METHODS: We conducted a randomized controlled psychotherapy trial of 61 women from 2 urban medical practices who met criteria for major depressive disorder and chronic pelvic pain. Participants were assigned to receive either 8 sessions of IPT or a facilitated psychotherapy referral to a community mental health center, and assessed for depression, social interactions, and pain at 0-, 12-, 24-, and 36-weeks, with score on the Hamilton Rating Scale for Depression as the primary outcome. Both intent-to-treat (ITT) and causal modeling analyses correcting for treatment attendance were conducted. RESULTS: ITT analyses were not significant. In causal modeling analyses, participants assigned to IPT showed significantly more improvement for depression and social interactions, but not for pain. CONCLUSION: IPT may be a viable option as part of a comprehensive treatment program for women in medical practices with depression and chronic pain. CLINICAL TRIALS REGISTRATION: ClinicalTrials.gov, NCT00895999.

Psychologists partnering with obstetricians and gynecologists: Meeting the need for patient-centered models of women's health care delivery.

As obstetrics and gynecology (ob/gyn) practices move toward becoming patient-centered medical homes for their patients, the need for providing integrated behavioral health care has increased. Themes common in ob/gyn settings-such as menstruation concerns, initiation of contraception, pregnancy, childbirth, and menopause-serve as occasions for health promotion and as life transitions where behavioral health concerns may arise. When these transitions are complicated by issues such as trauma, infertility, and pregnancy loss, the need for sensitive, collaborative care between psychology and obstetrics/gynecology becomes particularly critical. Women's health psychologists can serve a key role for ob/gyn practices by co-managing patients' care, offering consultation to providers, providing brief behavioral health consultations to patients, facilitating psychotherapy engagement, and providing treatment for women and their families.

A pilot study of interpersonal psychotherapy for alcohol-dependent women with co-occurring major depression.

BACKGROUND: Co-occurring major depression is prevalent among alcohol-dependent women and is a risk factor for poor treatment outcomes. This uncontrolled pilot study tested the feasibility, acceptability, and initial effects of interpersonal psychotherapy (IPT) for women with co-occurring alcohol dependence and major depression (AD-MD) in an outpatient community addiction treatment program. METHODS: Fourteen female patients with concurrent diagnoses of alcohol dependence and major depression participated. Assessments were conducted at baseline, midtreatment (8 and 16 weeks), posttreatment (24 weeks), and follow-up (32 weeks). RESULTS: Participants attended a mode of 8 out of 8 possible sessions of IPT in addition to their routine addiction care, and reported high treatment satisfaction on the Client Satisfaction Questionnaire-8. Women's drinking behavior, depressive symptoms, and interpersonal functioning improved significantly over the treatment period and were sustained at follow-up. CONCLUSIONS: These preliminary findings suggest that IPT is a feasible, highly acceptable adjunctive behavioral intervention for AD-MD women.

Depressive symptoms, pain, chronic medical morbidity, and interleukin-6 among primary care patients.

OBJECTIVE: Pain, chronic medical morbidity, and depression are highly prevalent problems that frequently co-occur in primary care. Elevated levels of inflammatory markers are linked with all three of these conditions and may play an important role in patients' comorbidities. The current study aimed to examine if the associations among pain, chronic medical morbidity, and the inflammatory marker interleukin (IL)-6 are dependent on depression status in primary care patients. SETTING, SUBJECTS, AND OUTCOME MEASURES: Primary care patients (N = 106) aged 40 and older were assessed for pain (36-item Medical Outcomes Study Survey Form), chronic medical morbidity (checklist of chronic health conditions), and depressive symptoms (Center for Epidemiologic Studies Depression Scale), and provided a blood sample for the measurement of serum IL-6. RESULTS: Among patients with elevated depressive symptoms, higher IL-6 levels were associated with both greater pain and greater chronic medical comorbidity. IL-6 was unrelated to pain or chronic medical comorbidity among patients without clinically significant depressive symptoms. In mediation analyses, chronic medical morbidity did not mediate the association between IL-6 and pain, and depression severity and pain remained independently associated after adjustment for chronic medical comorbidity. CONCLUSIONS: Depression may increase primary care patients' vulnerability to pain and elevated levels of inflammatory markers such as IL-6.

Underserved women in a women's health clinic describe their experiences of depressive symptoms and why they have low uptake of psychotherapy.

Low-income and African American patients in women's health clinics are at risk for depression and under-treatment of their depression. This study aimed to understand women's health patients' experiences of depressive symptoms and perspectives on the low uptake of psychotherapy. Twenty-three women with depressive symptoms from a women's health clinic completed individual qualitative interviews. Women reported risk of harm in the therapeutic relationship as the primary barrier; physical and mental health symptoms and doubt that psychotherapy will help were also described. Women also reported psychotherapy can be helpful by allowing women to express their feelings, gain insight, and make life changes.

Anxiety but not social stressors predict 12-month depression and pain severity.

OBJECTIVES: To determine whether baseline anxiety and social stressors as well their early change (first 3 months) predict 12-month depression and pain severity. METHODS: We analyzed data from the Stepped Care for Affective Disorders and Musculoskeletal Pain study, a randomized clinical trial of a combined medication-behavioral intervention for primary care patients with chronic musculoskeletal pain and depression. Using multivariable linear regression modeling, we examined the independent association of baseline anxiety and social stressors with depression and pain severity at 12 months. In addition, we modeled whether changes in anxiety and social stressors predicted 12-month depression and pain severity. RESULTS: Overall, the sample (N=250) was 52.8% women with a mean age of 55.5 years, and a racial distribution of 60.4% white, 36.4% black, and 3.2% other. Depression and pain were moderately severe at baseline (mean SCL-20 depression=1.9 and Brief Pain Inventory pain severity=6.15) and similar across intervention and usual care arms. Baseline anxiety symptoms predicted both depression (t score=2.13, P=0.034) and pain severity (t score=2.75, P=0.007) at 12 months. Also, early change in anxiety predicted 12-month depression (t score=-2.47, P=0.014), but not pain. Neither baseline nor early change in social stressors predicted depression or pain severity. CONCLUSIONS: Anxiety, but not social stressors predict 12-month depression and pain severity. The presence of comorbid anxiety should be considered in the assessment and treatment of patients with musculoskeletal pain and depression, particularly as a factor that may adversely affect treatment response.

Domain-specific social functioning improvements during treatment of depressed women with histories of childhood sexual abuse.

BACKGROUND: Deterioration in social functioning and depression are often intertwined, particularly for women with histories of childhood sexual abuse (CSA). Among women with CSA histories, some relationship domains may be more modifiable than others during time-limited depression treatment. Women with CSA histories often report long-standing interpersonal difficulties in close relationships. Thus, we expected that patients' relationships with immediate family and intimate partners would be less likely to improve during treatment than relationships with co-workers, friends, or extended family, unless patients received an interpersonally-focused intervention that targeted close relationships. METHODS: To examine domain-specific social functioning improvements and determine whether some domains were more likely than others to respond to an interpersonally-focused intervention, we analyzed data from a randomized controlled trial investigating Interpersonal Psychotherapy (IPT) vs. usual care (UC) in 69 depressed women with CSA histories. Participants completed the Social Adjustment Scale-SR at pretreatment, 10-, 24-, and 36-weeks. RESULTS: Consistent with our hypotheses, patients reported significant improvements in work roles, leisure activities with friends, and relationships with extended family members over the course of treatment. Relationships with immediate family members and intimate partners did not improve in the overall sample. However, relationships with immediate family improved significantly more among IPT than UC patients. LIMITATIONS: The sample size is small and generalizability may be limited. CONCLUSIONS: Social functioning improvements during depression treatment may be domain-specific among depressed women with CSA histories. IPT is more effective than UC at improving relationships with close family members in this population.

Interpersonal Psychotherapy for Co-occurring Depression and Chronic Pain.

Up to 37% of individuals experience chronic pain during their lifetimes. Approximately one-fourth of primary care patients with chronic pain also meet criteria for major depression. Many of these individuals fail to receive psychotherapy or other treatment for their depression; moreover when they do, physical pain is often not addressed directly. Women, socioeconomically disadvantaged individuals, African Americans and Latinos all report higher rates of pain and depression compared to other groups. This article describes a version of Interpersonal Psychotherapy tailored for patients with comorbid depression and chronic pain, Interpersonal Psychotherapy for Depression and Pain (IPT-P). While IPT-P potentially could be delivered to many different patient populations in a range of clinical settings, this article focuses on its delivery within primary care settings for socioeconomically disadvantaged women. Adaptations include a brief 8-session protocol that incorporates strategies for anticipating barriers to psychotherapy, accepting patients' conceptualization of their difficulties, encouraging patients to consider the impact of their pain on their roles and relationships, emphasizing self-care, incorporating pain management techniques, and flexible scheduling. In addition, IPT-P is designed as an adjunct to usual medical pain treatment, and seeks to engage non-treatment seeking patients in psychotherapy by focusing on accessibility and relevance of the intervention to concerns common among patients with pain. Identifying patients with comorbid depression and chronic pain and offering IPT-P as a treatment option has the potential to improve clinical outcomes for individuals with depression and chronic pain.

Oral desipramine and topical lidocaine for vulvodynia: a randomized controlled trial.

OBJECTIVE: To estimate the efficacy of common treatments for vulvodynia: topical lidocaine monotherapy, oral desipramine monotherapy, and lidocaine-desipramine combined therapy. METHODS: A 12-week randomized, double-blinded, placebo-controlled trial was conducted on 133 vulvodynia-afflicted women assigned to four treatment arms: placebo tablets-placebo cream, desipramine tablets-placebo cream, placebo tablets-lidocaine cream, and desipramine tablets-lidocaine cream. The tampon test was selected as primary end point using a modified intention-to-treat analysis. Twelve secondary end points were also examined. At completion of the 12-week randomized phase, women were examined "open label" through 52 weeks postrandomization. RESULTS: All treatment arms reported substantial tampon-test pain reduction: 33% reduction placebo cream-placebo tablet, 20% reduction lidocaine cream-placebo tablet, 24% reduction placebo cream-desipramine tablet, and 36% reduction lidocaine cream-desipramine tablet. Compared with placebo, we found no significant difference in tampon-test pain reduction with desipramine (t=0.90; P=.37) or lidocaine (t=1.27; P=.21). Of the remaining 12 outcome measures, only the Index of Sexual Satisfaction, improved with desipramine compared with placebo (t=-2.81; P=.006). During the open-label phase, women undergoing vestibulectomy surgery reported significantly improved pain as measured by cotton swab test and the McGill Pain Scale compared with nonsurgical alternatives. CONCLUSION: Oral desipramine and topical lidocaine, as monotherapy or in combination, failed to reduce vulvodynia pain more than placebo. Placebo or placebo-independent effects are behind the substantial pain improvement seen in all treatment allocations. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov, www.clinicaltrials.gov, NCT00276068. LEVEL OF EVIDENCE: I.

Interpersonal psychotherapy for women with comorbid depression and chronic pain.

Chronic pain is prevalent among patients with depression and a risk factor for poor depression treatment outcomes. No known psychotherapy approaches have been developed to target the needs of patients with comorbid depression and chronic pain. This study's goals were to evaluate feasibility, acceptability, and initial effects of interpersonal psychotherapy adapted for women with depression and chronic pain. Seventeen women with major depression and chronic pelvic pain were offered 8 sessions of individual treatment, interpersonal psychotherapy for depression and pain (IPT-P). Participants were recruited from a women's health clinic, were predominantly low-income and minority, and generally did not initially self-identify as depressed. Large effect sizes with significant improvements were found for depression severity and social adjustment; pain interference remained unchanged. Most enrolled patients reported a high level of satisfaction with IPT-P. This pilot study provides preliminary support for the use of IPT-P for patients with comorbid depression and chronic pain.

Pain and depression in gynecology patients.

BACKGROUND: The prevalence and consequences of comorbid pain and depression in gynecology patients are understudied. OBJECTIVE: The purpose of the study was to determine the prevalence of pain, depression, and their co-occurrence among gynecology patients, and to examine how pain and depression are associated with additional comorbid mental disorders. METHOD: Self-reported pain, depressive symptoms, other mental-disorder symptoms, functional status, interpersonal distress, and abuse were assessed in 1,647 gynecology patients by use of the Patient Health Questionnaire and the Medical Outcomes Study (SF-20). RESULTS: Moderate-to-severe pain was reported by 29% of patients; depression, by 21%; with both present in 10.3%. Comorbid pain and depression was associated with anxiety, suicidal or death ideation, functional impairment, interpersonal distress, and physical or sexual abuse. DISCUSSION: Innovative approaches are needed to assess and treat gynecology patients with comorbid pain and depression, given the degree of overlap between them.

Pain as a predictor of depression treatment outcomes in women with childhood sexual abuse.

OBJECTIVES: Childhood sexual abuse (CSA) increases risk for both depression and pain in women. Pain is associated with worse depression treatment response. The contribution of pain to depression treatment outcomes in women with histories of CSA is unknown. This study examined whether clinically significant pain would be associated with worse depression and functioning outcomes among women with CSA histories treated with interpersonal psychotherapy. METHOD: Participants were 66 women with major depression and CSA who presented to a community mental health center. An interpersonal psychotherapy protocol planned for 14 weekly sessions followed by 2 biweekly sessions. Patients were classified as experiencing high pain or low pain based on reported pain severity and interference with functioning. Generalized estimating equations were used to assess change over time in intent-to-treat analyses. RESULTS: High pain patients entered treatment with greater depression symptom severity than low pain patients. Although both high and low pain patients demonstrated improvement in mood, high-pain patients continued to report more depressive symptoms posttreatment. Furthermore, high pain patients demonstrated less change in their emotion-related role functioning over the course of treatment than low pain patients. LIMITATIONS: Small sample size, secondary analyses, lack of a control group, and limited assessment of pain all limit confidence in the findings of this study. CONCLUSION: Findings support the evidence that depression is particularly severe and difficult to treat in patients with CSA and pain. Clinicians should evaluate pain in depressed patients with CSA histories. Role functioning may prove to be a particularly important target in the treatment of patients with pain.

Psychosocial stress and anxiety in musculoskeletal pain patients with and without depression.

OBJECTIVE: The objective of this study was to determine if psychosocial stress and anxiety were associated with depression severity in primary care patients with chronic musculoskeletal pain. METHODS: A cross-sectional sample of 500 primary care patients with musculoskeletal pain (250 with depression and 250 without depression) was assessed for anxiety, psychosocial stress, depression severity and demographics. The depressed and nondepressed participants were compared using t test and chi(2) analyses. Multiple linear regression analyses were used to evaluate the respective associations of psychosocial stressors and anxiety with depression severity based on the 20-item Symptoms Check List across all 500 participants. RESULTS: Compared with nondepressed patients, the depressed patients reported significantly more psychosocial stressors and more severe anxiety. Depressed patients reported a higher frequency of difficulties with every psychosocial stressor assessed. After controlling for covariates, both anxiety and psychosocial stressors were found to be associated with depression severity. CONCLUSIONS: Both anxiety and psychosocial stress should be considered in the assessment and treatment of patients with musculoskeletal pain and depression. Psychosocial stressors among patients with pain may have an impact on depression beyond that of anxiety. Tailored, integrated treatments that target the psychosocial needs of patients with pain and depression are needed. In addition to pharmacotherapy, psychotherapy and other behavioral treatments may be especially important for depression complicated by anxiety or psychosocial stress.