Economic disadvantage and depressive symptoms among Arab and Jewish women in Israel: the role of social support and formal services.

OBJECTIVES: Depression is a major public health concern due to its high prevalence and association with functioning. Ethnic minorities in Western countries are more likely to experience economic disadvantage and exposure to stressors that may put them at higher risk of developing depression. One major protective factor associated with reduced depressive symptoms is an existing support network. This study examined the associations between economic disadvantage, formal and informal social support, and depressive symptoms among two ethnicity groups in Israel: Arab and Jewish mothers of young children, as well as the potential mediating role of formal and informal social support in the associations between economic disadvantage and depressive symptoms. DESIGN: We recruited a representative sample of 837 Jewish and Arab mothers of children aged 2-6 years. We collected data via structured face-to-face interviews following approval of the university ethic committee. We used the Center for Epidemiologic Studies Depression Scale (CES-D), the Medical Outcomes Study (MOS) scale to measure maternal perceived social support, and a measure designed for this study to quantify formal social support. RESULTS: Compared to the Jewish mothers, Arab mothers reported more depressive symptoms, greater economic disadvantage, and fewer informal and formal support networks. Economic disadvantage was negatively associated with informal support but positively associated with formal support among both Jewish and Arab mothers. Results further revealed that informal and formal social support mediated the associations between economic disadvantage and symptoms of depression. CONCLUSIONS: More attention should be paid to the associations between social determinants and mothers' mental health, with a possible shift of focus to macro-level factors, such as economic inequality and minority status.

Support and Informational Needs of Ultra-Orthodox Jewish Women Coping with Advanced Cancer: A Pilot Observational Study.

In Israel, as in other countries, the emotional and physical needs of minority populations receiving palliative care, are largely unknown. The ultra-Orthodox Jewish sector is one such minority population. This study's goal was to identify perceived social support, desire to receive information about illness and prognosis, and willingness to disclose information to others. Various measures assessing perception of social support, psychological symptoms and information disclosure were completed. Fifty-one women consented to participate; approximately 50% of participants had disclosed the diagnosis to their rabbi or a friend, in addition to their spouse. Almost all of the participants would want to be told if their condition were worsening (86.3%), yet only 17.6% reported that their doctor had discussed future care options if their health situation were to worsen. Overall, participants felt that the level of support they received was high and reported low levels of mental distress. This is the first known study regarding perceptions and needs of ultra-Orthodox Jewish women with advanced-stage cancer. Both diagnosis disclosure and palliative care options should be addressed and discussed with these patients so they may make important end-of-life decisions.

The protective effects of social support and family functioning on parenting stress among Hispanic/Latino/a American immigrant parents with traumatic life experiences: A mediation analysis.

Despite high rates of traumatic experiences reported among Hispanic/Latino/a immigrants in the U.S., the effect of post-traumatic stress on parenting stress among Hispanic/Latino/a immigrant parents with young children has been overlooked. The present study tested the direct and indirect relationships of self-reported maternal post-traumatic stress symptoms on parenting stress, and the mediating role of protective factors among Hispanic/Latino/a mothers with young children. Baseline data collected from mothers participating in a community-based child-parent dyadic intervention were analyzed. Measures included the post-traumatic stress disorder (PTSD) Checklist, the Protective Factors Survey, and the Parenting Stress Index-Short Form (PSI). The sample included 80 mothers with a child between ages 0-6 years. About 75% of these mothers were migrants from Central America. A multivariate regression analysis showed that maternal post-traumatic stress symptoms predicted higher levels of PSI, and two protective factors (social support and family functioning/resilience) fully mediated the relationship between maternal post-traumatic stress symptoms and PSI. Higher social support and family functioning/resiliency may have protective effects on Hispanic/Latino/a mothers with post-traumatic stress, leading to lower levels of stress related to parenting. Findings underscore the importance of interventions that enhance access to social support and promote family functioning/resilience for Hispanic/Latino/a immigrant mothers with trauma histories to cope better with parenting stress.

A pesar de las altas tasas de experiencias traumáticas entre inmigrantes hispano/latinos/as en Estados Unidos, el efecto del estrés postraumático en la crianza entre progenitores inmigrantes hispano/latinos/as con niños pequeños ha pasado desapercibido. El presente estudio puso a prueba las directas e indirectas relaciones de síntomas de estrés postraumático materno auto reportado sobre el estrés de crianza, así como el papel mediador de factores de protección entre madres hispano/latinas con niños pequeños. Se analizaron los datos de referencia obtenidos de madres participantes en una intervención diádica progenitor-niño con base comunitaria. Entre las medidas se incluyeron la lista de verificación de Trastorno de Estrés Postraumático (PTSD), la Encuesta de Factores de Protección, así como el Formulario Corto del Índice de Estrés de Crianza (PSI). El grupo muestra contaba con 80 madres con un niño entre 0 y 6 años de edad. Cerca del 75% de estas madres eran inmigrantes de América Central. Un análisis de regresión multivariado mostró que los síntomas de estrés postraumático materno predecían más altos niveles de PSI, y dos factores de protección (apoyo social y funcionamiento y resiliencia familiar) completamente mediaron la relación entre los síntomas de estrés postraumático materno y PSI. Un más alto apoyo social y funcionamiento y resiliencia de la familia pudiera tener efectos de protección sobre madres hispanas/latinas con estrés postraumático, llevando a más bajos niveles de estrés relacionado con la crianza. Los resultados resaltan la importancia de mejorar el acceso al apoyo social y promover el funcionamiento y resiliencia de la familia para madres inmigrantes hispanas/latinas con un historial de trauma y así poder arreglárselas mejor con el estrés de crianza.

En dépit de taux élevés d'expériences traumatiques rapportés chez les immigrés hispaniques/latinos et latinas aux Etats-Unis d'Amérique l'effet du stress post-traumatique sur le stress de parentage chez les parents hispaniques/latinos et latinas immigrés avec de jeunes enfants est souvent oublié. Cette étude a testé les relations directes et indirectes des symptômes de stress post-traumatique maternel auto-rapporté sur le stress de parentage et le rôle médiateur de facteurs de protection chez les mères hispaniques/latinas avec de jeunes enfants. Les données de base recueillies de mères participant à une intervention dyadique enfant-parent Communautaire ont été analysées. Les mesures ont inclus la Checklist TSPT, le Sondage de Facteurs Protecteurs (Protective Factors Survey), et le Formulaire Court de l'Index de Stress de Parentage (Parenting Stress Index-Short Form, soit PSI). L'échantillon a inclus 80 mères avec un enfant entre l'âge de 0-6 ans. A peu près 75% de ces mères avaient immigré de l'Amérique Centrale. Une analyse de régression multivariée a montré que les symptômes de stress post-traumatique maternel a prédit des niveaux plus élevés de PSI et seuls deux facteurs protecteurs (le soutien social et le fonctionnement/la résilience familial(e) ont totalement médiatisé la relation entre les symptômes de stress post-traumatique et le PSI. Un soutien social plus élevé et le fonctionnement/la résilience familial(e) peuvent avoir des effets protecteurs sur les mères hispaniques/latinas avec du stress post-traumatique, menant à des niveaux moins élevés de stress lié au parentage. Les résultats soulignent l'importance des interventions qui renforcent l'accès au soutien social et promeuvent le fonctionnement/la résilience familial(e) pour les mères hispaniques/latinas avec un passé de trauma pour mieux faire face au stress de parentage.

Treatment Preferences for Postpartum Depression Among New Israeli Mothers: The Contribution of Health Beliefs and Social Support.

BACKGROUND: Postpartum depression (PPD) may have adverse outcomes for mothers, their infants, and families. Despite the negative consequences of PPD many women hesitate to seek treatment. The theoretical concepts of this study were based on the health belief model, which focuses on the individual's attitudes, beliefs, and intentions to seek treatment. AIM: The aim of the study was to examine whether health beliefs and social support mediate the links between sociodemographic variables and treatment preferences for PPD. METHOD: Cross-sectional survey, including 1,000 Jewish mothers attending the maternal and child health clinics in Israel for their infant's medical exam, 4 weeks to 6 months postpartum. RESULTS: Mother's age and years of education correlated positively with preferences to receive treatment in the private sector and from professionals working in mental health clinics. The greater the number of children, the less likely new mothers were to favor these preferences. Structural equation modeling showed several mediating pathways: social support mediated the links between sociodemographic variables to health belief model components such as perceived benefits, barriers, and environmental cues. Health belief model components also mediated the links between sociodemographic factors and preferences for place of treatment, professionals, and modes of treatment for PPD. CONCLUSIONS: Health belief model components and social support are important mediating components that help explain mothers' PPD treatment preferences. Health professionals such as psychiatric or public health nurses should increase awareness of women at risk for PPD and elicit their preferred treatment options.

Are we overlooking the obvious? Addressing social determinants of health that contribute to perinatal depression.

Mental health disorders among women during the perinatal period are common and cause significant morbidity, yet precise reasons why some women develop depression during this period, and others do not, are, as yet, unknown. Pregnancy may burden populations of women differently, and sociological variables, such as finances, social position, interpersonal resources; and extreme events, the coronavirus disease 2019 (COVID-19) pandemic for example, may be as significant as biological determinants. However, current treatment for depression remains focused on the individual woman as the main agent for change. Incorporating a systems-wide approach to diagnosing and treating perinatal depression by addressing structural and systemic determinants may be a more effective way to treat this illness. In this paper, we explore social determinants of health and their correlation with clinical depression in the antenatal period. We also investigate broader, society-wide interventions that may reduce this significant morbidity among women of reproductive age, in both developed and developing nations.

A Cognitive-Behavioral Intervention for Postpartum Anxiety and Depression: Individual Phone vs. Group Format.

Cognitive-behavioral interventions can effectively treat symptoms of perinatal mood and anxiety disorders (PMADs). We assessed the acceptability and effectiveness of a workbook-based intervention (What Am I Worried About? (WAWA)) comprising of cognitive-behavioral and mindfulness techniques and weekly professional guidance to address symptoms of depression, anxiety, and stress among postpartum mothers. We compared the efficacy of group versus individual telephone consultation using a pre-and post-test single group, open trial, research design in replication pilot study. A convenience sample of community-residing postpartum women (n = 34) chose between group intervention (n = 24) or individual phone consultation with a mental health professional (n = 10). Outcome measures were anxiety (GAD-7), depression, anxiety, and stress (DASS21), and postpartum depression (PPD-EPDS). After four weeks intervention, significant reductions were observed in postpartum depression, anxiety, and stress scales. Cohen's d statistics showed medium effect sizes (0.35-0.56). A small but significantly larger change in PPD-EPDS and DASS stress scores was reported among participants who opted for the phone intervention compared to those in the group intervention. Most participants felt that the intervention was highly beneficial and would recommend it to other postpartum women. In conclusion, the WAWA intervention showed efficacy for reducing postpartum anxiety, distress, and depressive symptoms among postpartum women, with a slightly greater reduction in PPD-EPDS and stress symptoms found among those who opted for individual phone consultation. Definitive evaluation of the intervention requires a larger sample and a RCT research design with two treatment arms: telephone and group intervention.

Hidden Figures: Are Ultra-Orthodox Jewish Women Really so Different When it Comes to Health Care?

Incorporating the needs of at-risk populations into national health care initiatives is essential. Israel has identified ultra-Orthodox Jewish, or Haredi, women, as at risk of increased morbidity and mortality, yet actual data on this insular community are lacking. We reviewed published research on Israeli Haredi women's health status, behaviors and health care access and examined methodologies. Of 273 articles identified, 14 publications and four government reports were included. More research is needed on this community, essential not only to Israeli health care policy, but to that of the USA and the UK, who share the largest percentages of Haredi Jews.

Preferences for mental health treatment for post-partum depression among new mothers.

BACKGROUND: The prevalence rate of postpartum depression (PPD) is 9 to 17% among mothers, with higher rates among low income and immigrant populations. Due to the negative effects of PPD symptoms on both the mother and baby, treating mothers with depression symptoms is of great importance. This study examined treatment preferences for PPD among Israeli mothers with and without PPD symptoms, specifically focusing on treatment centers, type of professional and mode of treatment, to help develop relevant policies to promote the health of mothers by reaching a deeper understanding of their preferences. METHODS: 1000 mothers who attended Maternal Child Health Clinics (MCHCs) in Israel for their infant's first medical exam participated in a cross-sectional survey. RESULTS: In this sample, 8.4% of the participants suffered from PPD. Mothers with PPD compared to those without symptoms had lower economic status, were more likely to be single, to be first-time mothers, have an unemployed partner and to have immigrated to Israel. Mothers with PPD preferred private mental health practice and community treatment centers by mental healthcare professionals. They also preferred group interventions and personal psychotherapy rather than technology-based interventions. CONCLUSIONS: The study findings support the formulation of mother-sensitive health policies based on understanding mothers' preferences, and thus, help prepare treatment alternatives that will suit different groups of mothers with PPD, for the benefit of mothers, newborns, and families. Disseminating the results of this study among professionals as part of professional training, can promote appropriate treatment facilities and modes of care for mothers with PPD.