Associations Between Direct and Indirect Forms of Racism Exposure and Stress-Induced Inflammatory Response and Health in Pregnancy.

Theory and research suggest chronic direct and indirect exposures to racism impact health, and stress-responsive inflammation may play a role in these paths. This study examines links between forms of racism-related stress, salivary markers of inflammation during acute psychosocial stress, and perinatal mental and physical health in a racially heterogenous sample. Pregnant people (n = 108, 27% non-white) self-reported personal and vicarious exposure to racism (racial microaggressions, online racism, overt racial/ethnic discrimination) and racial collective self-esteem, as well as affective symptoms and general physical health. Five saliva samples collected before and after the Trier Social Stress Test were assayed for pro-inflammatory cytokines and C-reactive protein. Results revealed associations between racism-related stress and greater inflammatory reactivity/delayed recovery to acute stress, between racial collective self-esteem and lower levels of inflammation, and between profiles of inflammatory responses to stress and mental and physical symptoms. We discuss implications for understanding perinatal health disparities.

Mindfulness and acceptance-based interventions with Black Americans: A meta-analysis of intervention efficacy for depressive symptoms.

OBJECTIVE: A growing literature supports mindfulness and acceptance-based interventions (MABIs) for depression prevention and treatment with individuals from dominant cultural groups, and MABIs have been theorized to be well suited to resonate with individuals from nondominant groups. The aim of the current meta-analysis was to determine whether this promise is realized in practice by evaluating the efficacy of MABIs for depression symptoms in Black Americans. METHOD: Thirty studies with an adequate proportion (>20%) of Black Americans were identified using previous reviews and electronic databases, yielding a total of 1,703 participants with an average proportion of 70% Black Americans. Data on moderators (i.e., geographic location, study design, and intervention protocol) and outcomes were extracted and analyzed using metaregression. RESULTS: Results indicated a moderate effect of MABIs on symptom outcomes in the full sample g = 0.48. Effect sizes were similar in study subsets comprising majority (>50%; k = 19) g = 0.39, and predominantly (>90%; k = 10) g = 0.35, Black participants, with no significant moderating effect of racial composition. Effects were moderated by both sample and intervention level characteristics. CONCLUSIONS: The current findings support the conclusion that MABIs are efficacious to varying degrees for Black Americans; with stronger support for use in adult samples than youth samples. These results are promising, and further support efforts to expand research on evidence-based treatments (EBTs) to meet the specific mental health needs of Black Americans. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Gender discrimination and women's HPA activation to psychosocial stress during the postnatal period.

Stress due to discrimination may contribute to physiological dysregulation and health risk during the postnatal period. This study examined longitudinal associations between gender discrimination and women's cortisol responses to subsequent stress. Mothers (N = 79) reported gender discrimination and completed mother-infant stress tasks with saliva sampling for cortisol at 6, 12, and 18 months postnatal. Multilevel modeling results indicated more overall gender discrimination was associated with higher cortisol. Changes in gender discrimination were not associated with cortisol over time. Gender discrimination may be a factor in women's postnatal stress and associated health risk via the sensitization of physiological stress responses.

Disentangling levels of mother-infant neuroendocrine attunement and longitudinal relations with maternal risk and protective factors.

Scientific understanding of mother-infant HPA axis attunement has been limited by discrepant methods for assessing attunement that often conflate different levels of association. We sought to refine the conceptualization of attunement by investigating whether mother-infant cortisol attunement exists as coupling of response trajectories within an acute stress episode, separate from shared developmental patterns and/or overall dyadic similarity in cortisol levels, and whether the degree of attunement depends on within- or between-dyad differences in maternal risk and protective factors. We examined these questions using a longitudinal study with mother/infant salivary cortisol during dyadic stressors at 6, 12, and 18 months postnatal. A three-level hierarchical linear model showed that sample-wide associations between mother and infant cortisol were not significant at any level, suggesting normative lack of attunement; however, there was significant variability in degree of attunement across dyads. Concurrent levels of family resources and social support satisfaction predicted lower mother-infant cortisol attunement within the session, and overall (mean) parenting stress predicted the opposite. Follow-up analyses showed this was typically due to an increase in infants' (but not their mothers') within-session cortisol response slopes with increasing support and decreasing stress. Implications for the role of mother-infant cortisol attunement in intergenerational stress transmission are discussed.

Synergistic Effects of Psychological Intimate Partner Violence Exposure and Gender Discrimination on Postnatal Mental Health Trajectories.

While the literature examining physical intimate partner violence (IPV) is extensive, the impact of psychological IPV on mental health during high-risk times such as the period following childbirth is not well understood. The current study examined associations between psychological IPV and the course and severity of women's postnatal mental health symptoms (depression, anxiety, and trauma symptoms). Both main effects of psychological IPV exposure and possible exacerbation by broader social victimization (i.e., gender discrimination) were considered. Participants were 76 mothers from a larger longitudinal study, who completed self-report measures of IPV, gender discrimination, and affective symptoms at 3, 6, 12, and 18 months postnatal. Hierarchical linear modeling revealed a main effect of psychological IPV on the course of trauma symptoms only. As hypothesized, gender discrimination moderated the effect of psychological IPV on all symptom trajectories in a synergistic manner. At moderate to high levels of gender discrimination only, psychological IPV predicted higher affective symptom severity and an escalating course of postnatal anxiety symptoms. These findings underscore the importance of expanding current conceptualizations of IPV impacts to incorporate relevant aspects of individuals' social-ecological context. Future directions and implications for prevention and intervention are discussed.

Perimenstrual exacerbation of symptoms in borderline personality disorder: evidence from multilevel models and the Carolina Premenstrual Assessment Scoring System.

BACKGROUND: Individuals with a borderline personality disorder (BPD) suffer from a constellation of rapidly shifting emotional, interpersonal, and behavioral symptoms. The menstrual cycle may contribute to symptom instability among females with this disorder. METHODS: Fifteen healthy, unmedicated females with BPD and without dysmenorrhea reported daily symptoms across 35 days. Urine luteinizing hormone and salivary progesterone (P4) were used to confirm ovulation and cycle phase. Cyclical worsening of symptoms was evaluated using (1) phase contrasts in multilevel models and (2) the Carolina Premenstrual Assessment Scoring System (C-PASS), a protocol for evaluating clinically significant cycle effects on symptoms. RESULTS: Most symptoms demonstrated midluteal worsening, a perimenstrual peak, and resolution of symptoms in the follicular or ovulatory phase. Post-hoc correlations with person-centered progesterone revealed negative correlations with most symptoms. Depressive symptoms showed an unexpected delayed pattern in which baseline levels of symptoms were observed in the ovulatory and midluteal phases, and exacerbations were observed during both the perimenstrual and follicular phases. The majority of participants met C-PASS criteria for clinically significant (⩾30%) symptom exacerbation. All participants met the emotional instability criterion of BPD, and no participant met DSM-5 criteria for premenstrual dysphoric disorder (PMDD). CONCLUSIONS: Females with BPD may be at elevated risk for perimenstrual worsening of emotional symptoms. Longitudinal studies with fine-grained hormonal measurement as well as hormonal experiments are needed to determine the pathophysiology of perimenstrual exacerbation in BPD.

Emotion-related impulsivity and rumination predict the perimenstrual severity and trajectory of symptoms in women with a menstrually related mood disorder.

OBJECTIVE: Women with menstrually related mood disorders (MRMDs) demonstrate clinically significant distress during the premenstrual week that remits with the onset of menses. Relatively little is known about psychosocial mechanisms of MRMDs. Given the core affective and behavioral symptoms of MRMDs, dysfunctional responses to emotion (e.g., difficulties with awareness and regulation of emotion; rumination and impulsive or maladaptive behavior in response to emotion) may be important factors to explore as cognitive and behavioral mechanisms in MRMDs. The purpose of the present study was to examine the associations of various dysfunctional responses to emotion (as measured using the Difficulties in Emotion Regulation Scale [DERS] and brooding on the Ruminative Responses Scale [RRS]) with premenstrual symptom severity and trajectory. METHOD: A total of 54 women (mean age = 38.11; 65% Caucasian) with prospectively confirmed MRMDs completed the DERS and RRS, and provided 2-4 menstrual cycles of daily symptom reports. RESULTS: Only the emotion-related impulsivity subscale of the DERS was robustly associated with premenstrual symptom severity. Brooding rumination predicted a more rapid premenstrual increase and slower postmenstrual remission of some symptoms. CONCLUSION: Both rumination and emotion-related impulsivity may be important treatment targets in cognitive behavioral interventions aimed at reducing symptom severity and cyclicity in MRMDs.

Toward the Reliable Diagnosis of DSM-5 Premenstrual Dysphoric Disorder: The Carolina Premenstrual Assessment Scoring System (C-PASS).

OBJECTIVE: Despite evidence for the validity of premenstrual dysphoric disorder (PMDD) and the inclusion of the disorder in DSM-5, variable diagnostic practices compromise the construct validity of the diagnosis and threaten the clarity of efforts to understand and treat its underlying pathophysiology. In an effort to hasten and streamline the translation of the DSM-5 criteria for PMDD into terms compatible with existing research practices, the authors present the development and initial validation of the Carolina Premenstrual Assessment Scoring System (C-PASS). The C-PASS (available as a worksheet, Excel macro, and SAS macro) is a standardized scoring system for making DSM-5 PMDD diagnoses using two or more months of daily symptom ratings with the Daily Record of Severity of Problems (DRSP). METHOD: Two hundred women recruited for retrospectively reported premenstrual emotional symptoms provided two to four months of daily symptom ratings on the DRSP. Diagnoses made by expert clinician and by the C-PASS were compared. RESULTS: Agreement of C-PASS diagnosis with expert clinical diagnosis was excellent; overall correct classification by the C-PASS was estimated at 98%. Consistent with previous evidence, retrospective reports of premenstrual symptom increases were a poor predictor of prospective C-PASS diagnosis. CONCLUSIONS: The C-PASS is a reliable and valid companion protocol to the DRSP that standardizes and streamlines the complex, multilevel diagnosis of DSM-5 PMDD. Consistent use of this robust diagnostic method would result in more clearly defined, homogeneous samples of women with PMDD, thereby improving the clarity of studies seeking to characterize and treat the underlying pathophysiology of the disorder.