Protocol for a pilot study assessing a virtual mindfulness intervention for postpartum African American women.

Elevated perinatal depressive symptoms are more common among disadvantaged African American women, and they are almost four times as likely to have postpartum posttraumatic stress compared to white women. For new mothers, depressive symptoms and posttraumatic stress can lead to negative parenting, poor mother-infant bonding, and delayed infant development. For African American women, a culturally adapted mindfulness-based intervention offers great potential as an acceptable approach to reduce psycho-behavioral symptoms and improve mother-infant interactions (i.e., bonding). Additionally, it is critical that mindfulness interventions consider time constraints of new mothers, provide accessible intervention delivery, address parenting, and consider the challenges of caring for an infant. Given these considerations, we describe a pilot research protocol in which we evaluate a culturally adapted mindfulness program: Mindfulness for African Americans Postpartum (MAAP). The intervention is based upon Kabat-Zinn's Mindfulness Based Stress Reduction program, but is adapted to include culturally relevant concepts of spirituality, inter-dependence, self-empowerment, and storytelling, which are salient to African American culture. To accommodate the needs of new mothers, a certified mindfulness interventionist delivers each session virtually using Zoom. The investigation uses a randomized controlled design in which African American women within 12 months of giving birth are randomized either to the MAAP intervention or to an Education Program. The primary aim is to determine the extent to which the MAAP intervention decreases maternal psycho-behavioral symptoms (perceived stress, depressive symptoms, anxiety, poor sleep, posttraumatic stress, and fatigue) and improves mother-infant bonding. A secondary aim is to explore the effects of MAAP on proinflammatory cytokines and oxytocin. Culturally adapted mindfulness interventions delivered virtually will make mindfulness more accessible and meaningful to populations, like African American new mothers, who are at higher risk for postpartum mood disorders and poor infant outcomes.

Using a Randomized Clinical Trial to Test the Efficacy of a Culturally Responsive Mobile Health Application in African Americans.

Mindfulness is a promising health promotion strategy for African Americans, and it is imperative that culturally responsive mindfulness approaches be accessible to this population. One way to address this need is to develop and test if culturally responsive mobile health (mhealth) applications are efficacious in reducing stress-related outcomes in this population. With this goal in mind, we employed a repeated-measures randomized control trial (RCT) across a 12-week intervention period to evaluate if participants in the intervention group outperformed a wait-list control group in reductions in stress, depressive symptoms, anxiety, emotional regulation difficulties as well as in increases in self-compassion, resilience, and mindfulness attitudes and behaviors. Our sample included 170 Black/African American participants who were randomly assigned to either the intervention condition (n = 84) or the wait-list control group (n = 86). Participants in the intervention condition reported more self-compassion, used more mindfulness, and had greater self-efficacy using mindfulness; yet, no other differences were evident. Participants expressed high levels of satisfaction with the app and gave it a positive rating for its relevance to their lives. These findings support the efficacy of a culturally responsive mindfulness mHealth app to enhance self-compassion and increase the use of health-promoting behaviors, like mindfulness, among African Americans. Implications for future research are discussed.

"I can do bad all by myself": Indirect effect of social support beliefs on the Strong Black Woman schema and depressive symptoms.

OBJECTIVES: The Strong Black Woman (SBW) schema, a multidimensional construct that promotes self-reliance, self-silencing, self-sacrificial caregiving, and resilience, has been linked to depressive symptoms in Black women. Yet, additional research is needed to examine the mechanisms through which this association exists. The present study examines the indirect effect of social support beliefs on the relationship between the SBW schema and depressive symptoms. METHOD: Data from a sample of 194 Black women (Mage = 37.53, SD = 19.88) were collected using an online survey assessing internalization of the SBW schema, depressive symptoms, and social support-seeking beliefs. RESULTS: A primary dimension of the SBW schema, the expectation to manifest strength, was significantly positively correlated with depressive symptoms and negatively correlated with social support seeking. Depressive symptoms were also significantly negatively correlated with social support beliefs. In addition, an indirect effect of support-seeking beliefs was observed between the expectation to manifest strength and depressive symptoms (ab = .12, 95% CI [.02, .24]). CONCLUSIONS: Findings from this study suggest that Black women experience impairing depressive symptoms, which can be explained by race and gender-specific stress-coping ideologies and behaviors, specifically, the SBW schema. Furthermore, the SBW schema is a factor that may contribute to adverse mental health outcomes among Black women vis-à-vis decreased support-seeking beliefs. We discuss the implications of these findings and how these results can help facilitate culturally competent care for Black women. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Perinatal Complications, Poor Hospital Treatment, and Positive Screen for Postpartum Depressive Symptoms Among Black Women.

Though mandatory screening for depression during pregnancy and the postpartum period is recommended, postpartum depression is still underdiagnosed and overlooked among Black women. Understanding risk factors during pregnancy and delivery that may increase the risk for postpartum depression is important for Black women. Thus, the purpose of this study is to examine the relationship between perinatal complications (i.e., preterm birth, low birth weight, gestational diabetes, unplanned cesarean section, undesired pregnancy, depression during pregnancy), poor hospital treatment, and postpartum depressive symptoms (i.e., depressed mood, anhedonia, and positive screen on PHQ-2) among Black women. Using the Listening to Mothers III survey, we conducted logistic regression analyses in a nationally representative sample of 368 Black women to examine the relationship between perinatal complications, poor hospital treatment, and positive screen for postpartum depressive symptoms, measured by the Patient Health Questionnaire-2 (PHQ-2). We also examined these factors in predicting anhedonia and depressed mood. Poor hospital treatment was associated with a positive screen for postpartum depression, anhedonia, and depressed mood. Perinatal complications, when measured continuously, were associated with a positive screen for depression and depressed mood. Gestational diabetes and preterm birth were associated with depressed mood while depression during pregnancy was associated with anhedonia. Perinatal complications during pregnancy and delivery may increase the risk for postpartum depression among Black women. When screening for postpartum depression, it may also be important to inquire about poor hospital treatment and stressors emanating from these experiences.

Toward a socially just diversity science: Using intersectional mixed methods research to center multiply marginalized Black, Indigenous, and People of Color (BIPOC).

OBJECTIVE: Plaut's breakthrough 2010 publication on diversity science-the study of meaningful human differences-set in motion a generative field of theory and research. Yet, to move diversity science forward, innovative methods that explicitly center the experiences of Black, Indigenous, and People of Color (BIPOC) who encounter multiple forms of marginalization must be adopted. One such approach is intersectional mixed methods research-a methodological approach that uses intersectionality theory to guide the use of both quantitative and qualitative methods within a single study. CONCLUSIONS: We argue that intersectional mixed methods research includes four tenets: (1) research questions prioritize multiply marginalized BIPOC individuals, (2) the multiple realities of BIPOC individuals are honored and embraced, (3) identity-related variables (e.g., self-reported discrimination) are studied alongside systems-level variables (e.g., structural racism), and (4) scholars engage in critical reflexivity. We also propose that intersectional mixed methods research can advance scholarship on multiply marginalized BIPOC individuals by fulfilling one of five purposes: Triangulation, complementarity, expansion, development, and initiation. We close with a discussion of tensions and recommendations. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Racism's (un)worthiness trap: The mediating roles of self-compassion and self-coldness in the link between racism and distress in African Americans.

OBJECTIVES: Racism is a key determinant of mental health for African Americans. Although research has started to uncover moderators and mediators of the racism-health link, additional research in this area is warranted. Constructs that have yet to be examined in this link are self-compassion and self-coldness-two distinct ways of relating to oneself during adversity. METHOD: Data from 133 African American college students were used to assess parallel mediation models in which the frequency and stress appraisal of racism were the predictor variables, psychological distress was the outcome variable, and dimensions of self-compassion and self-coldness were treated as mediators. RESULTS: Neither frequency nor appraisal of racism were related to the three types of self-compassion (i.e., self-kindness, common humanity, and mindfulness); yet, both racism frequency and appraisal were related to the three types of self-coldness (i.e., self-judgment, isolation, and over-identification). However, only self-judgment emerged as a significant mediator in the links between both frequency and appraisal of racism and distress, respectively. CONCLUSIONS: Reducing self-coldness in the face of racism can be a promising, individual-level wellness strategy for African Americans. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Racism's effect on depressive symptoms: Examining perseverative cognition and Black Lives Matter activism as moderators.

Additional research is needed on the link between racial discrimination and depressive symptoms over time as well as the risk and resilience moderators that influence this link. One understudied factor that may exacerbate this link is perseverative cognition-chronic activation of stress-related cognitive representations. However, race-specific activism, like Black Lives Matter (BLM) activism, may attenuate this association. Given this, the current study investigated autoregressive and cross-lagged associations between racial discrimination and depressive symptoms across two time points over 6 months. We also tested if perseverative cognition and two domains of Black Lives Matter activism-support and behavior-moderated the cross-lagged associations between racial discrimination and depressive symptoms. Using data from 232 African Americans, findings revealed a significant cross-lagged effect of Time 1 racial discrimination on Time 2 depressive symptoms (but no cross-lagged effect of T1 depressive symptoms on T2 racial discrimination). This cross-lagged effect was moderated by both perseverative cognition and support for BLM activism such that the association between Time 1 racial discrimination was only associated with Time 2 depressive symptoms at lower levels of perseverative cognition and lower levels of BLM support. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Culturally Responsive Mindfulness Interventions for Perinatal African-American Women: A Call for Action.

Perinatal African-American women experience perinatal health disparities with increased levels of stress. Stress includes exposure to racism and sexism for African-American women. African-American perinatal women need a culturally tailored intervention to decrease stress and improve health. Culturally tailored interventions are more effective than non-adapted interventions. Mindfulness can reduce stress and improve health and may be an ideal intervention to culturally modify for perinatal African-American women. We will first discuss stress and its impact on perinatal health. Second, we will present stress and intersectionality for perinatal African-American women. Third, we will describe the existing research on mindfulness and its proposed benefits for perinatal women. Finally, we will highlight culturally responsive mindfulness approaches and how these may be uniquely suited to target and mitigate perinatal stress outcomes and promote healthy behaviors.

Validation of the difficulties with emotion regulation scale in a sample of trauma-exposed Black women.

BACKGROUND: The Difficulties in Emotion Regulation Scale (DERS) is commonly used to assess dimensions of emotion dysregulation, including emotion nonacceptance, limited strategies, and difficulty with goal-directed behavior, impulse control, and emotional clarity. Despite considerable work examining the DERS' factor structure, reliability, and validity, there is limited psychometric support for its use with Black women. OBJECTIVES: (1) Examine the factor structure of the DERS; (2) Compare fit of short-form versions; and (3) Assess whether scores differ based on diagnoses. METHOD: Sample consisted of Black women (n = 667) recruited in urban, community hospital setting. RESULTS: The DERS-18 correlated traits model without awareness demonstrated the best fit, χ2 (80) = 261.09, root mean square error of approximation = 0.06 [0.05, 0.07], comparative fit index = 0.99, Tucker Lewis Index = 0.98, weighted root mean square residual = 0.89. Additionally, those with current diagnoses of posttraumatic stress disorder (PTSD) or major depressive disorder (MDD) reported higher dysregulation (vs. lifetime/no diagnoses). Further, women with comorbid PTSD/MDD reported greater dysregulation (vs. single disorder/no diagnoses). CONCLUSIONS: This study provides evidence supporting the model fit, reliability, and validity of the DERS-18 for Black women.

Racial discrimination and posttraumatic stress: examining emotion dysregulation as a mediator in an African American community sample.

Background: African Americans experience more severe and chronic posttraumatic stress disorder (PTSD) symptoms compared to other racial groups, and thus it is important to examine factors that are relevant for the aetiology of PTSD in this population. Although racial discrimination has been implicated as an exacerbating factor in the development and maintenance of PTSD, relatively less is known about mechanisms through which this process may occur. Objective: The purpose of this study was to examine one such mechanism, emotion dysregulation, in two independent samples of African American adults. Method: Trauma-exposed participants were recruited in a large, urban community hospital setting (initial sample n = 1,841; replication sample n = 294). In the initial sample, participants completed a unidimensional measure of emotion dysregulation and self-reported PTSD symptoms based on the DSM-IV. In the replication sample, participants completed a multidimensional measure of emotion dysregulation and a diagnostic interview of PTSD symptoms based on the DSM-5. Mediation analyses were used to test our hypotheses. Results: Across both samples, results indicated that racial discrimination was indirectly associated with PTSD symptoms through emotion dysregulation (even when trauma load was added as a covariate). Conclusions: Taken together, these results provide strong evidence that the association between racial discrimination and PTSD symptoms may be partially explained by the association between racial discrimination and worse emotion dysregulation. These findings elucidate the impact of racist incidents on mental health and identify modifiable emotion regulatory processes that can be intervened upon to enhance the psychological and social wellbeing of African Americans.

Antecedentes: Los afroamericanos experimentan síntomas de trastorno de estrés postraumático (TEPT) en forma más severa y crónica en comparación con otros grupos raciales y, por lo tanto, es importante examinar los factores que son relevantes para la etiología del TEPT en esta población. Aunque la discriminación racial ha sido implicada como un factor agravante en el desarrollo y mantenimiento del TEPT, se sabe relativamente poco acerca de los mecanismos por los cuales este proceso puede ocurrir.Objetivo: El propósito de este estudio fue examinar uno de tales mecanismos, la desregulación emocional, en dos muestras independientes de adultos afroamericanos.Método: Los participantes expuestos a trauma fueron reclutados en un gran hospital comunitario urbano (Muestra 1 n= 1.841; Muestra 2 n= 294).Todos los participantes completaron una medida de discriminación racial, pero para la muestra 1, los participantes completaron una medida unidimensional de desregulación emocional y síntomas de TEPT auto-informados y para la Muestra 2, los participantes completaron una medida multidimensional de desregulación emocional y una entrevista diagnostica de síntomas de TEPT. Para probar nuestra hipótesis se utilizaron análisis de mediación.Resultados: En ambas muestras, los resultados indicaron que la discriminación racial estuvo asociada indirectamente con síntomas de TEPT a través de la desregulación emocional (incluso cuando la carga del trauma se agregó como una covariable).Conclusiones: En conjunto, estos resultados proveen una fuerte evidencia que la asociación entre discriminación racial y síntomas de TEPT puede explicarse en parte por la asociación entre discriminación racial y una peor desregulación emocional. Estos hallazgos dilucidan el impacto de los incidentes racistas en la salud mental e identifican procesos reguladores de emociones modificables que pueden intervenirse para mejorar el bienestar psicológico y social de los afroamericanos.

Psychosocial Mediators Between Intimate Partner Violence and Alcohol Abuse in Low-Income African American Women.

Intimate partner violence (IPV) exposure can increase alcohol use. Although African Americans use less alcohol compared with European Americans, African American women experience disparate rates of IPV, potentially intensifying their alcohol abuse. We used data from 171 African American women to test if IPV was related to alcohol abuse and if psychosocial factors-loneliness, embarrassment, fear of harm, hope, social support, childcare needs, and finances-mediated this link. IPV and alcohol abuse were related, and several factors were related to either IPV or alcohol abuse. Social support was related to both, and it mediated the IPV-alcohol abuse link, explaining women's alcohol abuse relating to IPV.

Past Discrimination, Race-Related Vigilance, and Depressive Symptoms: The Moderating Role of Mindfulness.

OBJECTIVES: African Americans experience numerous adverse health consequences due to race-related stress. Yet, mindfulness may serve as a relevant and vital protective factor in the link between race-related stressors and depressive symptoms for this population. METHODS: Data from 190 African American participants, ages 18-53, were used to investigate if past discrimination and race-related vigilance, two types of race-related stressors, interactively predicted greater depressive symptomatology among this sample. We also assessed if mindfulness moderated the association between race-related stressors, as indicated by past discrimination and race-related vigilance, and depressive symptomatology. RESULTS: Our results indicated that past discrimination and race-related vigilance did not interactively predict depressive symptomatology in our sample; however, these stressors were independently related to greater depressive symptoms. Additionally, we found that greater levels of mindfulness were associated with lower levels of depressive symptoms, and mindfulness significantly moderated the association between both race-related stressors and depressive symptoms. CONCLUSIONS: These findings support mindfulness' ability to buffer the negative health consequences of past discrimination and race-related vigilance for African Americans. Additional conclusions and future research directions are discussed.

Recommendations for a culturally-responsive mindfulness-based intervention for African Americans.

BACKGROUND: African Americans are at increased risk for stress-related disparities. Mindfulness-based interventions are effective in reducing adverse outcomes; yet, racial/ethnic minorities are underrepresented in these interventions. Also, the development of culturally-responsive interventions has been mostly non-existent. MATERIALS AND METHODS: Focus group and interview data were acquired following a four-week mindfulness intervention with African American women. RESULTS: Using Brigg's (2011) mental health utilization model to guide analysis, several recommended culturally-responsive modifications emerged. Recommended modifications internal to the intervention included using African American facilitators, incorporating cultural values, using culturally-familiar terminology, and providing cultural resources. Suggested modifications to the intervention's external factors included offering the intervention within culturally-familiar settings. Individual-level factors to address were religious concerns, perceived benefits, and holistic health goals. CONCLUSIONS: Themes were used to propose a model toward the creation of a culturally-responsive mindfulness-based interventions to guide culturally-relevant treatment modifications and improve underserved communities' engagement in these interventions.

Self-Criticism and Depressive Symptoms: Mediating Role of Self-Compassion.

Self-compassion is gaining recognition as a resilience factor with implications for positive mental health. This study investigated the role of self-compassion in alleviating the effect of self-criticism on depressive symptoms. Participants were 147 urban, low-income African Americans with a recent suicide attempt. They were administered measures of self-criticism, depressive symptoms, and self-compassion. Results from this cross-sectional investigation showed that self-criticism was positively associated with depressive symptoms and negatively associated with self-compassion, and self-compassion was negatively associated with depressive symptoms. Bootstrapping analysis revealed that self-compassion mediated the self-criticism-depressive symptoms link, suggesting that self-compassion ameliorates the negative impact of self-criticism on depressive symptoms. Our findings suggest that low-income African Americans with recent suicide attempt histories may benefit from interventions that focus on enhancing self-compassion. These results also highlight self-compassion as a positive trait with promise to improve people's quality of life and suggest that self-compassion-focused interventions are consistent with a positive psychology framework.

Shame and Depressive Symptoms: Self-compassion and Contingent Self-worth as Mediators?

Research has identified the experience of shame as a relevant predictor of depressive symptoms. Building upon resilience theory, this is the first study to investigate if self-compassion and/or contingent self-worth (i.e., family support and God's love) mediate the link between shame and depressive symptoms. Participants were 109 African Americans, within the age range of 18 and 64, who sought service following a suicide attempt from a public hospital that serves mostly low-income patients. Findings suggest that shame was related to depressive symptoms through self-compassion but not through contingent self-worth, underscoring the significant role that self-compassion plays in ameliorating the aggravating effect of shame on depressive symptoms. Results highlight the value of incorporating self-compassion training into interventions for suicidal African Americans in an effort to reduce the impact of shame on their depressive symptoms and ultimately their suicidal behavior and as a result enhance their capacity for resilience.

Emotional Benefits and Barriers of Psychological Services Scale: Initial construction and validation among African American women.

The current study used the Health Belief Model to develop a measure that assessed the emotional benefits and barriers of professional psychological services in an African American women sample. Data from 251 African American women recruited from online organizations from across the United States (n = 164) and a Midwestern university psychology subject pool (n = 87) were used for exploratory factor analysis. Results revealed a 2-factor structure of the Emotional Benefits and Barriers of Psychological Services (EBBPS) Scale: Life Enhancement and Concerns about Distress, respectively. Confirmatory factor analysis was performed with data from 208 African American women who were recruited from a Midwestern university psychology subject pool (n = 81), Mturk (n = 104), and online organizations across the United States (n = 23). Results confirmed the EFA 2-factor model and demonstrated superior fit compared with a unidimensional model as well as a 3 factor model. Both factors exhibited excellent internal consistency. Construct validity was supported given that EBBPS factors were correlated with theoretically related constructs, like psychological help-seeking attitudes, intentions to seek counseling, and cultural identity, as well as uncorrelated with theoretically unrelated constructs, like psychological distress. These findings support the utility and cultural relevance of the EBBPS with African American women. (PsycINFO Database Record