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.

Impact of maternal trauma-related psychopathology and life stress on HPA axis stress response.

To understand and curb intergenerational transmission of stress-related disorder, it is important to identify how trauma-related psychopathology in mothers impacts their psychophysiological stress regulation, particularly in the context of parenting their infants. In this study we investigated associations between mothers' trauma-related psychopathology and life stress and HPA axis response to a personally relevant stressor (infant separation stress) in a non-clinical sample followed longitudinally postpartum. A community sample of low-income mothers (n = 73) and their infants completed laboratory sessions at 3, 6, 12, and 18 months postnatal, and salivary cortisol samples collected before and after dyadic stress tasks at the latter three sessions. These tasks were used to assess HPA function. A three-level hierarchical linear model of repeated cortisol measures nested within sessions within mother-infant dyads did not reveal significant main effects of trauma-related psychopathology on maternal cortisol response, but there was evidence that both a clinical interviewer-rated diagnosis of PTSD and ongoing self-reported trauma symptoms blunted effects of life events on cortisol reactivity. Region of significance analyses indicated that current life stress predicted more pronounced cortisol reactivity only among mothers without trauma-related psychopathology; for those with trauma-related psychopathology, life stress did not relate to cortisol response. Effects held when controlling for childhood trauma and previous (prenatal) maternal distress symptoms, suggesting they did not reflect ongoing impacts of past trauma exposure and/or psychopathology. Blunting effects of trauma-related psychopathology on maternal life stress responsiveness may help clarify how stress sensitivities and mental health are transmitted from parent to child.

Patients' Perceptions Of Perinatal Depression Screening: A Qualitative Study.

Screening for perinatal depression is a clinical approach to identifying women in need of mental health diagnoses, referral, and treatment. Many states mandate screening for perinatal depression, but it remains unclear whether screening leads to increased access to treatment and better health outcomes. The aim of this qualitative study was to identify how women from diverse backgrounds perceive the quality of perinatal depression screening and whether the perceived quality affected their decisions about mental health care. During 2019 a sample of twenty-nine participants who had been screened for perinatal depression completed semistructured in-depth interviews in which they were asked for their impressions of the screening process. Common themes were that the screening was ineffective because providers didn't explain the purpose or uses of the screening tool, didn't tell patients anything about the results, and failed to provide any follow-up relating to patient depression scores. The results suggest the need for health care facilities to engage patients in a dialogue about screening results and for health care delivery systems to refine the screening process. These findings offer a foundation to design more comprehensive, patient-centered screening protocols that might result in improved mental health outcomes.

The Indirect Effect of Parental Intolerance of Uncertainty on Perinatal Mental Health via Mindfulness During COVID-19.

OBJECTIVES: The COVID-19 pandemic is associated with mental health difficulties, especially during pregnancy and early postpartum. Intolerance of uncertainty (IU) and reduced capacity for mindfulness-a protective factor for child-bearers-may be particularly relevant factors driving mental health problems given the unpredictable nature of the pandemic. The current study aims to shed light on modifiable paths to perinatal psychological distress by testing whether there is an indirect effect of IU on psychological symptoms through a perceived reduction in mindfulness during the pandemic. METHODS: Pregnant individuals (67%, n = 133) and new mothers within 6 months postpartum (33%, n = 66) participated in a cross-sectional online survey assessing IU, current and retrospective pre-pandemic mindfulness (FFMQ), and psychological symptoms (anxiety, depression, somatization; BSI). Perceived change in mindfulness was captured by including retrospective mindfulness as a covariate in the PROCESS macro used for analyses. RESULTS: Tests of the direct association between mindfulness, IU, and psychological symptoms showed significant effects of IU (b = 0.46, SE = 0.064; p < .001) and perceived decrease in mindfulness during the pandemic (b = - 0.72, SE = 0.08, p < .001) on psychological symptoms (R 2 = .21-.34; F[2, 197] = 51.13-52.81, p < .001). The indirect effect of IU on symptoms via perceived decrease in mindfulness during the pandemic (b = 0.13, SE = 0.043, 95%CI [.060, .226]) was significant (R 2 = .41, F[3, 195] = 45.08, p < .001). CONCLUSIONS: Results suggest that mothers who are less able to tolerate uncertainty experience more psychological symptoms, in part due to perceived reduction in mindfulness during the pandemic. Future research should examine whether IU is a screening risk marker and target for mindfulness-based interventions to improve maternal well-being and family outcomes.

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.

Effects of prenatal mindfulness-based childbirth education on child-bearers' trajectories of distress: a randomized control trial.

BACKGROUND: The perinatal period is a time of immense change, which can be a period of stress and vulnerability for mental health difficulties. Mindfulness-based interventions have shown promise for reducing distress, but further research is needed to identify long-term effects and moderators of mindfulness training in the perinatal period. METHODS: The current study used data from a pilot randomized control trial (RCT) comparing a condensed mindfulness-based childbirth preparation program-the Mind in Labor (MIL)-to treatment as usual (TAU) to examine whether prenatal mindfulness training results in lower distress across the perinatal period, and whether the degree of benefit depends on child-bearers' initial levels of risk (i.e., depression and anxiety symptoms) and protective (i.e., mindfulness) characteristics. Child-bearers (N = 30) in their third trimester were randomized to MIL or TAU and completed assessments of distress-perceived stress, anxiety, and depressive symptoms-at pre-intervention, post-intervention, six-weeks post-birth, and one-year postpartum. RESULTS: Multilevel modeling of distress trajectories revealed greater decreases from pre-intervention to 12-months postpartum for those in MIL compared to TAU, especially among child-bearers who were higher in anxiety and/or lower in dispositional mindfulness at baseline. CONCLUSIONS: The current study offers preliminary evidence for durable perinatal mental health benefits following a brief mindfulness-based program and suggests further investigation of these effects in larger samples is warranted. TRIAL REGISTRATION: The ClinicalTrials.gov identifier for the study is: NCT02327559 . The study was retrospectively registered on June 23, 2014.

Maternal stress and social support prospectively predict infant inflammation.

Maternal stress has been suggested to be a risk factor for offspring health, while social support has been shown to be a protective factor for offspring functioning. Currently, research has yet to investigate how both of these factors may relate to infant inflammatory processes and associated biological aging in the first years of life. In 48 mother-infant dyads, we investigated whether maternal parenting stress and social support when infants were 12 and 18 months of age were cross-sectionally associated with infant salivary C-reactive protein (sCRP) during these times. In addition, we investigated whether parenting stress and social support were prospectively associated with later sCRP and changes in sCRP from 12 to 18 months of age, as well as whether those changes in sCRP were associated with subsequent infant salivary telomere length (sTL), a marker of biological aging. Analyses revealed that while there were no cross-sectional associations between maternal factors and infant sCRP, maternal parenting stress and social support when infants were 12 months of age predicted infant sCRP at 18 months of age. Further, maternal social support predicted changes in infant sCRP from 12 to 18 months of age. We observed a null association between infant sCRP and sTL. Implications for the ways that maternal mental health and social support may impact biological mechanisms related to disease processes in infants are discussed.

The quality of early infant-caregiver relational attachment and longitudinal changes in infant inflammation across 6 months.

The quality of early caregiver-infant relationships has powerful implications for health trajectories across the lifespan, including associations with adult inflammation. However, because relatively few studies have examined this association during infancy, it remains unclear when this impact occurs and whether it is associated with longitudinal changes in salivary concentrations of inflammation across infancy. In 45 infants, we investigated whether the quality of infant-caregiver attachment (secure vs. insecure) was associated not only with levels of salivary C-reactive protein (sCRP) cross-sectionally, but also with changes in sCRP across 6 months. Interestingly, while there were no cross-sectional associations between infant-caregiver attachment and inflammation at 12 months of age, infant-caregiver attachment security predicted lower levels of sCRP 6 months later. In addition, attachment security predicted decreasing levels of sCRP from 12 months to 18 months of age. Implications for understanding the influence of the quality of early relationships on biological mechanisms related to disease are discussed.

Childhood abuse predicts affective symptoms via HPA reactivity during mother-infant stress.

Despite extensive literature positing the hypothalamic-pituitary-adrenal (HPA) axis as a mechanism in the association between early childhood maltreatment and later adult psychopathology, empirical support for this full pathway is lacking. We tested indirect effects of childhood maltreatment on women's later affective symptomatology via HPA axis responding to a stressor involving their own infant. Women (n = 47) in a larger longitudinal study were assessed following the birth of their infant from 3 to 18 months postnatal. They reported childhood maltreatment history at 3 months and participated in a dyadic stress task with their infant at 12 months, at which time four salivary cortisol samples were collected to assess HPA response. Depression and anxiety symptoms at 18 months (controlling for symptom levels reported at 12 months) served as the primary outcome. Multilevel modeling was used to estimate both levels and dynamics of women's cortisol response trajectories. Tests of indirect effects revealed a significant effect of total Childhood Trauma Questionnaire (CTQ) scores on anxiety symptoms and a marginally significant effect on depression symptoms. Follow-up analyses with CTQ subscales revealed significant indirect effects of emotional and physical abuse on women's ongoing anxiety symptoms via more pronounced cortisol reactivity curves during the mother-infant stressor. We discuss methodological choices that may have allowed these effects to be detected in the present study and implications for stress-related risk and intervention.

Can Simulated Nature Support Mental Health? Comparing Short, Single-Doses of 360-Degree Nature Videos in Virtual Reality With the Outdoors.

Nature exposure in virtual reality (VR) can provide emotional well-being benefits for people who cannot access the outdoors. Little is known about how these simulated experiences compare with real outdoor experiences. We conduct an experiment with healthy undergraduate students that tests the effects of 6 min of outdoor nature exposure with 6 min of exposure to a 360-degree VR nature video, which is recorded at the outdoor nature exposure location. Skin conductivity, restorativeness, and mood before and after exposure are measured. We find that both types of nature exposure increase physiological arousal, benefit positive mood levels, and are restorative compared to an indoor setting without nature; however, for outdoor exposure, positive mood levels increase and for virtual nature, they stay the same. The nature-based experience shows benefits above and beyond the variance explained by participants' preferences, nature and VR experiences, and demographic characteristics. Settings where people have limited access to nature might consider using VR nature experiences to promote mental health.

Mindfulness-related differences in neural response to own infant negative versus positive emotion contexts.

Mindfulness is thought to promote well-being by shaping the way people respond to challenging social-emotional situations. Current understanding of how this occurs at the neural level is based on studies of response to decontextualized emotion stimuli that may not adequately represent lived experiences. In this study, we tested relations between mothers' dispositional mindfulness and neural responses to their own infant in different emotion-eliciting contexts. Mothers (n = 25) engaged with their 3-month-old infants in videorecorded tasks designed to elicit negative (arm restraint) or positive (peekaboo) emotion. During a functional MRI session, mothers were presented with 15-s clips from these recordings, and dispositional mindfulness scores were used to predict their neural responses to arm restraint > peekaboo videos. Mothers higher in nonreactivity showed relatively lower activation to their infants' arm restraint compared to peekaboo videos in hypothesized regions-insula and dorsal prefrontal cortex-as well as non-hypothesized regions. Other mindfulness dimensions were associated with more limited areas of lower (nonjudgment) and higher (describing) activation in this contrast. Mothers who were higher in mindfulness generally activated more to the positive emotion context and less to the negative emotion context in perceptual and emotion processing areas, a pattern that may help to explain mindfulness-related differences in well-being.

Out of harm's way: Secure versus insecure-disorganized attachment predicts less adolescent risk taking related to childhood poverty.

Although some risk taking in adolescence is normative, evidence suggests that adolescents raised in conditions of socioeconomic disadvantage are disproportionately burdened with risk taking and its negative consequences. Using longitudinal data from the NICHD Study of Early Child Care and Youth Development, we investigated quality of the early caregiving environment as a potential prospective buffer against the long-term association between childhood poverty and adolescent risk taking. Multicategorical moderation model results indicated that if raised in poverty across age 1-54 months (average family income to needs ratio ≤ 1.02), relative to affluence (income to needs ratio ≥ 6.16), adolescents with histories of secure attachment to caregivers exhibited two times the number of risk behaviors at age 15, whereas adolescents with insecure-disorganized histories exhibited nearly five times the number of risk behaviors. Both early family economic hardship and history of insecure-disorganized attachment remained significant predictors of increased adolescent risk taking, alongside the interactive effect. Probing the interaction's region of significance revealed that history of secure (vs. insecure-disorganized) attachment is associated with protective reductions in risk taking below a family income to needs ratio of 2.24, or about 220% poverty level. Findings support a diathesis-stress model in which children with secure attachment histories are less deleteriously impacted by early socioeconomic adversity than their insecure-disorganized peers.

Mothers Who Were Neglected in Childhood Show Differences in Neural Response to Their Infant's Cry.

The present study used functional magnetic resonance imaging to investigate how a mother's experience of neglect in her own childhood is associated with her neural response to her infant's distress cues. During scanning, 22 high-risk primiparous mothers were exposed to both their own 18-month-old infant's cry sound and a control sound. Mothers' continuous Neglect subscale scores from the Childhood Trauma Questionnaire were examined as a predictor of their neural response to own infant cry > control sound. Mothers who reported high levels of neglect from childhood showed regions of hyperactivation to their infant's cry (relative to control sound) in the anterior and posterior cingulate cortices and insula as well as specific prefrontal (precentral gyrus) and parietal (posterior supramarginal gyrus) areas. These results may suggest how important early life experiences are for future parenting responses and behaviors.

Mindful parenting predicts mothers' and infants' hypothalamic-pituitary-adrenal activity during a dyadic stressor.

Mindfulness in the parenting relationship has been proposed to help both parents and children better regulate stress, though this has not yet been shown at the physiological level. In this study, we tested relations between maternal mindfulness in parenting and both mothers' and their infants' hypothalamic-pituitary-adrenal (HPA) axis activity during a dyadic stressor 3 months later. Participants were 73 mother-infant dyads from a larger longitudinal study. At 3 months postpartum, mothers completed self-report measures of general dispositional mindfulness and parenting-specific mindfulness, as well as stressful life events. At 6 months postpartum, mother-infant dyads completed the Still Face task. Four saliva samples were collected from each dyad member for cortisol assay to index the HPA axis response. Hierarchical linear modeling of cortisol trajectories revealed a main effect of maternal parenting-specific mindfulness (mindful parenting), but not general dispositional mindfulness, on mothers' cortisol; mothers with higher mindful parenting showed steeper cortisol recovery slopes. In addition, maternal mindful parenting moderated the effect of life stress on later mother and infant cortisol. In the context of high life stress, maternal mindful parenting predicted lower infant cortisol levels, but more extended maternal cortisol elevations. Implications for a biobehavioral model of mindful parenting are discussed. (PsycINFO Database Record

Shaping emotion regulation: attunement, symptomatology, and stress recovery within mother-infant dyads.

The foundations of emotion regulation are organized, in part, through repeated interactions with one's caregiver in infancy. Less is known about how stress physiology covaries between a mother and her infant within these interactions, leaving a gap in our understanding of how the biological basis of emotion regulation develops. This study investigated physiological attunement between mothers and their 5-month-old infants, as well as the influence of maternal depression and anxiety, during stress recovery. During the reengagement phase of the Still Face Paradigm, mother-infant dyads exhibited negative attunement, as measured by inverse covariation of respiratory sinus arrhythmia (RSA). Increases in maternal RSA corresponded to decreases in infant RSA, underscoring dyadic adjustment during recovery. Moreover, infant regulation differed as a function of maternal anxiety, with more anxious mothers having infants with higher RSA during reengagement. Implications for the consolidation of regulatory capabilities within the context of the early caregiving relationship are discussed.

Perceived Discrimination, Racial Identity, and Multisystem Stress Response to Social Evaluative Threat Among African American Men and Women.

OBJECTIVE: Understanding individual differences in the psychobiology of the stress response is critical to grasping how psychosocial factors contribute to racial and ethnic health disparities. However, the ways in which environmentally sensitive biological systems coordinate in response to acute stress is not well understood. We used a social-evaluative stress task to investigate coordination among the autonomic nervous system, hypothalamic-pituitary-adrenal axis, and immune/inflammatory system in a community sample of 85 healthy African American men and women. METHODS: Six saliva samples, 2 at each of baseline, event, and recovery phases of the stressor task, were assayed for cortisol, dehydroepiandrosterone-sulfate, salivary alpha-amylase, and salivary C-reactive protein. Individual differences in perceived discrimination and racial identity were also measured. RESULTS: Factor analysis demonstrated that stress systems were largely dissociated before stressor exposure but became aligned during event and recovery phases into functional biological stress responses (factor loadings ≥ .58). Coordinated responses were related to interactions of perceived discrimination and racial identity: when racial identity was strong, highly perceived discrimination was associated with low hypothalamic-pituitary-adrenal axis activity at baseline (B's = .68-.72, p < .001), low stress mobilization during the task (B's = .46-.62, p < .049), and a robust inflammatory response (salivary C-reactive protein) during recovery (B's = .72-.94, p < .002). CONCLUSION: Culturally relevant social perceptions may be linked to a specific pattern of changing alignment in biological components of the stress response. Better understanding these links may significantly advance understanding of stress-related illnesses and disparities.

Coordination of cortisol response to social evaluative threat with autonomic and inflammatory responses is moderated by stress appraisals and affect.

Recent approaches to stress regulation have emphasized coordination among multiple biological systems. This study builds on evidence that hypothalamic-pituitary-adrenal (HPA) axis activity should be considered in coordination with other stress-sensitive biological systems to characterize healthy responses. Healthy African-Americans (n=115) completed the Trier Social Stress Test, and biological responses were assessed through salivary cortisol, dehydroepiandrosterone-sulfate (DHEA-S), alpha amylase (sAA), and C-reactive protein (sCRP). Multilevel modeling demonstrated that cortisol responses typically aligned with changes in DHEA-S, sAA, and sCRP across the session. At the same time, the degree of cortisol coordination with sAA and sCRP varied by participants' subjective stress following the task; participants with higher secondary stress appraisals showed greater cortisol-sAA alignment, whereas those experiencing more negative affect showed greater cortisol-sCRP alignment. Results highlight the importance of a multisystem approach to stress and suggest that positive HPA axis coordination with the autonomic response, but not with the immune/inflammatory response, may be adaptive.

Depression and anxiety predict sex-specific cortisol responses to interpersonal stress.

Clinical theories posit interpersonal stress as an important factor in the emergence and exacerbation of depression and anxiety, while neuroendocrine research confirms the association of these syndromes with dysregulation in a major stress response system, the hypothalamic-pituitary-adrenal (HPA) axis. However, the proposal that depression and anxiety symptoms and diagnoses are associated with problematic HPA responses to close relationship stress has not been directly tested. We examined 196 heterosexual dating couples' depression and anxiety symptoms and diagnoses, assessed with questionnaires and diagnostic interviews, in relation to cortisol responses to discussion of an unresolved relationship conflict. Participants provided seven salivary samples in anticipation of and directly following the discussion, and throughout an hour-long recovery period, which were assayed for cortisol. Multilevel models of the HPA response predicted by symptoms or diagnoses showed that women's depressive symptoms predicted attenuated cortisol levels, with a flatter response curve. In contrast, men's depression symptoms and women's anxiety symptoms and diagnoses predicted higher cortisol levels. These findings highlight the importance of examining sex differences in responses to interpersonal stressors for understanding HPA dysregulation in internalizing psychopathology.