Addie Weaver

Urban vs Rural Residence and the Prevalence of Depression and Mood Disorder Among African American Women and Non-Hispanic White Women

IMPORTANCE There is a paucity of research among African Americans and rural residents. Little is known about the association between urbanicity and depression or about the interaction of urbanicity, race/ethnicity, and sex on depression and mood disorder prevalence. OBJECTIVE To examine the interaction of urbanicity and race/ethnicity on lifetime and 12-month major depressive disorder (MDD) and mood disorder prevalence for African American women and non-Hispanic white women. DESIGN, SETTING, AND PARTICIPANTS The US National Survey of American Life data were used to examine the interaction of urbanicity and race/ethnicity on lifetime and 12-month diagnoses of DSM-IV MDD and mood disorder among female respondents, who included noninstitutionalized African American, Caribbean black, and non-Hispanic white women in the United States between February 2001 and June 2003. Participants included 1462 African American women and 341 non-Hispanic white women recruited from the South because all suburban and rural National Survey of American Life respondents resided in this region. Bivariate multiple logistic regression and adjusted prevalence analyses were performed. Urban, suburban, or rural location (assessed via Rural-Urban Continuum Codes), self-reported race/ethnicity, and sociodemographic factors (age, education, household income, and marital status) were included in the analysis. MAIN OUTCOMES AND MEASURES Lifetime and 12-month MDD and mood disorder assessed via the World Mental Health Composite International Diagnostic Interview. RESULTS Compared with urban African American women, rural African American women had a significantly lower odds of meeting criteria for lifetime (odds ratio [OR], 0.39; 95% CI, 0.23-0.65) and 12-month (OR, 0.29; 95% CI, 0.18-0.46) MDD and for lifetime (F = 0.46; 95% CI, 0.29-0.73) and 12-month (F = 0.42; 95% CI, 0.26-0.66) mood disorder. However, the interaction of urbanicity and race/ethnicity suggested that rural non-Hispanic white women had a significantly higher odds of meeting criteria for lifetime (OR, 2.76; 95% CI, 1.22-6.24) and 12-month (OR, 9.48; 95% CI, 4.65-19.34) MDD and for lifetime (OR, 2.27; 95% CI, 1.06-4.87) and 12-month (OR, 5.99; 95% CI, 3.01-11.94) mood disorder than rural African American women. Adjusted prevalence analyses revealed significantly lower rates of lifetime (4.2%) and 12-month (1.5%) MDD among rural African American women than their urban counterparts (10.4% vs 5.3%; P ≤ .01). The same pattern was found for mood disorder, with rural African American women experiencing significantly lower rates of lifetime (6.7%) and 12-month (3.3%) mood disorder when compared to urban African American women (13.9% vs 7.6%; P ≤ .01) Conversely, rural non-Hispanic white women had significantly higher rates of 12-month MDD (10.3%) and mood disorder (10.3%) than their urban counterparts (3.7% vs 3.8%; P ≤ .01). CONCLUSIONS AND RELEVANCE Rural residence differentially influences MDD and mood disorder prevalence among African American women and non-Hispanic white women. These findings offer a first step toward understanding the cumulative effect of rural residence and race/ethnicity on womens depression prevalence, suggesting the need for further research in this area.

Critical Race Theory: Opportunities for Application in Social Work Practice and Policy:

Critical race theory (CRT) provides a framework for examining power structures that maintain racial inequities and developing strategies for action and change. Though social work acknowledges racial disparities and the role of racism when identifying and attempting to ameliorate social problems, the profession has not fully incorporated CRT. This article introduces CRT, articulates its alignment with social works professional mission and values, describes its central tenets, and applies the tenets to racial disparities within three areas of practice particularly relevant for social work: child welfare system involvement, receipt of public assistance, and access to mental health treatment. CRTs broader implications for social work practice are identified and discussed.

Rural Women's Transitions to Motherhood: Understanding Social Support in a Rural Community

Social support protects women from various negative consequences, yet we have little understanding of how rural women acquire and utilize social support. Using interviews of 24 women in a North Dakota community, this research sought to understand how rural women were supported as new mothers. One, familial women and partners were vital supports to these women. Two, medical professionals were expected to provide only the “medical part,” consisting of medical information and delivery procedures. Finally, dangers of limited social support were examined. Peer support programs and screening are discussed as potential avenues for addressing maternal distress in rural communities.

Employment barriers, skills, and aspirations among unemployed job seekers with and without social anxiety disorder.

OBJECTIVE The literature has consistently demonstrated that social anxiety disorder has substantial negative impacts on occupational functioning. However, to date, no empirical work has focused on understanding the specific nature of vocational problems among persons with social anxiety disorder. This study examined the association between perceived barriers to employment, employment skills, and job aspirations and social anxiety among adults seeking vocational rehabilitation services. METHODS Data from intake assessments (June 2010-December 2011) of 265 low-income, unemployed adults who initiated vocational rehabilitation services in urban Michigan were examined to assess perceived barriers to employment, employment skills, job aspirations, and demographic characteristics among participants who did or did not screen positive for social anxiety disorder. Bivariate and multiple logistic regression analyses were performed. RESULTS After adjustment for other factors, the multiple logistic regression analysis revealed that perceiving more employment barriers involving experience and skills, reporting fewer skills related to occupations requiring social skills, and having less education were significantly associated with social anxiety disorder. Participants who screened positive for social anxiety disorder were significantly less likely to aspire to social jobs. CONCLUSIONS Employment-related characteristics that were likely to have an impact on occupational functioning were significantly different between persons with and without social anxiety problems. Identifying these differences in employment barriers, skills, and job aspirations revealed important information for designing psychosocial interventions for treatment of social anxiety disorder. The findings underscored the need for vocational services professionals to assess and address social anxiety among their clients.

Benefits and Challenges of Service-Learning in Baccalaureate Social Work Programs

Service-learning is a pedagogical approach that integrates students’ classroom instruction with community experience. This article discusses qualitative results from a national survey examining service-learning in Council on Social Work Education–accredited baccalaureate programs. Almost 80% of the 202 program respondents required service-learning. They reported that benefits of incorporating service-learning in the BSW curriculum include assisting students in building community connections, applying theory and skills, socializing to the social work profession, and increasing self-awareness and exposure to diverse populations. Cited challenges include securing agency sites, time, and logistics. Findings support existing research suggesting that service-learning may benefit social work undergraduate education.

Effects of structural family therapy on child and maternal mental health symptomatology

Objective: This pilot study examined the effect of structural family therapy (SFT) on children’s impairment and depressive symptomatology and mothers’ depressive symptomatology and anxiety for 31 families served by a community mental health clinic. Method: A one group predesign/postdesign, with a baseline and two follow-up time points, was used. Results: A series of repeated measures analyses of variance showed significant improvement for mothers’ depression, F(2, 36) = 6.93, p = .003, η2 = .278, and anxiety, F(2, 34) = 6.44, p = .004, η2 = .275. Mothers’ ratings of their children’s impairment significantly improved, F(2, 42) = 6.27, p = .005, η2 = .270, though children’s self-rated impairment and depressive symptomatology did not change. Results were confirmed using random regression analyses. Conclusion: SFT has promise for simultaneously addressing mothers’ and children’s needs in community mental health settings. However, structural barriers impacting feasibility were identified and discussed.

Mental Health Interventions with Community Health Workers in the United States: A Systematic Review

Abstract:Mental health conditions are common in the United States, yet the mental health workforce is limited in its capacity to reach disadvantaged populations. While a number of recent reviews demonstrate that community health worker (CHW)-supported physical health interventions are effective, and increase access to services, there are no recent reviews that systematically assess CHW-supported mental health interventions. To address this gap, the authors conducted a systematic review of mental health interventions with CHWs in the United States, and assessed the methodological rigor of such studies. Nine studies met review criteria. Though most of the studies reviewed showed inadequate methodological rigor, findings suggest CHW-supported mental health interventions show promise, particularly given evidence of feasibility and acceptability with underserved populations. The authors describe the rationale for mental health CHWs in the workforce, offer recommendations to strengthen the evidence base, and discuss implications of mental health interventions with CHWs for underserved populations.

Awareness enhancing and monitoring device plus habit reversal in the treatment of trichotillomania: An open feasibility trial

Habit Reversal Therapy (HRT) is helpful for many persons suffering from trichotillomania. However successful habit reversal therapy requires awareness of hair pulling behaviors. Available methods to monitor hair pulling behaviors are less than ideal, particularly when sufferers are unaware of their pulling-related behaviors. This open feasibility trial included 20 persons with trichotillomania who were treated with nine weeks of HRT with experienced clinicians following a well-established HRT protocol. HRT was augmented with an electronic Awareness Enhancing and Monitoring Device (AEMD) designed to alert users of hand to head contact and to monitor the frequency of pulling-related behaviors. The AEMD included a neck unit and two wrist units, each equipped with vibrating alert functions. The results of the open trial revealed significant improvements in trichotillomania symptoms as measured by clinician and self-report rating scales. Most participants met study criteria for HRT completion and treatment effects were large. Participants reported that the AEMD, when operational, was effective in alerting participants to TTM-related behaviors. The monitoring function of the AEMD did not operate as designed. Subjective feedback focused on the AEMD concept was positive but AEMD reliability problems and complaints about the wearability the units were common. Recommendations for AEMD design modifications were included.

Cognitive–behavioral therapy for depression and anxiety disorders in rural settings: A review of the literature.

Depression and anxiety disorder prevalence rates are similar across urbanicity levels, yet rural Americans are less likely to receive mental health treatment. Barriers related to availability, accessibility, and acceptability of care in rural areas have been well documented. Cognitive–behavioral therapy (CBT) is gold-standard, evidence-based care for these mental health conditions, though its delivery in rural settings has not been systematically assessed. We reviewed the existing literature to identify adaptations made to CBT for depression and anxiety disorders for rural delivery, and to examine the effect of CBT delivered in the rural context on depression and anxiety. We also assessed the studies’ methodological rigor. Sixteen articles published between 2000 and 2012 met review criteria, all of which adapted CBT for rural delivery. Common adaptations included technology-assisted treatment, delivery in non-mental-health settings, and services offered by nontraditional and less experienced providers. Results suggest CBT for depression and anxiety delivered with adaptations in rural areas is effective; however, less than 20% of the studies reviewed reported on fidelity to standard CBT. This article reviewed the limited literature that has tested CBT for depression and anxiety disorders in the rural context. Given the existing literature’s low methodological rigor, results must be interpreted with caution. Findings suggest that adaptations are needed to address barriers to care in rural communities, but little is known about how adaptations impact fidelity or outcomes. We synthesize the current knowledge, provide recommendations for bolstering future research, and discuss implications of rural residents’ lack of access to standard CBT.

Educating Social Workers for Practice in Integrated Health Care: A Model Implemented in a Graduate Social Work Program

ABSTRACT This article introduces a curricular innovation, the Integrated Health Scholars Program (IHSP), developed to prepare masters-level social work students for practice in integrated health care settings, and presents preliminary findings related to students’ self-reported program competencies and perceptions. IHSP, implemented in a research-intensive school of social work in a large midwestern public university, includes specialized course work, interprofessional education across health science disciplines, and field practicum in integrated health care settings. Curricular components support stepwise learning and follows the British Columbia model of interprofessional education learning tiers: exposure, immersion, and skill mastery. Despite IHSPs successful development in a well-resourced, supportive environment, challenges facing our professions ability to develop and sustain training of MSW students in integrated health care are discussed.