Alexa Bonacquisti

Rates and predictors of prenatal depression in women living with and without HIV

Depression is a significant mental health and public health concern, and women living with HIV are at increased risk for depression. This risk may be especially elevated during pregnancy; however, few studies have attempted to identify rates and predictors of depression in pregnant, HIV-infected women. The purpose of the present study was to investigate rates and predictors of prenatal depression, such as history of depression, childhood sexual abuse (CSA), and social support among HIV-infected and HIV-uninfected women in Philadelphia, Pennsylvania. It was hypothesized that pregnant women with HIV will have higher rates of depressive symptoms and will exhibit a greater number of mood disorder diagnoses as compared to HIV-uninfected pregnant women. It was also hypothesized that HIV status, history of depression, CSA, and inadequate social support will emerge as predictors of depressive symptoms. A sample of 163 women, 31% (n=50) of whom were HIV-infected and 69% (n=113) of whom were HIV-uninfected, were recruited from an obstetrics/gynecology clinic affiliated with an urban university hospital. The Center for Epidemiological Studies-Depression Scale (CES-D) was used to identify depressive symptoms, and Modules A and D of the Structured Clinical Interview for DSM-IV (SCID) confirmed the presence of a mood disorder. Findings demonstrated that rates of depressive symptoms and mood disorder diagnoses during pregnancy did not differ according to HIV serostatus. History depression, CSA, and inadequate social support predicted depressive symptoms during pregnancy in this sample. Due to their association with depressive symptoms, history of depression, CSA, and inadequate social support may be important to identify during pregnancy.

Small-for-Gestational-Age Births in Pregnant Women with HIV, due to Severity of HIV Disease, Not Antiretroviral Therapy

Objectives. To determine rate and factors associated with small-for-gestational-age (SGA) births to women with HIV. Methods. Prospective data were collected from 183 pregnant women with HIV in an urban HIV prenatal clinic, 2000–2011. An SGA birth was defined as less than the 10th or 3rd percentile of birth weight distribution based upon cut points developed using national vital record data. Bivariate analysis utilized chi-squared and t-tests, and multiple logistic regression analyses were used. Results. The prevalence of SGA was 31.2% at the 10th and 12.6% at the 3rd percentile. SGA at the 10th (OR 2.77; 95% CI, 1.28–5.97) and 3rd (OR 3.64; 95% CI, 1.12–11.76) percentiles was associated with cigarette smoking. Women with CD4 count >200 cells/mm3 at the first prenatal visit were less likely to have an SGA birth at the 3rd percentile (OR 0.29; 95% CI, 0.10–0.86). Women taking NNRTI were less likely to have an SGA infant at the 10th (OR 0.28; 95% CI, 0.10–0.75) and 3rd (OR 0.16; 95% CI, 0.03–0.91) percentiles compared to those women on PIs. Conclusions. In this cohort with high rates of SGA, severity of HIV disease, not ART, was associated with SGA births after adjusting for sociodemographic, medication, and disease severity.

Providing Sensitive Care for Adult HIV-Infected Women With a History of Childhood Sexual Abuse

&NA; Childhood sexual abuse (CSA) is a serious public health issue. Women with HIV who have a history of CSA are at increased risk for sporadic medical treatment, nonadherence to HIV medications, and HIV risk behaviors. These associations pose a challenge to providing health care for this population and are complicated by the possible psychological sequelae of CSA, such as anxiety, depression, dissociation, and posttraumatic stress disorder. This article reviews the effects of CSA on the health status of women with HIV, barriers to treatment adherence, suggested components of trauma‐sensitive medical care, and mental health approaches. A trauma‐informed, trauma‐sensitive care model that addresses barriers associated with health care for women with a history of CSA is suggested. Specific recommendations are offered for the provision of effective clinical care for women with HIV who also have a history of CSA to help HIV care providers better recognize and appreciate the distinct needs of this patient population.

Women's health psychology

Foreword ix Preface xi Acknowledgments xiii List of Contributors xv SECTION 1: Women s Health in Context Chapter 1 Historical Roots of Women s Healthcare 3 Heather Munro Prescott and Wendy Kline Chapter 2 Retheorizing Women s Health Through Intersectionality s Prism 25 Lisa Bowleg Chapter 3 Employment and Women s Health 46 Nancy L. Marshall Chapter 4 Effects of Intimate Partner Violence Against Women 64 Kathy McCloskey and Deidre Hussey SECTION II: Well-Being and Health Challenges Chapter 5 Alcohol Use in Women 91 Nancy Vogeltanz-Holm, Kaitlin Lilienthal, Allison Kulig, and Sharon C. Wilsnack Chapter 6 Women and Smoking 123 Bradley N. Collins and Uma S. Nair Chapter 7 Obesity in Women 149 Michael R. Lowe, Meghan L. Butryn, and Alice V. Ely Chapter 8 Eating and Weight-Related Disorders 173 Matthew Fuller-Tyszkiewicz, Ross Krawczyk, Lina Ricciardelli, and J. Kevin Thompson Chapter 9 Cosmetic Medical Procedures and Body Adornment 199 Canice E. Crerand, Leanne Magee, Jacqueline Spitzer, and David B. Sarwer Chapter 10 Women s Sleep Throughout the Lifespan 223 Jacqueline D. Kloss and Christina O. Nash Chapter 11 Promotion of Physical Activity for Women s Health 255 Dori Pekmezi, Sarah Linke, Sheri Hartman, and Bess H. Marcus SECTION III: Reproductive Health Chapter 12 Women s Sexual Health 281 Patricia J. Morokoff and Maggie L. Gorraiz Chapter 13 Premenstrual Dysphoric Disorder 305 Simone N. Vigod and Meir Steiner Chapter 14 The Stress of Infertility 328 Lauren B. Prince and Alice D. Domar Chapter 15 The Psychology of Agency in Childbearing 355 Pamela A. Geller, Alexandra R. Nelson, and Efrat Eichenbaum Chapter 16 Psychiatric Symptoms and Pregnancy 389 Danielle M. Novick and Heather A. Flynn Chapter 17 Breastfeeding and Maternal Mental and Physical Health 414 Jennifer Hahn-Holbrook, Chris Dunkel Schetter, and Martie Haselton Chapter 18 Rethinking Menopause 440 Paula S. Derry and Heather E. Dillaway SECTION IV: Disability and Chronic Conditions Chapter 19 Women s Responses to Disability 467 Rhoda Olkin Chapter 20 The Experience of Cancer in Women 491 Annette L. Stanton and Betina Yanez Chapter 21 The Psychology of Irritable Bowel Syndrome 514 Sarah K. Ballou and Laurie Keefer Chapter 22 Stress and Resilience in Women With Rheumatic Disease 539 Sharon Danoff-Burg Chapter 23 Neurological Disorders in Women 556 M. Meredith Gillis, Kara R. Douglas-Newman, and Mary V. Spiers Chapter 24 Converging Issues in Heart Disease, Stroke, and Alzheimer s Disease in Women 581 Mary V. Spiers Author Index 605 Subject Index 637

Condom‐use intentions and the influence of partner‐related barriers among women at risk for HIV

AIMS AND OBJECTIVES To examine intentions to engage in condom use and potential partner-related barriers to condom use, including intimate partner violence (IPV), low levels of sexual relationship power and perceptions of monogamy, among women at risk for HIV. BACKGROUND In the United States, women account for approximately one in four new HIV infections. Despite the effectiveness of consistent condom use, women often confront biological, cultural and psychosocial barriers that limit their ability to engage in condom-use. DESIGN Cross-sectional, quantitative study. METHODS Participants (N = 90) were recruited from a domestic violence shelter, a domestic violence support organisation and an obstetrics/gynaecology clinic in Philadelphia, PA. Data were collected by questionnaires to assess womens condom-use intentions, actual condom-use behaviour, sexual partner risk factors, experience of IPV, level of sexual relationship power and perceptions of monogamy. RESULTS Fifty-eight per cent of participants (n = 52) indicated a difference between their preference and intentions to use condoms vs. their actual use, with 62% (n = 32) using condoms less frequently than they would like. Significant differences in condom use emerged for women with low vs. high sexual relationship power and women who reported being in a monogamous relationship vs. those who did not. Of particular concern, a majority of these relationships were with high-risk partners, further increasing womens already elevated risk of acquiring HIV. CONCLUSIONS Condom use is a multifaceted issue, particularly in sexual relationships involving power differentials and perceived monogamy. Condom use was complicated by womens own preferences, sexual relationship power differentials and by the perceived exclusivity of the relationship with their sexual partners. RELEVANCE TO CLINICAL PRACTICE These findings have important implications for nurses as they are uniquely positioned to facilitate HIV risk reduction among their patients through the discussion of sexual health issues and barriers to negotiating condom use that women may confront.

Acceptance and commitment therapy for perinatal mood and anxiety disorders: development of an inpatient group intervention

Perinatal mood and anxiety disorders are a leading cause of morbidity and mortality for childbearing women. Current treatments, such as cognitive behavioral therapy and interpersonal therapy, have demonstrated modest success in addressing perinatal psychiatric symptoms; however, additional treatment options are needed to address the limitations of current approaches, particularly for women experiencing moderate to severe perinatal mental illness during pregnancy or postpartum. We discuss the use of acceptance and commitment therapy (ACT) as a promising treatment approach that may be uniquely suited for perinatal women due to its emphasis of values, mindfulness, and acceptance; these psychological constructs notably address the significant psychiatric and behavioral health condition comorbidity, somatic symptoms, and stigma associated with perinatal mood and anxiety disorders. In addition, we describe the development of a four-session ACT-based group intervention at the Perinatal Psychiatry Inpatient Unit at the University of North Carolina at Chapel Hill. Sessions focus on core ACT processes of acceptance, cognitive defusion, present-moment awareness, value identification, and goal setting, and we describe how each of these processes is relevant to the perinatal population. Implications for future clinical applications and research investigations are discussed.

Maternal Experience of Neonatal Intensive Care Unit Hospitalization: Trauma Exposure and Psychosocial Responses

For mothers in the postpartum period, admission of their newborn to a neonatal intensive care unit (NICU) is often an unanticipated experience that can be shocking and traumatic, and can elevate maternal risk for psychiatric symptoms, including posttraumatic stress. In this chapter, the NICU experience, psychosocial implications, mental health consequences, and screening tools that have been used to identify maternal psychiatric symptoms in this setting will be reviewed. Psychosocial interventions and programs addressing the stress and psychological reactions of mothers with an infant in a NICU will be introduced, as will recently developed interdisciplinary recommendations for the support of NICU families and a nurse training program to promote optimal communication between NICU nurses and parents. The chapter concludes with future clinical and research directions to continue improving maternal adjustment and mental health during a child’s NICU hospitalization.

Increasing racially and ethnically underrepresented women in medical school through an innovative program

In 2014, women comprised nearly half of medical school graduates; 1 yet, the proportion of female medical students from underrepresented racial-ethnic groups remains low. The Association of American Medical Colleges, recognizing this disparity, introduced the term “underrepresented in medicine” (URM) to refer to those groups that are underrepresented in the medical profession relative to their numbers in the general population.2 The United States (US) has experienced a continual increase in diverse populations, but the number of URM physicians has not risen to match this pace.3 At the same time, the persistent shortage of primary care physicians, particularly those in family medicine who serve high-need populations,4 is a welldocumented phenomenon.5 The past fifty years have witnessed growth in medical education and practice among URM women; however, there remain significant improvements to be made in terms of permitting access and engagement for these women, specifically related to the debt associated with financing their education and the provision of available mentors who can assist in the career development process. Improvements in this area can offer significant benefits to diverse communities, as a large proportion of underrepresented women who graduate from medical school plan to specialize in primary care and locate their practice in underserved areas. This underscores the need to make systems-level improvements and develop innovative programming to recruit, enroll, and retain minority women in medical education. One such approach is the Woman One Award and Scholarship Fund program, developed by the Drexel University College of Medicine’s (DUCOM) Institute for Women’s Health and Leadership (IWHL) in Philadelphia, Pennsylvania. Woman One aims to effectively address the primary financial barriers faced by minority women in the pursuit of medical education, thereby increasing access, improving retention, and facilitating their goal of becoming physicians who may practice in underserved communities.