Audrey M. Pottinger

Tridimensional Acculturation and Adaptation among Jamaican Adolescent-Mother Dyads in the United States.

A bidimensional acculturation framework cannot account for multiple destination cultures within contemporary settlement societies. A tridimensional model is proposed and tested among Jamaican adolescent-mother dyads in the United States compared to Jamaican Islander, European American, African American, and other Black and non-Black U.S. immigrant dyads (473 dyads, M adolescent age = 14 years). Jamaican immigrants evidence tridimensional acculturation, orienting toward Jamaican, African American, and European American cultures. Integration is favored (70%), particularly tricultural integration; moreover, Jamaican and other Black U.S. immigrants are more oriented toward African American than European American culture. Jamaican immigrant youth adapt at least as well as nonimmigrant peers in Jamaica and the United States. However, assimilated adolescents, particularly first generation immigrants, have worse sociocultural adaptation than integrated and separated adolescents.

Detecting depression during pregnancy and associated lifestyle practices and concerns among women in a hospital-based obstetric clinic in Jamaica

OBJECTIVE Antenatal depression, despite its association with increased maternal morbidity risks, is understudied in the developing world. We determined the rate and predictors of depression throughout pregnancy and the use of medication in women attending an obstetric clinic. METHOD Prospective longitudinal study of 452 women newly registered at the antenatal clinic at the University Hospital of the West Indies between September 2005 and February 2006. Sociodemographic data, clinical information and self reports of depression using Edinburgh Postnatal Depression Scale (EPDS) were gathered over three trimesters. RESULTS On average, 25% of women were identified as having a probable depressive disorder over the three trimesters. Independent demographic predictors were youth and unemployment (P<05). Planned pregnancy, exercising, not smoking, being married and support from physician and family were protective factors (P<.05). Using a multivariable model, prior history of depression was the strongest predictor of depression during pregnancy. Of those taking medication for depression prior to pregnancy, only 1.6% remained on medication during the pregnancy. CONCLUSIONS Poverty-related factors and lifestyle are associated with higher EPDS scores during pregnancy in Jamaican women. A protocol of psychosocial management in obstetric care is discussed along with recommendations for future research.

Gender Differences in Coping with Infertility among Couples Undergoing Counselling for In Vitro Fertilization Treatment

OBJECTIVE To identify gender differences in coping responses and the association between coping and psychological distress in couples undergoing In Vitro Fertilization (IVF) treatment at the University of the West Indies (UWI). METHODS All men and women (n = 52) who were offered psychological counselling prior to beginning IVF treatment between October 2003 and May 2004 were invited to complete questionnaires on their coping responses, self-reported distress and socio-demographic data. One female declined. RESULTS Of the 51 participants, 52% had completed secondary education, 44% tertiary education, and 37% were 38 years or older; 42% of the couples were trying for more than seven years to have a child. Gender differences in coping included more women than men keeping others from knowing their pain (p < 0.01) and more women ruminating about what they did wrong to cause the infertility (p < 0.01). These strategies were also associated with reports of heightened distress (p < 0.05). Talking to others to obtain information was associated with less negative feelings. Coping skills that were commonly used by both genders included seeking medical advice and engaging in wishful thinking. CONCLUSION Women coping with infertility may be at risk for self-depreciation and isolation because of their choice of coping strategies and the meaning they ascribe to the infertility. As a result, they are likely to experience more heightened distress than men who are also infertile. Counselling that is specific to gender-needs is indicated.

Sexual Violence and Reproductive Health Among Young People in Three Communities in Jamaica

A secondary analysis of data collected from 1,130 young people ages 15 to 24 in a population-based household survey to assess the reproductive health needs of young people in three communities in Jamaica was conducted to determine the relationships among three measures of sexual violence, background variables, three measures of sexual risk taking (early sexual debut, multiple partners, and no condom at last sex), and two reproductive health outcomes (genital discharge within the past 12 months and pregnancy). In the multivariate analyses, forced first sex increased the likelihood of genital discharge among males (odds ratio, OR = 5.33) and females (OR = 2.02) and pregnancy among females (OR = 2.05), controlling for background characteristics and sexual risk taking. Associations between sexual violence and reported genital discharge and pregnancy that were not mediated by our measures of sexual risk taking were found. More research into the causal mechanisms for this association is needed.

Disaster preparedness and management in the Caribbean the need for psychological support

Over the last 10 years, the world has seen a number of mass casualty disasters. Within that period, the Caribbean has had its own share of such disasters. These include the eruption of the Soufriere Hills volcano, Montserrat, in 1995, the passage of Hurricane Ivan through Grenada, Jamaica and the Cayman Islands in September 2004 and floods in Guyana in 2005. The 2005 hurricane season is predicted to be a busy one with 12 to 15 tropical storms with nine likely to become hurricanes. Of those, three to five could become major hurricanes (1). In Jamaica, there are yearly floods and frequent fires which destroy multi-family dwellings, often in inner city communities. Disasters leave in their wake much devastation and loss: death, physical destruction and dislocation. This is often associated with long-term adverse economic impact on both the individual and the community. What is not often recognized or responded to is the psychological impact of these disasters. The emotional turmoil, trauma and hopelessness that often accompany these events are not as visible as the physical needs. Further, the psychological trauma does not always present soon after the event and the recovery from them often takes far longer (2). Research on mental health outcomes following mass trauma is relatively new to the Caribbean. Data are being analyzed with respect to post-traumatic stress disorder (PTSD) in children following Hurricane Ivan in 2004 in Jamaica (A Pottinger: personal communication). Further, a 2003 study has cited what appeared to be a significant increase in anxiety and depressive symptoms among the elderly population in Montserrat following the volcanic eruptions (3). Studies elsewhere have suggested that children and the elderly may be at particular risk (4, 5). For the elderly, a decline in their physical health was noted for persons who resided near to disaster sites, although a short-term improvement in cognitive functioning was also found (4). The psychosocial impact of other disasters studied in the Caribbean and Central America include Hurricane Mitch on Honduras in 1998. The Pan American Health Organization (PAHO) found that 19.5% of the affected population in Honduras suffered from a severe depressive episode and 10.6% with PTSD. When the criteria of duration and disability were excluded from PTSD, the proportion of PTSD symptoms related to the hurricane was much higher (23.0%) (6). In addition to psychological responses associated with trauma, an increase in alcohol-related problems have been found particularly among those who lived in shelters following the disaster (6). Research in the Caribbean and Central America has also indicated an increase in violence in the community. In the aftermath of the disaster in Montserrat, an apparent increase in attendance at the Casualty Department of the hospital for violence-related injuries was noted for two years following the disaster (3). A similar finding was also reported by PAHO following Hurricane Mitch (6). Psychological support programmes designed to eliminate or reduce the risk of long-term emotional distress related to disasters are beginning to emerge in the Caribbean. In 2000, a counselling programme was developed in Montserrat for those at risk in the population after the volcanic eruption (3). In Jamaica, the Disaster Mental Health Unit (DMHU) of the Jamaica Red Cross was established in 2001 (7). It is the only such unit in the English-speaking Caribbean. The current team of 20 volunteer mental health professionals worked with affected individuals in Jamaica, Grenada and Grand Cayman following Hurricane Ivan in 2004 (8). The unit has been instrumental in training the Red Cross staff and volunteers in all three island states in psychological first aid and selfcare. The DMHU of the Jamaica Red Cross has also embarked on a nation-wide training of community workers that has included promoting interventions that focus on resilience-building, encouraging community solidarity and integrating mental health skills within general services (8). The following are some recommendations as the Caribbean approaches the 2005 Hurricane season: 1. There is a need to raise awareness among the public about typical emotional responses during and after a disaster, such as, flashbacks, insomnia, disturbance of appetite and heightened irritability, as well as when it is necessary to seek professional help. 2. Health professionals need to be sensitized to the presentation of emotional, behavioural and somatic symptoms such as anxiety, depression, domestic and From: Counselling Services, University Health Centre and Department of Obstetrics, Gynaecology and Child Health, The University of the West Indies, Kingston 7, Jamaica.

Associations between Marijuana Use and Sperm Quality in Jamaican Men: Implications for the Subfertile Male

Objective: To evaluate the associations of frequency, quantity and duration of marijuana use with sperm parameters and reproductive histories of male non-smokers and chronic marijuana users. Methods: Semen samples and marijuana consumption histories were obtained from 94 men aged 23–72 years who attended a university-based private fertility management unit for infertility investigations between February and September 2014. Routine semen analyses were performed, and the associations of frequency and duration of marijuana use with sperm parameters and reproductive history were assessed. Results: Lower motility was associated with higher quantities (Spearman’s correlation coefficient, rs = -0.226; p = 0.045) and frequency (rs = -0.234, p = 0.047) of marijuana smoked at a given time. However, duration of marijuana use showed no clear pattern of association with sperm quality. No significant associations were found between marijuana use and reproductive history. Conclusion: Preliminary findings, using a small sample of subfertile men, suggested that sperm motility may be impacted by the quantity and frequency of marijuana use. Screening for excessive use of marijuana and counselling on the potential impact of the drug should be routinely considered for men being treated for infertility.

Stressful events and coping with infertility: factors determining pregnancy outcome among IVF couples in Jamaica

Abstract Objective: The goal of this study was to investigate infertility-coping patterns and pregnancy outcome among IVF participants who face stressful life events in addition to their infertility. Background: Many studies on stress and IVF-assisted pregnancy focus specifically on infertility-related stress without considering the role of other stressful events. Additionally, these studies seldom include the mediating influence of coping patterns. Methods: In a retrospective study, we reviewed the clinical records of 430 men and women who attended the sole fertility centre in Jamaica over a 10-year period. Using cross-sectional analyses, we examined exposure to past significant losses (death, intimate relationship, income) and current stressors (health, work, financial, personal relationships), as well as different coping patterns that emerged (problem-focused, emotion-focused, congruence between partner) with pregnancy outcome. Results: Univariate analyses and logistic regression revealed that participants exposed to multiple stressors were not at increased risk for a negative pregnancy outcome, but women who used problem-focused strategies to cope with their infertility were more likely to become pregnant than those who used emotion-focused strategies. Regardless of coping strategies, however, age was the only independent predictor of pregnancy outcome. Conclusions: Determinants of pregnancy outcome are identified, and the experience of general stress for IVF couples is discussed within the context of a developing country. Areas of future research are highlighted along with implications for psychosocial interventions.

Whither IVF assisted birth or spontaneous conception? Parenting anxiety, styles and child development in Jamaican families

Objective: This research compared Jamaican parents who were assisted to reproduce through in vitro fertilisation or intracytoplasmic sperm injection (IVF/ICSI) with parents who conceived spontaneously (SC) for differences in parenting anxiety, perceived burden of having a child and parenting styles; and whether the cognitive and social-adaptive development of the children of these parents differed. Background: Despite the growing popularity of assisted reproductive technology (ART), the change in attitude towards and acceptance of ART by society has not been considered much in the relevant literature. Methods: Semi-structured interviews were conducted with 22 IVF/ICSI parents and 60 SC parents using measures of parenting styles and anxiety, spousal relationship and impact of having a child on the family. First-born children, 7 years and under, were assessed using standardised measures of cognitive and social-adaptive functioning. Results: SC parents reported higher levels of parenting anxiety, emotional burden and the child impacting negatively on family life. Regardless of type of conception, only age was predictive of parenting anxiety. There were no significant differences in parenting practices between the groups, but SC parents reported parenting beliefs that were permissive or autocratic in nature. IVF children obtained higher mean scores on IQ measures and most social-adaptive domains. Linear regressions showed that parents’ education was associated with communication skills. Conclusions: IVF/ICSI parents were not more anxious than SC parents in a culture where ART is emerging and seemingly controversial. The findings have implications for coping with having a child not only for IVF/ICSI families but for young families in general.