Cindy H. Liu

Rates and Predictors of Postpartum Depression by Race and Ethnicity: Results from the 2004 to 2007 New York City PRAMS Survey (Pregnancy Risk Assessment Monitoring System)

The objective of this study was to examine racial/ethnic disparities in the diagnosis of postpartum depression (PPD) by: (1) identifying predictors that account for prevalence rate differences across groups, and (2) comparing the strength of predictors across groups. 3,732 White, African American, Hispanic, and Asian/Pacific Islander women from the New York City area completed the Pregnancy Risk Assessment Monitoring System from 2004 to 2007, a population-based survey that assessed sociodemographic risk factors, maternal stressors, psycho-education provided regarding depression, and prenatal and postpartum depression diagnoses. Sociodemographic and maternal stressors accounted for increased rates in PPD among Blacks and Hispanics compared to Whites, whereas Asian/Pacific Islander women were still 3.2 times more likely to receive a diagnosis after controlling for these variables. Asian/Pacific Islanders were more likely to receive a diagnosis after their providers talked to them about depressed mood, but were less likely than other groups to have had this conversation. Prenatal depression diagnoses increased the likelihood for PPD diagnoses for women across groups. Gestational diabetes decreased the likelihood for a PPD diagnosis for African Americans; a trend was observed in the association between having given birth to a female infant and increased rates of PPD diagnosis for Asian/Pacific Islanders and Whites. The risk factors that account for prevalence rate differences in postpartum diagnoses depend on the race/ethnic groups being compared. Prenatal depression is confirmed to be a major predictor for postpartum depression diagnosis for all groups studied; however, the associations between other postpartum depression risk factors and diagnosis vary by race/ethnic group.

Perinatal Risks and Childhood Premorbid Indicators of Later Psychosis: Next Steps for Early Psychosocial Interventions

Schizophrenia and affective psychoses are debilitating disorders that together affect 2%-3% of the adult population. Approximately 50%-70% of the offspring of parents with schizophrenia manifest a range of observable difficulties including socioemotional, cognitive, neuromotor, speech-language problems, and psychopathology, and roughly 10% will develop psychosis. Despite the voluminous work on premorbid vulnerabilities to psychosis, especially on schizophrenia, the work on premorbid intervention approaches is scarce. While later interventions during the clinical high-risk (CHR) phase of psychosis, characterized primarily by attenuated positive symptoms, are promising, the CHR period is a relatively late phase of developmental derailment. This article reviews and proposes potential targets for psychosocial interventions during the premorbid period, complementing biological interventions described by others in this Special Theme issue. Beginning with pregnancy, parents with psychoses may benefit from enhanced prenatal care, social support, parenting skills, reduction of symptoms, and programs that are family-centered. For children at risk, we propose preemptive early intervention and cognitive remediation. Empirical research is needed to evaluate these interventions for parents and determine whether interventions for parents and children positively influence the developmental course of the offspring.

Racial and Ethnic Differences in Prenatal Life Stress and Postpartum Depression Symptoms

This study determined the risk of core depression symptoms based on life stress domains during pregnancy and whether stressors varied by race/ethnicity. The sample consisted of 2,344 White, African American, Hispanic, and Asian/Pacific Islander (API) Massachusetts women who recently gave birth. African Americans and Hispanics who endorsed high relational and high financial stress were more likely to report high depressed mood and loss of interest; high physical stress was associated with high depressed mood among API. Screening based on life stress domains may be informative in determining risk for core depression symptoms during the postpartum period especially for minority groups.

Re‐conceptualising Prenatal Life Stressors in Predicting Post‐partum Depression: Cumulative‐, Specific‐, and Domain‐specific Approaches to Calculating Risk

BACKGROUND Prenatal life stress predicts post-partum depression (PPD); however, studies generally examine individual stressors (a specific approach) or the summation of such exposure (a cumulative approach) and their associations with PPD. Such approaches may oversimplify prenatal life stress as a risk factor for PPD. We evaluated approaches in assessing prenatal life stress as a predictor of PPD diagnosis, including a domain-specific approach that captures cumulative life stress while accounting for stress across different life stress domains: financial, relational, and physical health. METHODS The Pregnancy Risk Assessment Monitoring System, a population-based survey, was used to analyse the association of prenatal life stressors with PPD diagnoses among 3566 New York City post-partum women. RESULTS Specific stressors were not associated with PPD diagnosis after controlling for sociodemographic variables. Exposure to a greater number of stressors was associated with PPD diagnosis, even after adjusting for both sociodemographic variables and specific stressors [odds ratio (OR) = 3.1, 95% confidence interval (CI) = 1.5, 6.7]. Individuals reporting a moderate-to-high number of financial problems along with a moderate-to-high number of physical problems were at greater odds of PPD (OR = 4.2, 95% CI = 1.2, 15.3); those with a moderate-to-high number of problems in all three domains were at over fivefold increased odds of PPD (OR = 5.5, CI = 1.1, 28.5). CONCLUSIONS In assessing prenatal stress, clinicians should consider the extent to which stressors occur across different life domains; this association appears stronger with PPD diagnosis than simple assessments of individual stressors, which typically overestimate risk or cumulative exposures.

Intra-individual stability and developmental change in hair cortisol among postpartum mothers and infants: Implications for understanding chronic stress.

The study goal was to determine the intra-individual stability, developmental change, and maternal-reported correlates (socio-demographic, stress experiences, hair characteristics, and care) of hair cortisol in mothers and their infants. To assess cortisol deposition in hair during the periods of 6-to-9 months and 9-to-12 months of age, 3 cm segments of hair samples deemed to represent approximately 3 months of retrospective hair cortisol were sampled longitudinally at 9- and 12-months in 41 mothers and infants. Bivariate correlations and mean level comparisons of log-transformed hair cortisol levels at 9- (T1) and 12-months (T2) in mothers and infants were examined. Hair cortisol values were positively correlated from T1 to T2 for mothers (r = .41, p < .05) and infants (r = .39, p < .05). Hair cortisol values did not significantly differ from T1 to T2 in infants but decreased for mothers (F(1,34) = 9.2, p < .01). Maternal and infant hair cortisol was not associated with each other at either time point. Self-reported measures of stress, and hair characteristics and care were not associated with hair cortisol. This is the first study to obtain hair cortisol from more than one time point within the first year after birth in mothers and infants. The intra-individual stability of hair cortisol suggests that it may be a possible biomarker for detecting change in chronic stress experiences within the first year of life and in the postpartum period.

Concerns and Structural Barriers Associated with WIC Participation among WIC-Eligible Women

OBJECTIVES To examine sociodemographic status, psychosocial concerns, and structural barriers associated with womens participation in the USDAs Women, Infants, and Children (WIC) program among those eligible for the program. DESIGN AND SAMPLE A total of 1,634 White, African-American, Hispanic, and Asian/Pacific Islander (A/PI) women from the New York City area completed the Pregnancy Risk Assessment Monitoring System (PRAMS) from 2004 to 2007, a population-based survey. MEASURES Data on WIC eligibility and participation, sociodemographic details, unintended pregnancy, social support, and structural barriers were evaluated. RESULTS Hispanics and Blacks were 4.1 and 2.4 times more likely to participate, respectively, in the WIC program relative to Whites. Mothers reporting unplanned pregnancies, fewer social supports, and more structural barriers (e.g., transportation) were less likely to participate in WIC. Race-stratified analyses revealed race/ethnic differences in the pattern of barriers; unintended pregnancy and structural problems were barriers associated with WIC participation particularly for A/PI. CONCLUSIONS WIC-eligible women with unintended pregnancies and fewer social supports tend to participate in WIC, but those who experience more structural barriers are less likely to participate. A/PI women may face specific challenges to WIC participation. Careful attention is needed to understand the unique attitudes and behaviors in the process of participating in WIC.

U.S. Caregivers with Mental Health Problems: Parenting Experiences and Children's Functioning

The 2007 National Survey of Childrens Health was used to determine the prevalence of poor mental health among U.S. mothers, fathers, and guardians, specific parenting experiences and childrens functioning. More guardians (13.7%) reported poor mental health compared to mothers (7.7%) and fathers (5.3%), generalizing to 4.6 million U.S. caregivers with poor mental health. Caregivers with poor mental health were at least 3 times more likely to report childrens problematic functioning after accounting for sociodemographic factors and parenting stress and experiences. Research and clinical activities should recognize poor caregiver mental health as a condition that affects parenting and childrens functioning.

Maternal Regulating Behaviors Through Face-to-Face Play in First- and Second-Generation Chinese American and European American Mothers of Infants

The purpose of this study was to evaluate the role of culture on maternal socioemotional behaviors (affect and vocalization) following a socially stressful situation between mothers and infants. Participants included 47 Chinese American and 54 European American mothers who took part in the double Face-to-Face Still-Face paradigm with their 16-week-old infants. Overall, the pattern of results suggests that cultural and acculturative differences are enhanced in situations that are socially stressful as emotion displays may be more salient under these conditions. Furthermore, patterns of maternal behaviors may not be consistent in the direction expected from a unidimensional conceptualization of acculturation.

Holistic student assessments

An assessment from a holistic perspective considers the overall well-being of the adolescent and seeks to understand the adolescents development and resiliency in relation to social relationships and their context and risks, given the association between these factors and the goal to promote each area. It is recommended that measures in the assessment obtain information from each of these factors from paper-and-pencil questionnaires, to more qualitative means such as forging relationship with practitioners. Ideally, an assessment should be easily administered by youth workers such as practitioners. A successful assessment procedure includes translation of the assessment findings to a referral by the assessment administrator to explain why the service is needed.

Cross-Cultural Approaches to Mental Health Challenges Among Students

Hillary Clinton described Asian Americans as “among the most prosperous, well-educated, and successful ethnic groups in America.” This seemingly positive stereotype of the “model minority,” frequently promoted by the popular media, may in fact serve to obscure significant challenges faced by this population, particularly with regard to mental health. Issues such as depression and suicidality among Asian American and Asian international students in the United States have become increasingly recognized as major problems at both the high school and university levels, driven by a range of cross-cultural, psychological, familial, and systemic factors. In this chapter, we focus on depression in Asian American and Asian international students as one example of the unique mental health challenges faced by diverse populations in the United States. After outlining the background and context for the chapter, the available literature regarding prevalence of depression in Asian American and Asian international students is summarized. Next, contributing factors and correlates of depression in Asian American and Asian international students are reviewed. Finally, the founding of the MGH Center for Cross-Cultural Student Emotional Wellness is described as one innovative approach to tackling these complex challenges. Clinical recommendations based on the experience of the Center are offered to help foster greater cultural awareness when working with members of these populations.