Marci Lobel

Social Support in Pregnancy: Psychosocial Correlates of Birth Outcomes and Postpartum Depression

This prospective study examined the effects of prenatal social support on maternal and infant health and well-being in a sample of low-income pregnant women (N = 129). Three aspects of support (amount received, quality of support received, and network resources) and four outcomes (birth weight, Apgar scores, labor progress, and postpartum depression) were studied. Results indicated that women who received more support had better labor progress and babies with higher Apgar scores. Women with higher quality support had babies with higher Apgar scores and experienced less postpartum depression. Also, women with larger networks had babies of higher birth weight. Further analyses indicated that the outcomes as a whole were more consistently predicted by instrumental rather than emotional forms of support. Finally, although there was some evidence for stress-buffering effects of support, the overall findings were more consistent with a main effect model.

Prenatal maternal stress and prematurity: a prospective study of socioeconomically disadvantaged women.

Developed and tested a biopsychosocial model of birthweight and gestational age at delivery using structural equation modeling procedures. The model tested the effects of medical risk and prenatal stress on these indicators of prematurity after controlling for whether a woman had ever given birth (parity). Subjects were 130 women of low socioeconomic status interviewed throughout pregnancy in conjunction with prenatal care visits to a public clinic. The majority of women were Latino or African-American. Half were interviewed in Spanish. Lower birthweight was predicted by earlier delivery and by prenatal stress. Earlier delivery was predicted by medical risk and by prenatal stress. Parity was not related to time of delivery or to birthweight. Implications of results for the development of biopsychosocial research on pregnancy and on stress are discussed.

Pregnancy-Specific Stress, Prenatal Health Behaviors, and Birth Outcomes

OBJECTIVE Stress in pregnancy predicts earlier birth and lower birth weight. The authors investigated whether pregnancy-specific stress contributes uniquely to birth outcomes compared with general stress, and whether prenatal health behaviors explain this association. DESIGN Three structured prenatal interviews (N = 279) assessing state anxiety, perceived stress, life events, pregnancy-specific stress, and health behaviors. MAIN OUTCOME MEASURES Gestational age at delivery, birth weight, preterm delivery (<37 weeks), and low birth weight (<2,500 g). RESULTS A latent pregnancy-specific stress factor predicted birth outcomes better than latent factors representing state anxiety, perceived stress, or life event stress, and than a latent factor constructed from all stress measures. Controlling for obstetric risk, pregnancy-specific stress was associated with smoking, caffeine consumption, and unhealthy eating, and inversely associated with healthy eating, vitamin use, exercise, and gestational age at delivery. Cigarette smoking predicted lower birth weight. Clinically-defined birth outcomes were predicted by cigarette smoking and pregnancy-specific stress. CONCLUSION Pregnancy-specific stress contributed directly to preterm delivery and indirectly to low birth weight through its association with smoking. Pregnancy-specific stress may be a more powerful contributor to birth outcomes than general stress.

Conceptualizations, measurement, and effects of prenatal maternal stress on birth outcomes

This article analyzes the conceptual and methodological approaches which have been used to investigate effects of prenatal maternal stress on birth outcomes and highlights the major findings of this research. By viewing the most widely used operational definitions of prenatal stress in a broader theoretical framework, it can be seen that most studies have failed to conceptualize stress reliably. This, in addition to common methodological and design flaws which are described in the article, has produced equivocal findings about the role of stress in adverse birth outcomes such as preterm delivery and low birth weight. Recent studies using more powerful, multidimensional approaches to stress definition and measurement provide more definitive evidence and suggest some precise effects. Implications and strategies for future research are presented.

Explaining Disproportionately High Rates of Adverse Birth Outcomes among African Americans: The Impact of Stress, Racism, and Related Factors in Pregnancy.

Compared with European Americans, African American infants experience disproportionately high rates of low birth weight and preterm delivery and are more than twice as likely to die during their 1st year of life. The authors examine 5 explanations for these differences in rates of adverse birth outcomes: (a) ethnic differences in health behaviors and socioeconomic status; (b) higher levels of stress in African American women; (c) greater susceptibility to stress in African Americans; (d) the impact of racism acting either as a contributor to stress or as a factor that exacerbates stress effects; and (e) ethnic differences in stress-related neuroendocrine, vascular, and immunological processes. The review of literature indicates that each explanation has some merit, although none is sufficient to explain ethnic disparities in adverse birth outcomes. There is a lack of studies examining the impact of such factors jointly and interactively. Recommendations and cautions for future research are offered.

When God Disappoints Difficulty Forgiving God and its Role in Negative Emotion

In light of growing empirical interest in the links between forgiveness, religious belief, and well-being, a study was designed to examine the emotional impact of a specific problem with forgiveness: difficulty forgiving God. Difficulty forgiving God was found to predict anxious and depressed mood within a college student sample (N 5 200), and its contribution was independent of difficulties forgiving the self and others. Two psychological factors emerged as central in explaining the link between difficulty forgiving God and negative emotion: an angry disposition and feelings of alienation from God. Also, among those who currently believed in God, forgiving God for a specific, powerful incident predicted lower levels of anxious and depressed mood. These findings suggest that an unforgiving attitude toward God is a distinct type of problem with forgiveness, one that serves as a potent predictor of negative emotion.

Coping and distress in pregnancy: An investigation of medically high risk women

The association between coping and pregnancy-specific distress was examined in 167 pregnant women at high medical risk. A population-appropriate coping inventory and prenatal distress measure were administered in mid-pregnancy (mean of 24 weeks gestation). Subjects experienced moderately high levels of distress about preterm delivery, physical symptoms, labor and delivery, weight gain, and having an unhealthy baby. They most frequently coped with the demands and challenges of pregnancy through prayer and positive appraisal. Sociodemographic variables including age, income, education, and parity were significantly associated with ways of coping. Coping by avoidance, preparation for motherhood, and substance use were associated with greater distress, whereas coping by positive appraisal was associated with less distress. These effects differed somewhat when levels of global, non-specific distress were controlled. Findings underscore the unique nature of high-risk pregnancy as a stressful life event.

Emotional Distress Following Genetic Testing for Hereditary Breast and Ovarian Cancer: A Meta-Analytic Review

OBJECTIVE Meta-analysis was used to synthesize results of studies on emotional consequences of predictive genetic testing for BRCA1/2 mutations conferring increased risk of breast and ovarian cancer. DESIGN Studies assessing anxiety or cancer-specific distress before and after provision of test results (k = 20) were analyzed using a random-effects model. Moderator variables included country of data collection and personal cancer history of study participants. MAIN OUTCOME MEASURES Standardized mean gain effect sizes were calculated for mutation carriers, noncarriers, and those with inconclusive results over short (0-4 weeks), moderate (5-24 weeks), or long (25-52 weeks) periods of time after testing. RESULTS Distress among carriers increased shortly after receiving results and returned to pretesting levels over time. Distress among noncarriers and those with inconclusive results decreased over time. Some distress patterns differed in studies conducted outside the United States and for individuals with varying cancer histories. CONCLUSION Results underscore the importance of time; changes in distress observed shortly after test-result disclosure frequently differed from the pattern of distress seen subsequently. Although emotional consequences of this testing appear minimal, it remains possible that testing may affect cognitive and behavioral outcomes, which have rarely been examined through meta-analysis. Testing may also affect understudied subgroups differently.

The perils of outperformance: sensitivity about being the target of a threatening upward comparison.

Outperforming others, although privately satisfying, can be a source of interpersonal strain. This article presents the framework of a major form of outperformance-related distress, which we label sensitivity about being the target of a threatening upward comparison (STTUC). To become STTUC, an individual must believe that another person is making an upward comparison against the self and feels threatened by the contrast in status. The outperformer must also experience concern about some facet of the others response, and this concern may be focused on the other, the self, or the relationship. In addition to offering new predictions about outperformance-related distress, the STTUC framework unites many previously disconnected findings on topics such as fear of success, envy, self-presentation, and self-evaluation maintenance.

Psychological Reactions to Infertility

Like many other life stresses, infertility is not a discrete event but an unfolding process. The beginning of the process is frequently marked by the passing of a year attempting to conceive without success, and by entry into medical treatment, although many couples begin to worry and seek treatment sooner. For some, a medical condition necessitates treatment such as the surgical removal of reproductive organs that suddenly impairs fertility. Thus, many events may signify the beginning of the infertility process, a process that often continues over a long period of time as individuals contend with the prospect of being unable to conceive. Indeed, in most cases, it is the possibility rather than the reality of infertility that is at issue, because there is some degree of ambiguity about the outcome. This situation initially involves a threat rather than a loss (Lazarus, 1966; Lazarus & Launier, 1978; Lazarus & Folkman, 1984). As time passes without conception, the situation is gradually transformed into one of loss.