MarySue V. Heilemann

Intimate partner violence, depression, and PTSD among pregnant Latina women.

PURPOSE We undertook a study to describe factors related to depression and posttraumatic stress disorder (PTSD) among pregnant Latinas who were or were not exposed to intimate partner violence. METHODS We interviewed 210 pregnant Latinas attending prenatal clinics located in Los Angeles, California. Latinas who did and did not have histories of intimate partner violence were recruited. We then assessed the women for strengths, adverse social behavioral circumstances, posttraumatic stress disorder (PTSD), and depression. RESULTS Significantly more women exposed to intimate partner violence scored at or above the cutoff point for depression than women who were not (41% vs 18.6%; P<.001). Significantly more women exposed to intimate partner violence scored at or above the cutoff point for PTSD than women who were not (16% vs 7.6%; P <.001). Lack of mastery, which measures feelings of being in control of forces that affect life (odds ratio [OR], 0.72; 95% confidence interval [CI], 0.62–0.84), a history of trauma not associated with intimate partner violence (OR, 1.33; 95% CI, 1.08–1.63), and exposure to intimate partner violence (OR, 2.43; 95% CI, 1.16–5.11) were associated with depression after adjusting for age, language of interview, and site effects. Stress (OR, 1.72; 95% CI, 1.34–2.2) and a history of trauma (OR, 1.45; 95% CI, 1.03–2.04) were independently associated with PTSD, whereas higher income was associated with decreased risk of PTSD (OR, 0.10; 95% CI, 0.02–0.63), after adjusting for age, language of interview, and site effects. CONCLUSIONS Intimate partner violence was significantly associated with depression and PTSD but was associated with depression only after controlling for other factors in the multivariate model. The risk for depression declined with greater mastery but increased with a history of trauma or exposure to intimate partner violence. Stress, a history of trauma not associated with intimate partner violence, and lower income were all independently associated with increased risk for PTSD.

PROTECTIVE STRENGTH FACTORS, RESOURCES, AND RISKS IN RELATION TO DEPRESSIVE SYMPTOMS AMONG CHILDBEARING WOMEN OF MEXICAN DESCENT

As an immigrant population becomes more prominent in an established culture, research strategies for examining intragroup differences are needed to understand their health care risks and strengths. However, acculturation also must be taken into account. Our objective in this secondary analysis was to identify the most useful acculturation parameter for examining depressive symptoms in relation to strengths and resources among women of Mexican descent living in the United States during the vulnerable perinatal period and to examine other intragroup differences among the women by childbearing status (pregnant or postpartum). Our secondary analysis was done with a subsample of 129 women from a larger cross-sectional study of 315 women of Mexican descent who were recruited from three urban community health centers and an associated bilingual school in the United States. Exposure to the United States in childhood, a poor sense of mastery, and dissatisfaction with life were more related to depressive symptom experience than childbearing status or more traditional demographic variables such as age, income, or education.

From "death sentence" to "good cancer": couples' transformation of a prostate cancer diagnosis.

BackgroundWhile little is known about the couple’s process of moving from diagnosis of prostate cancer to treatment, it is acknowledged that cancer—and prostate cancer in particular—affects the couple, not just the patient. This highlighted the need to illuminate this process as a foundation for development of nursing interventions. ObjectivesTo describe the experience of men who are diagnosed with prostate cancer and their wives, from the time of diagnosis through staging to the completion of radical prostatectomy. MethodsA qualitative cross-sectional approach was used to elicit couples’ experiences from diagnosis to the time of the interview including their response to diagnosis, their treatment decision-making process, and how the couple moved from the decision to have surgery through the staging process to the time that the surgery was completed. A total of 20 couples participated. ResultsAnalysis of the data revealed that a number of themes related to the couples’ process of moving from diagnosis to treatment. Initially, the diagnosis of prostate cancer represented a loss of control that led these couples to put themselves through a “crash course” on prostate cancer. The information gathered led these couples to conclude that prostate cancer was “good cancer.” This enabled them to refocus their energies and start their “quest for the best” treatment and surgeon. Once this was accomplished, the couples began to prepare for surgery that culminated in the turning over of complete control to the surgeon and hospital staff at the time of surgery. ConclusionsThe participants discovered they were able to manage the demands presented by the intrusion of a cancer diagnosis and mount a response to what at first threatened to be a “death sentence.” By engaging in the challenge of gathering a volume of facts and a variety of details, they could make informed decisions. Couples were able to regain a sense of control through the engagement in decision-making related to treatment, surgeon, and hospital, and through the transformation of the meaning of the malignant diagnosis to that of a “good cancer.”

Strengths and vulnerabilities of women of Mexican descent in relation to depressive symptoms.

BackgroundThe majority of research related to depression among women of Mexican descent has focused on risk factors and resources without considering intrinsic strength factors that may have a protective function. An additional focus on mastery, resilience, and life satisfaction will expand the context for understanding the mental health of women of Mexican descent. ObjectivesThis study describes the level of depressive symptoms experienced by low-income women of Mexican descent living in an urban community in northern California and compares the level of symptoms by exposure to the United States (US) during childhood. Rather than focus only on negative demographic characteristics (such as lower socioeconomic status) associated with high levels of depressive symptoms, this study also focused on strengths and resources that may minimize or modify depressive symptoms. MethodsQuestionnaires were completed by a cross-sectional convenience sample of 315 women of Mexican descent, aged 21–40 years. Data were analyzed using descriptive statistics and multiple regression. ResultsWomen who spent all of their childhood years in Mexico before coming to the US had a lower level of depressive symptoms (p < .05) and more satisfaction with life than women who were exposed to the US in childhood (p = .001). While income, adequacy of financial resources, partner status, alcohol use, and childhood exposure to the US accounted for 13% of the variance in depressive symptoms, intrinsic strength factors such as mastery, life satisfaction, and resilience accounted for an additional 31% of the variance (p < .001). DiscussionAlthough intrinsic strength factors have rarely been included in research related to depression in women of Mexican descent, they were more directly related to lack of depressive symptoms than traditional demographic risk factors.

Intimate Partner Violence and Maternal Depression During the Perinatal Period: A Longitudinal Investigation of Latinas:

This study assessed the course of perinatal depression among 210 Latinas who were and were not affected by intimate partner violence (IPV) and identified associated psychosocial factors. Peak depression prevalence occurred prenatally among 45.7% of IPV-exposed and 24.6% of non-IPV-exposed Latinas. At each assessment, depression was significantly higher for IPV-exposed compared to non-IPV-exposed mothers. Mastery and social support were associated with lower depression, whereas history of IPV, perceived stress, and avoidant coping behaviors were associated with higher depression. Findings support recommendations for routine depression and IPV screening of Latinas in perinatal clinical settings.

Acculturation and perinatal health outcomes among rural women of Mexican descent

Research has shown that health outcomes for urban women of Mexican descent are related to acculturation. The purpose of this research was to compare perinatal outcomes of 773 women of Mexican descent who gave birth in three rural northern California hospitals, in relation to acculturation measured three different ways: by place of birth, by language spoken, and by the two factors combined as an Acculturation Index (AI). The prenatal and birth records of 773 Mexico-born or U.S.-born women of Mexican descent were reviewed. Results showed that language spoken was a less useful indicator of acculturation associated with perinatal complications than place of birth or the AI. The categorization of acculturation with the AI enhanced understanding of more specific groups of rural women and their particular health outcomes.

Factors associated with sleep disturbance in women of Mexican descent

AIMS The aims were to identify the most useful parameters of acculturation in relation to self-reported sleep disturbance and describe risk factors for sleep disturbance in women of Mexican descent. BACKGROUND Little is known about acculturation as a factor for poor sleep in the context of other personal factors such as income or sense of resilience or mastery for Latinas in the United States. DESIGN This study was a secondary analysis of cross sectional survey data. METHODS Personal factors were incorporated into a modification of the conceptual framework of impaired sleep to guide our secondary analysis of self-reported sleep disturbance. Data were collected from a convenience sample of 312 women of Mexican descent of childbearing age (21-40 years) located in an urban California community were collected and previously analysed in relation to depressive symptoms and post-traumatic stress disorder. The general sleep disturbance scale (in English and Spanish) was used to assess sleep disturbance. Data was collected in 1998 from September through December. RESULTS Early socialization to the United States during childhood was the most useful acculturation parameter for understanding self-reported sleep disturbance in this sample. In a multivariate regression analysis, three factors (higher acculturation, lower income and higher depressive symptoms) were statistically significant in accounting for 40% of the variance in sleep disturbance. CONCLUSION When low income Latinas of Mexican descent report sleep problems, clinicians should probe for environmental sleep factors associated with low income, such as noise, over-crowding and exposure to trauma and violence, and refer the woman to psychotherapy and counselling rather than merely prescribing a sleep medication.

Strength Factors Among Women of Mexican Descent

Whereas few studies with Latina samples include strength factors (resilience, mastery, life satisfaction, and perceived energy level) as variables, even fewer include strength factors together with acculturation in the same study. As part of a larger study, the purpose of this analysis is to describe and examine the relationships between strength factors, risk factors such as acculturation and substance use, resource factors including financial adequacy and education, and the health and illness factor of perceived health status among a convenience sample of 315 lowincome women of Mexican descent, ages 21 to 40. Cross-sectional survey data were collected and analyzed. Results show intragroup differences related to the well-being of women of Mexican descent living with low incomes in urban settings.

Trauma and posttraumatic stress disorder symptoms among low income women of Mexican descent in the United States.

Survey methods were used to collect cross-sectional data on PTSD symptoms in the context of resources, risks, and strengths of a convenience sample of 315 low income women of Mexican descent. Women were compared by generation in the US, including Mexico-born women who immigrated as adults (≥age 18), as teens (age 12–17), or as children (≤age 12), and US-born women whose parents and/or grandparents were Mexico-born. Results showed that US-born women reported significantly more types of trauma than women who immigrated as adults or teens, and more PTSD symptoms than women who immigrated as adults. Also, one to three times as many women who were exposed to the United States before age 18 reported sexual trauma exposure compared with women who immigrated as adults. In a three-step multiple regression analysis, lack of intrinsic strength factors (13%) accounted for more variance in PTSD symptoms than resources (6%) or risks (10%; p < 0.001).

How condom use, number of receptive anal intercourse partners and history of external genital warts predict risk for external anal warts.

Few analytic opportunities have allowed us to evaluate the role that specific sexual acts and male latex condoms play in the acquisition of external anal warts (EAW) using longitudinal data. The acquisition of EAWs occurs from epithelial contact with other HPV-infected surfaces, and hence is dependent upon sexual behaviour. Our objectives were to classify the relative importance of condom use, receptive anal intercourse (RAI) and prior history of EGWs on acquisition of EAWs. The observational Multicenter AIDS Cohort Study followed 2925 men over nine semiannual study visits for behavioural and physical examinations with laboratory testing. The main outcome measure was the occurrence of examiner-diagnosed EAWs in a homosexual population. EAWs were diagnosed among 10% of men studied across 22,157 visits reviewed for this study. Men with history of EGWs were more likely than those previously unaffected to have developed EAWs (cOR = 2.4 (2.0, 2.9)), as were men who reported multiple anoreceptive intercourse partners (e.g., compared with men who reported no RAI partners, men with 1, 2–5, ≥6 RAI partners had crude risk ratios 1.0 (0.8, 1.3), 1.6 (1.2, 2.1), 3.9 (2.7, 5.8), respectively). These relations persisted after other demographic and sexual risk factors were controlled for in the analyses. Consistent condom usage showed no protective effect for EAWs in our crude or adjusted analyses. Patient education messages should be tailored to reflect our uncertainty about the protective nature of condoms for the development of anal warts, but to continue to assert the protective effects of a limited lifetime number of sexual partners and the heightened risk for wart recurrence once infected.