McClain Sampson

A Problem-Solving Therapy Intervention for Low-Income, Pregnant Women at Risk for Postpartum Depression

Postpartum Depression (PPD) occurs at higher rates among impoverished mothers than the general population. Depression during pregnancy is one of the strongest predictors of developing PPD. Research indicates that non-pharmacological interventions are effective in reducing depressive symptoms but engaging and retaining low-income mothers remains a challenge. A brief, educational intervention delivered through home visits may be an ideal setting for low-income pregnant mothers at risk for PPD. Problem Solving Therapy (PST) is an effective treatment for depression. However, its effectiveness has not been tested among low-income mothers at risk of postpartum depression. This research tests the feasibility and pretest to posttest outcome of an adaptation of PST among a sample of low-income, expectant mothers. This research used a pre-post pilot study. Fourteen pregnant women at risk for postpartum depression were provided 5 home visits of motivational interviewing introduction for engagement and PST for symptom reduction. The intervention had a 93% retention rate. Analysis revealed statistically significant improvements on measures of depression symptoms after intervention This pilot study demonstrates the feasibility of implementation of a home visiting PPD intervention in a community based agency and provides the grounds for optimism about the effectiveness of a PST intervention for low-income women at risk for postpartum depression.

Latina Immigrants’ Cultural Beliefs About Postpartum Depression:

It is estimated that U.S. Latinas have a higher risk of developing postpartum depression (PPD) than the general population, with even higher risk among immigrant Latinas. We conducted three focus groups with immigrants from Mexico and Central America (19) inquiring about cultural messages regarding PPD. Groups were conducted in Spanish, and thematic analysis was used to uncover themes. Themes are presented within three categories: views of PPD, cultural messages and beliefs that prevent treatment seeking, and suggestions to promote treatment seeking. Community and family-led efforts to decrease stigma and normalize PPD are suggested.

Closing the Gap between Policy and Practice in Screening for Perinatal Depression: A Policy Analysis and Call for Action

Although perinatal depression (PND) is one of the most common maternal morbidities, it is frequently undetected. Screening for early detection and intervention has the potential to prevent depressive symptoms from worsening. In the United States, five states have enacted legislation in relation to screening for PND, but a gap remains between policy and practice in providing continuum of care for mothers who may be suffering from depressive symptoms. From the perspective of policy formation, the reasons for this gap include a discrepancy between policy and practice goals, lack of regulations on capability building among perinatal care providers, and few pathways for establishing collaborations between medical providers and mental health professionals. The authors recommend involving social workers in the process to promote a better continuum of care after screening through comprehensive policy that explicitly states goals to effectively screen women in the perinatal period.

Childbearing in Geographically Isolated Communities: The Smith Island Experience

Objective: The objective of this study is to explore the childbearing beliefs and to describe the perspectives of pregnancy in women living on Smith Island, a geographically isolated community that lacks on-site obstetrical care services. Design: A qualitative exploratory, longitudinal focus group model consisting of two focus groups, conducted 6 years apart, that included 12 female participants was used. The focus group used open-ended questions regarding their childbirth experiences and the impact of geographic isolation and lack of healthcare access impacted them during the childbearing period. During the initial focus group, 60%multiparous and participated in a 70 minute interview. The second focus group contained only multiparous women and lasted 110 minutes. The timing interval represented the interval when another group of women had given birth. The study included 100% of women who were pregnant and subsequently gave birth who were living on the Island during the study period. Data collection and analysis were performed simultaneously and included: audio recordings with verbatim transcription, and subsequent coding using direct quotes from the participants. Findings: The majority of women identified acceptance of pregnancy as a safe, normal biological process and identified strong religious beliefs as the underlining factor for their perceptions. All women identified themselves as Methodist religion and “to be religious”. All of the women also identified anxiety, separation strain, and financial strain as normal components associated with pregnancy and childbearing in this remote island community. Of the women who had never given birth, all of them, and the majority of the multiparous women feared their family members, especially their husbands, would miss the actual birth due to geographic separation and feared being alone in labor and at the time of birth. Conclusions: The strong religious presence provided a foundation of acceptance of normalcy of childbearing. Women perceived their religious beliefs as a source of protection. They viewed childbirth as a rite of passage, but reported spending a great deal of time and financial resources on obtaining prenatal care. Separation strain occurred when the women were forced to be away from family and friends at the end of the pregnancy. Multiparous women with older children expressed a greater degree of stress in being separated from children and having to manage childcare and school issues. All of the women in the study had a fear that their husbands, working watermen, would missthe birth itself and that they would be alone at the time of birth.

Stress, Depression, and Drug Use Among Aging Mexican American Men Living in the Barrio

Residing in Mexican American barrios might place individuals at heightened risk for chronic financial and acute stress, which are associated with adverse mental health outcomes. Stressors could be exacerbated for substance users. This research explores relations between chronic financial stress, acute stress, and depressive symptomatology among aging Mexican American heroin and other drug-using men. A prospective cohort study and field-intensive outreach methodology were used to recruit 227 men for in-depth interviews. Participants were categorized into depressed and nondepressed groups based on symptomatology measured by the Center for Epidemiological Studies Depression Scale. Chronic financial stress (i.e., poverty) and acute stress (i.e., Life Events Questionnaire) associated with depressive symptomatology were tested using logistic regression. Findings suggest scores of depressive symptoms among substance users are highly related to chronic financial stress. Community-level interventions targeting chronic stressors present in the barrio could be especially salient in improving the mental health of Latino drug users.

Depression in the barrio: An analysis of the risk and protective nature of cultural values among Mexican American substance users

ABSTRACT Understanding the effect of cultural values on depression and how social networks influence these relationships may be important in the treatment of substance-using, Mexican American populations. Latino cultural values, familismo, personalismo, fatalismo, and machismo, may be associated with depression among Latinos. The current study identified the association of traditional Latino values on depressive symptomatology among a sample of Mexican American heroin injectors. A cross-sectional research design and field-intensive outreach methodology were utilized to recruit 227 Mexican American men. Participants were categorized into depressed and nondepressed groups. Relations among cultural values and depression were examined using logistic regression. Findings indicate that drug-using men with higher familismo and fatalismo scores are protected against depressive symptomatology. Relations between familismo and depression seem to be moderated by having a drug use network. In addition, findings reveal that age is inversely related to depressive symptomatology. Young Mexican American heroin users who do not ascribe to traditional Latino values may be highly associated with depression and therefore more vulnerable to riskier drug use behaviors. Moreover, drug-using social networks may affect the protective nature of certain cultural values. Further research is needed to identify whether culturally tailored treatments can cultivate these values while simultaneously undermining the effect of substance-using social networks in order to reduce depression symptoms among this group of high-risk substance users.

What Tension Between Fidelity and Cultural Adaptation? A Reaction to Marsiglia and Booth

This paper is a reaction to Marsiglia and Booths’ paper, Cultural Adaptation of Interventions in Real Practice Settings. In their paper, Marsiglia and Booth present the difficulty of implementing and replicating evidence-supported treatments, such as randomized clinical trials, among culturally diverse clients. Practitioners working in communities of diversity may spontaneously, rather than systematically, adapt interventions. Sampson and Torres concur that systematic cultural adaptation is a solution for effective interventions with minorities. Conversely, the authors challenge some key points of Marsiglia and Booth’s paper by outlining ways that systematic adaptation is often unrealistic for practitioners and may result in overlooking important other forms of evidence such as community-defined evidence, program evaluation, intervention research studies, and community expert opinion. Sampson and Torres support the argument that interventions should be culturally adapted and offer strategies for when to adapt in a manner that is both culturally inclusive and realistic for busy practitioners.

Perinatal Depression Treatments for US Latinas: A Review of Research Findings

The Hispanic-heritage population of the United States has grown considerably in the past 2 decades. While the growth in the Hispanic-origin population has been profoundly influenced by spikes in immigration from large countries (e.g., Mexico) and small countries from Central and South America, and the Caribbean, it has also been part of the growth of second and later generation Hispanics.