Prevalence and Correlates of Depressive Symptoms in Pregnancy

African American Women

Nancy Jallo, PhD, FNP-BC, WHNP-BCVirginia Commonwealth University

R. Jeanne Ruiz, PhD, WHNP-BC, Ohio State College of Nursing

Acknowledgements

Research supported by grant number 5-F31-NR008977 and 5-K30-AT000060 from the NINR and NCCAM at the NIH. Podium presentation supported by NIH/NINR-P30-NR011403.

Its contents are solely the responsibility of the author and do not necessarily represent the official views of NINR or NCCAM.

Overview of the Problem

• Prenatal depression is associated with adverse obstetrical, fetal and neonatal outcomes

• Disruption of the hypothalamic-pituitary-adrenal axis (HPA) is a proposed pathway linking depression to negative outcomes

• Pregnant African American women maybe at increase risk for depressive symptoms

• Limited evidence on the prevalence and correlates of depressive symptoms early in pregnancy in African American women

Biologic Pathways:

Neuroendocrine (CRH)

Biological andBehavioral

Factors:Demographics

Health BehaviorsRelationships

Medical ConditionsIndividual

CharacteristicsStress Perceptions

Coping

Threats toMaternal Wellbeing:

Depressive Symptoms

Stress, Anxiety,

Birth OutcomesMaternal-Infant

RelationshipChild Well-being

PNI Framework

Purpose

• The purpose of this study was to examine the prevalence and correlates of depressive symptoms in African American women at 14-17 weeks gestation

Methods

• Design– Secondary analysis– Baseline measure of cohort participating in 12

week intervention study• Setting

– Academic obstetrical service– Community obstetrical practice

Methods (cont’d)

• Participants– Inclusion– AA pregnant women between 18-40 yo – 14-17 weeks gestation– Ability to read, write and understand English– Verbalize a source of social support

– Exclusion– History of thyroid, adrenal, cardiac, or chronic renal disease– Dissociative disorders, borderline personalities or psychotic

psychology– Current use of corticosteroids– Multiple pregnancy– Cervical cerclage– Uterine or cervical abnormality– Current use of guided imagery

Methods (cont’d)Self Report Measures

• Demographic Questionnaire• Health History Questionnaire• Center for Epidemiologic Studies – Depression

(CES-D)• Perceived Stress Scale (PSS)• Numeric Rating Scale of Stress (NRSS)• State Anxiety Scale (STAI)

Methods (cont’d)Biological Measures

• CRH– Venipuncture, blood centrifuged and plasma

separated – Kept in -80 degree freezer until ready for assay– CRH was extracted using methanol technique to

separate the binding protein from the peptide, then run with a Radioimmunoassay

– Interassay coefficient of variation was <15%

Procedure

• Office staff invited potential participants to discuss study with researcher

• 14-17 weeks– Informed Consent– Demographic and Health History– PSS, STAI, CES-D, NRSS – Blood drawn for plasma CRH

Data analysis

• Statistical Package for the Social Sciences (SPSS) 14

• Level of significance 0.05• Assumptions tested• Descriptive – Demographics, Self Report Mean

Scores• One sample t-test • Pearson correlations• Multiple Regression

ResultsSample Characteristics

(n=59)

Demographic Mean (SD)Age 24.5 (4.95)

Education 12.33 (1.96)

Gravida 2.52 (1.69)

EGA 15.55 (1.32)

Marital Status Never Married42 (71%)

Married/Partner14 (24%)

Separated3 (5%)

Employment Full time 23 (39%)

Part time11 (19%)

Unemployed25 (42%)

ResultsMeasure Mean (SD) Compared to

Standard/ScoresCorrelation with CEDS-D

CES-D 20.22 (10.69) 66% > 16(t(58)=3.14, p <.01)

PSS 26.81 (8.24) r = .793 (p < 0.01)

NRSS 4.86 (2.65) r = .392 (p < 0.01)

STAI 40.81 (12.05) r = .734 (p < 0.01)

CRH 1.17 (1.74) r = .164 (p = .264)

ResultsPredictors of Depressive Symptoms

• A significant regression equation was found(F(2,56) = 42.644, p <.001) with an R2 of .604Both PSS (stress) and STAI (anxiety) scores were predictors of depressive symptoms

43210-1-2-3

Standardized Predicted Values from Regression of Stress and Anxiety

60

50

40

30

20

10

0

CE

S-D

Sco

res

Depressive Scores Related to Stress and Anxiety

Results

Conclusions

• In pregnant African American women at 14-17 weeks gestation:– High prevalence of depressive symptoms – PSS and NRRS (stress) and STAI (anxiety)

scores were correlated with CES-D (depressive symptoms)

– PSS and STAI scores predicted CES-D scores (depressive symptoms)

Discussion/Implications• Limitations• High prevalence of depressive symptoms and

strong correlations with psychosocial distress (stress and anxiety) in pregnant African American women early in the second trimester– Concept of maternal wellness/distress– Importance of early screening– Selection of screening tool

• Future Research– Interventions for modifiable variables– Psychological and Physiologic pathways