Examining Life-Course Socioeconomic Position, Contextualized Stress, and Depression among Well-Educated African-American Pregnant Women

Owens, Tracy Curry; Jackson, Fleda Mask

doi:10.1016/j.whi.2015.05.001

Cited by 19 publications

(17 citation statements)

References 61 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Lower income stood out as a factor that is independently associated with more depression and more unmet need. Poverty corresponds to experiences of material deprivation, unstable and unsafe housing, food insecurity, more exposure to violence, and less access to resources that support people through stress (Raphael , United Way of Greater Toronto , Curry Owens & Mask Jackson ). Canada's universal healthcare system is designed to eliminate financial barriers to receiving services (for permanent residents).…”

Section: Discussionmentioning

confidence: 99%

Depression and discrimination in the lives of women, transgender and gender liminal people in Ontario, Canada

Williams

Curling

Steele

et al. 2017

Health Soc Care Community

View full text Add to dashboard Cite

This article uses an intersectionality lens to explore how experiences of race, gender, sexuality, class and their intersections are associated with depression and unmet need for mental healthcare in a population of 704 women and transgender/gender liminal people from Ontario, Canada. A survey collecting demographic information, information about mental health and use of mental healthcare services, and data for the Everyday Discrimination Scale and the PHQ-9 Questionnaire for Depression was completed by 704 people via Internet or pen-and-paper between June 2011 and June 2012. Bivariate and regression analyses were conducted to assess group differences in depression and discrimination experiences, and predictors of depression and unmet need for mental healthcare services. Analyses revealed that race, gender, class and sexuality all corresponded to significant differences in exposure to discrimination, experiences of depression and unmet needs for mental healthcare. Use of interaction terms to model intersecting identities and exclusion contributed to explained variance in both outcome variables. Everyday discrimination was the strongest predictor of both depression and unmet need for mental healthcare. The results suggest lower income and intersections of race with other marginalised identities are associated with more depression and unmet need for mental healthcare; however, discrimination is the factor that contributes the most to those vulnerabilities. Future research can build on intersectionality theory by foregrounding the role of structural inequities and discrimination in promoting poor mental health and barriers to healthcare.

show abstract

Section: Discussionmentioning

confidence: 99%

Depression and discrimination in the lives of women, transgender and gender liminal people in Ontario, Canada

Williams

Curling

Steele

et al. 2017

Health Soc Care Community

View full text Add to dashboard Cite

show abstract

“…Although Black women report more stress (291)(292)(293), this has not consistently explained PTB disparities (294)(295)(296), possibly due to inadequate measurement (297,298), particularly a tendency to focus exclusively on stress during pregnancy. The physiologic "wear-and-tear" caused by chronic stress can compromise women's reproductive health well before they become pregnant (299).…”

Section: Stressmentioning

confidence: 99%

Explaining the Black-White Disparity in Preterm Birth: A Consensus Statement From a Multi-Disciplinary Scientific Work Group Convened by the March of Dimes

Braveman

Dominguez

Burke

et al. 2021

Front. Reprod. Health

Self Cite

106

130

View full text Add to dashboard Cite

In 2017–2019, the March of Dimes convened a workgroup with biomedical, clinical, and epidemiologic expertise to review knowledge of the causes of the persistent Black-White disparity in preterm birth (PTB). Multiple databases were searched to identify hypothesized causes examined in peer-reviewed literature, 33 hypothesized causes were reviewed for whether they plausibly affect PTB and either occur more/less frequently and/or have a larger/smaller effect size among Black women vs. White women. While definitive proof is lacking for most potential causes, most are biologically plausible. No single downstream or midstream factor explains the disparity or its social patterning, however, many likely play limited roles, e.g., while genetic factors likely contribute to PTB, they explain at most a small fraction of the disparity. Research links most hypothesized midstream causes, including socioeconomic factors and stress, with the disparity through their influence on the hypothesized downstream factors. Socioeconomic factors alone cannot explain the disparity's social patterning. Chronic stress could affect PTB through neuroendocrine and immune mechanisms leading to inflammation and immune dysfunction, stress could alter a woman's microbiota, immune response to infection, chronic disease risks, and behaviors, and trigger epigenetic changes influencing PTB risk. As an upstream factor, racism in multiple forms has repeatedly been linked with the plausible midstream/downstream factors, including socioeconomic disadvantage, stress, and toxic exposures. Racism is the only factor identified that directly or indirectly could explain the racial disparities in the plausible midstream/downstream causes and the observed social patterning. Historical and contemporary systemic racism can explain the racial disparities in socioeconomic opportunities that differentially expose African Americans to lifelong financial stress and associated health-harming conditions. Segregation places Black women in stressful surroundings and exposes them to environmental hazards. Race-based discriminatory treatment is a pervasive stressor for Black women of all socioeconomic levels, considering both incidents and the constant vigilance needed to prepare oneself for potential incidents. Racism is a highly plausible, major upstream contributor to the Black-White disparity in PTB through multiple pathways and biological mechanisms. While much is unknown, existing knowledge and core values (equity, justice) support addressing racism in efforts to eliminate the racial disparity in PTB.

show abstract

“…Understanding these relationships is important and, similar to our scale, partner relationships were found to contribute substantially to the women’s self-identified stress 14,24,33 . The JHP has been correlated with depression among well-educated pregnant African American women, regardless of life-course socioeconomic status as well 13 . This scale has contributed to our understanding of race, gender and health; however, it runs into similar challenges as the Prenatal Psychosocial Stress Profile in item specificity.…”

Section: Discussionmentioning

confidence: 96%

“…Currently, this approach has not been taken in the context of pregnancy stress, that includes a range of experiences including low-income African American women. Mixed methods scale development approaches have been used to understand gendered racism 12,13 and associations with pregnancy health 14 . What is not captured within such scales are structural factors or stressors that may not be a product of overt or explicit discrimination but might be disproportionately represented as a harmful exposure experienced at the intersection of race, class and gender.…”

Section: Introductionmentioning

confidence: 99%

The Development of the Healthy Pregnancy Stress Scale, and Validation in a Sample of Low-Income African American Women

Frazier

Hogue

Yount

2017

Matern Child Health J

View full text Add to dashboard Cite

Objectives The association of stress with pregnancy health is well-known. However, few studies take a mixed methods approach to understand the stressors contributing to a woman's pregnancy-related stress. Among African American women, exposure to stressors during pregnancy likely contributes to disparities in pregnancy health outcomes. This work aimed to understand the types and magnitude of stressors African American women are exposed to during pregnancy. Methods Using a mixed methods research design, we developed and administered the Healthy Pregnancy Stress Scale to measure stressors within the stress environment of African American women living in poverty. Results Exploratory factor analysis with one random split-half sample (N = 85) identified a two-factor model. Factor 1, defined as general pregnancy stressors, had significant loadings for ten items that ranged in magnitude from 0.319 to 0.724. Factor 2, defined as relationship strain, had significant loadings for three items ranging in magnitude from 0.613 to 0.856. Confirmatory factor analysis in the second random split-half sample (N = 88) showed a strong fit for the two factor model with factor loadings similar in magnitude. Standard fit statistics and those that adjust for item non-normality suggested an adequate fit to the data (RMSEA = 0.057, CFI = 0.947, TLI = 0.932; Satorra-Bentler RMSEA = 0.037, CFI = 0.972, TLI = 0.965). Conclusions for Practice Our measurement tool may provide a way to determine differences in pregnancy stress experiences across diverse populations of women. Future research should include a test for construct validity by correlating the scale with other measures that should have a specific directional relationship in diverse populations.

show abstract

Examining Life-Course Socioeconomic Position, Contextualized Stress, and Depression among Well-Educated African-American Pregnant Women

Cited by 19 publications

References 61 publications

Depression and discrimination in the lives of women, transgender and gender liminal people in Ontario, Canada

Depression and discrimination in the lives of women, transgender and gender liminal people in Ontario, Canada

Explaining the Black-White Disparity in Preterm Birth: A Consensus Statement From a Multi-Disciplinary Scientific Work Group Convened by the March of Dimes

The Development of the Healthy Pregnancy Stress Scale, and Validation in a Sample of Low-Income African American Women

Contact Info

Product

Resources

About