Which roads lead to depression in Latinas? A network analysis of prenatal depressive symptoms, discrimination, acculturative stress, and low birth weight

Abstract

Although immigrant mothers from some Latinx subgroups initially achieve healthy birth outcomes despite lower socioeconomic status, this advantage deteriorates across generations in the United States. Interpersonal discrimination and acculturative stress may interact with economic hardship to predict an intergenerational cascade of emotional and biological vulnerabilities, particularly perinatal depression. Network analyses may elucidate not only how and which psychosocial experiences relate to depressive symptoms, but which symptom-to-symptom relationships emerge. This study aims to understand (1) how economic, acculturative, and discrimination stressors relate to prenatal depression and low birth weight and(2) how Latinas may respond to and cope with stressors by exploring symptom-symptom and symptom-experience relationships. A sample of 151 pregnant Latinas (predominantly foreign-born and Mexican and Central American descent) completed the EPDS and psychosocial questionnaires (discrimination, acculturation, acculturative stress, economic hardship) during pregnancy (24-32 weeks). Birth weights were recorded from postpartum medical records. We created network models using the Extended Bayesian Information Criterion Graphical Least Absolute Shrinkage and Selection Operator to estimate the relationship between variables. Discrimination exposure connected psychosocial stressors to depressive symptoms, particularly worry, crying, sadness, and self-blame. Discrimination also revealed a connection between acculturation and low birth weight.Furthermore, younger age of migration and greater acculturation levels were correlated to greater discrimination stress and low birth weights. Perinatal research in Latinas must account not only for measures of cultural adaptation but recognize how developmental exposures across the life span, including discrimination, may be associated with adverse health trajectories for a mother and her child.

Acculturation, Acculturative Stress, Experience of Discrimination, and Cesarean Birth in Mexican American Women

“…The positive relationships between depressive symptomatology, acculturation, acculturative stress, and discrimination supported findings of other researchers (Calzada & Sales, 2019; D’Anna-Hernandez et al, 2015; Harris et al, 2022; Incollingo Rodriguez et al, 2022; Rodriguez et al, 2022). Although not all stressors result in depressive symptomatology, they can increase the risk.…”

“…Years in the United States and language spoken likely do not capture the unique elements of acculturation (or exposure to discrimination) that influence outcomes, underscoring the importance of studying acculturation with sensitive, nuanced instruments. These findings align with Berry's framework and existing research highlighting the dynamic nature of acculturation and the importance of including measures of acculturative stress in perinatal acculturation research (Berry, 2003; Harris et al, 2022).…”

“…Although not all stressors result in depressive symptomatology, they can increase the risk. Positive relationships between acculturation and experience of discrimination suggest the more acculturated a woman becomes, the more discrimination she experiences, potentially compounding depressive symptomatology, a conclusion supported by existing research with pregnant Latinas (Harris et al, 2022).…”

“…Acculturation is the process of psychological and cultural adjustment that occurs when different cultural groups make contact (Berry, 2005). Higher levels of acculturation are associated with depression (Rodriguez et al, 2022), preterm birth, and small for gestational age newborns in Hispanic populations (Harris et al, 2022; Ruiz et al, 2021). This well-documented phenomenon is referred to as the Hispanic Health Paradox, wherein Hispanic immigrants who are newly immigrated have better health outcomes than immigrants who have resided in the United States for longer (Calzada & Sales, 2019; Khan et al, 1997; Singh et al, 2018).…”

Depression in pregnant Hispanic women: Risk factors, pregnancy outcomes and plasma cytokines

“…In another study in late pregnancy, there were nearly a third of the Hispanic women with EPDS scores above the cutoff for probable depression, but the birth origins were not provided ( Lara-Cinisomo, D'Anna-Hernandez, Fujimoto and Pedersen, 2019 ). The concerns of particular importance for pregnant women of Hispanic ethnicity include stress related to stigma, discrimination and acculturation factors ( Harris et al, 2022 ; Lara-Cinisomo et al, 2018 ). One consideration is that there may be cultural influences that limit a mother's reporting of mood states in the Hispanic population, in that the culture prioritizes motherhood and family above personal issues ( Callister et al, 2011 ).…”