12-month prevalence of depression among single and married mothers in the 1994 National Population Health Survey.

While a number of studies have documented higher period prevalence rates of depression among single as compared to married mothers, all of the data have been based upon community surveys of mental illness. In Canada, all of the published work comes from Ontario. As a result, we do not know whether these results hold true for other regions of the country. Using a nationally representative sample, we find, consistent with previous work, that single mothers have almost double the 12-month prevalence rates of married mothers (15.4% versus 6.8%). As well, there are no significant differences in rates of depression between single and married mothers by region/province of the country. Our findings are compared with other epidemiologic data on the mental health of single mothers from Ontario.

Single motherhood and mental health: implications for primary prevention.

In this issue (page 639) Dr. Ellen L. Lipman and colleagues show that single motherhood is associated with an increased risk of affective disorder and poverty and with increased rates of mental health services utilization. These findings have important implications for primary prevention interventions that focus on the social determinants of family health. Studies have shown that higher levels of psychological distress among single mothers are more closely related to their exposure to stressors than to their personal vulnerability to stress. Research has also shown that the stresses that affect single-parent families are greater in degree but not in kind than those that affect other families. Therefore, intervention programs that address the needs of all families are preferable to those that target specific types of families. Community-based primary prevention programs can promote the well-being of all families by improving the social and economic conditions in which they live.

Employment transitions and psychological distress: the contrasting experiences of single and married mothers.

This paper presents a longitudinal examination of the effect of employment transitions on the psychological distress of 398 single and 454 married mothers. Our analyses reveal that the effects of employment transitions differ for single and married mothers. Among women who left their jobs during the course of this study, we find a significant increase in distress among single mothers but no change in distress among married mothers. Transitions out of employment among single mothers produce increases in financial strain that result in declines in levels of self-esteem and mastery which, in turn, manifest themselves in higher levels of psychological distress. When we examine the effects of transitions into paid work, there are surprisingly few effects on mothers' levels of distress. For single mothers, taking a job for pay offers no significant reduction in their feelings of distress. Among married mothers, transitions into employment are associated with declines in distress, but these declines are offset by the distressful consequences of increases in caregiving strain. Thus, the effects of employment transitions on distress are a function of the differential impact of changes in stressors and psychosocial resources among single and married mothers as well as variations in the economic context and meanings of employment transitions. Movements into or out of employment do not offer the same opportunities and benefits or engender the same costs for single and married mothers. Our results also highlight the different policy implications that emerge from a consideration of longitudinal as opposed to cross-sectional analyses of these issues.

Asian immigrants and the stress process: a study of Koreans in Canada.

The stress process paradigm is one of the most widely held perspectives in the sociology of mental health. While this model has been applied to a large number of research problems, relatively little work has examined whether the paradigm can assist in understanding the link between socially induced stressors and their consequences for the mental health of immigrants. In this paper, we employ a stress process formulation to examine the interplay among stressors, psychological and social resources, and psychological distress among a large sample of Korean immigrants living in Toronto, Canada. Data from a longitudinal study of over 600 respondents indicate that the stress process paradigm provides a useful perspective for understanding how chronic stressors associated with the immigration experience manifest themselves in psychological distress. Our results suggest that social and psychological resources have important deterrent effects on the experience of stressors and their subsequent distressful consequences. Ethnic social support and mastery are especially important factors in this process.

Admission to a neonatal intensive care unit as a predictor of long-term health: a 12-year follow-up.

Long-term physical, emotional, and social health of neonatal intensive care unit (NICU) graduates was assessed. Twelve-year follow-up interviews were conducted with 253 (86.3%) mothers from a cohort interviewed after their child's birth. One hundred and sixteen children had been admitted to the NICU and 137 to the normal neonatal nursery (NNN) at a tertiary care hospital (1978 to 1980). NICU boys have more chronic physical health problems and have been hospitalized more often than NNN boys. A larger proportion of NICU boys have a physical impairment. NICU girls have lower social competence, social support, and self-esteem than NNN girls, and the impact of NICU admission on these outcomes was significantly greater for girls than boys. Long-term follow-ups should not be limited to very low birth weight infants. NICU admission could be a simple flag for primary care providers to identify children at risk for problems in adolescence, especially psychosocial problems among girls. Physical and emotional health should continue to be monitored into adolescence for all NICU graduates.

Psychiatric disorders of children "in care": methodology and demographic correlates.

This paper examines psychiatric symptoms and disorders in children in the care of a Children's Aid Society. Youth, caretaker and teacher scores on the Standardized Clinical Information System questionnaire were correlated with demographic and maltreatment data gathered from the files of children from a Children's Aid Society. Mean externalizing and internalizing scores for the study group were significantly elevated above the norm on the youth, caretaker and teacher reports; externalizing more so than internalizing. Forty-one percent to 63% of the children studied scored in the pathological range for one or more disorders. Conduct disorder was the most common disorder (30% to 50%). Within the study sample, temporary wards and children with a history of having been abused had more elevated scores. The authors conclude that children in foster care have significant psychiatric morbidity reflective of the extreme adversity and maltreatment they have experienced.

Pain and functional limitations in individuals with rheumatoid arthritis.

The focus of this investigation was to determine if health status variables such as pain and functional limitations are correlated with an individual's occupational profile (work, activities of daily living and leisure), and psychological adjustment (depression, anxiety and dissatisfaction with life). This study reports our findings for 143 individuals with rheumatoid arthritis (RA). It would appear from the results of this study that functional limitations have an even greater impact on individuals with RA than pain. This findings and its implications are discussed.

Assessing psychopathology in Korean immigrants: some preliminary results on the SCL-90.

The goal of this study was to respond to a pressing need for translated versions of existing measurement scales that can reliably and validly rate degree of psychopathology among various groups of Asian immigrants. Specifically, the study investigated the cross-cultural utility of the Symptom Checklist-90 (SCL-90) by examining scores of community and patient samples of Korean immigrants and comparing them with norms for Americans and for Koreans living in Korea. Several analyses were also performed to establish the cross-cultural utility of the SCL-90. First, the reliability of the Korean version of SCL-90 was compatible with that of the original scale. Second, the scores of patient samples were unequivocally escalated compared with the scores of community samples within each population (Koreans, Korean immigrants and Americans), providing a partial confirmation of the concurrent validity of the SCL-90. Third, the cross-cultural validity of the scale was assessed by examining the scores of the patient samples. As expected, both symptom profiles and symptom levels were virtually invariant in the three patient samples. However, results of the study were clear in demonstrating that the SCL-90 scores of the community sample of Korean immigrants were substantially higher than the community norms of both North American and Korean samples.

Gender differences in symptoms of depression among adolescents.

In this paper, we examine sources of gender differences in depressive symptoms among adolescents. Using data collected from a self-administered survey of 306 high school students, we examine differences in the impact of life events, psychosocial resources, and parent-child relationships on levels of psychological distress. Our results confirm a substantial gender difference in level of psychological distress. Moreover, analyses indicate that this gender difference may be due largely to higher levels of self-esteem among males and a tendency for adolescents to perceive their fathers to be overprotective. There is, however, also evidence that other psychosocial resources and parent-child relationships are implicated in this gender difference. We also present analyses to support our contention that parent-child relationships have important effects on the development of psychosocial resources of adolescents that, in turn, influence levels of depressive symptoms.

Innovations in the measurement of life stress: crisis theory and the significance of event resolution.

Further progress in understanding the significance of stress for psychological well-being requires improved strategies for controlling both inter- and intra-event variability across subjects studied. This paper reports on an innovation in stress measurement suggested by a proposition drawn from crisis theory that recognizes life events as representing opportunities as well as hazards. The crucial contingency is hypothesized to be the outcome of the event with respect to the extent of its resolution in emotional and practical terms. This paper examines the possibility that life events that have been resolved successfully may not contribute to individual stress. Data was gathered from community samples of physically limited individuals and of non-limited comparison subjects. Results from separate analyses of these data generally support this hypothesis.

Gender and depression: assessing exposure and vulnerability to life events in a chronically strained population.

It has been suggested that higher levels of distress among women may be partially a function of their nurturant roles. Role-related differences in exposure and/or responsiveness to events occurring to network members are hypothesized to represent a "cost of caring" for women that translates into elevated levels of depressive symptoms. This paper examines the significance for depressive symptoms of gender differences in exposure and vulnerability to eventful stress among a sample of physically disabled subjects. This sample provides an opportunity to more fully assess the relevance of employment for understanding gender differences in depression. Our results indicate that men and women are equally exposed and equally vulnerable to life events occurring to themselves. However, we found women to be both more exposed and more vulnerable to events occurring to others. When labor force participation is taken into account, dramatic gender differences are revealed in the apparent significance of employment for exposure and vulnerability to various kinds of stressful events. The implications of these findings for public health interventions are discussed.

The discharged psychiatric patient: a review of social, social-psychological, and psychiatric correlates of outcome.

The authors review research over the past decade on the social, social-psychological, and psychiatric correlates of community adaptation among discharged psychiatric patients. A review of 33 studies suggests that little theoretical or methodological progress has been made in identifying the factors that are conductive to the adjustment of discharged patients on their return to the community. To stimulate subsequent efforts in this area, the authors suggest applying new approaches, such as the stress process perspective that has been used to study mental health in the general population.

Screening for problem parenting: preliminary evidence on a promising instrument.

This paper reports on efforts aimed toward the development of more effective procedures for identifying mothers who are at elevated risk for problems in parenting. We present data from two independent samples of known maladaptors and corresponding comparison mothers and report on our attempts to cross-validate a promising screening instrument composed of items that index social support and parenting attitudes. The resultant 20-item scale correctly identified over 90% of maladaptive and comparison mothers. When this scale was cross-validated on a second independent sample of maladaptors and comparison mothers, it was again almost 90% accurate. Issues concerning the field application of this promising instrument are discussed and its possible limitations are considered.