Defining subgroups of low socioeconomic status women at risk for depressive symptoms: the importance of perceived stress and cumulative risks.

BACKGROUND: Most disadvantaged women are exposed to risk factors for depression, but not all necessarily have an identical risk for this mental health problem. A better prediction of which low socioeconomic status (SES) women are most at risk for depressive symptoms can help target preventive interventions at high-risk subgroups most in need of support. AIMS: Exploring which demographic, socioeconomic and psychological risk factors are associated with self-reported depressive symptoms in a sample of low-SES women and whether the number of risk factors might expose them to an accumulated risk. METHODS: Between April 2005 and November 2007, 519 disadvantaged women from urban neighbourhoods in Maastricht, a southern Dutch city, participated in a cross-sectional survey on stress and depressive symptoms. RESULTS: Lower education levels, no current employment and lower net monthly family incomes were socioeconomic risk factors associated with higher scores for depressive symptoms. The psychological risk factor 'perceived stress' had the highest explained variance and was most strongly associated with depressive symptoms. Women exposed to multiple risk factors across domains had a cumulated risk for depressive symptomatology. CONCLUSION: Low-SES women who seem most eligible for targeted preventive action are those with cumulative risks. Depression prevention strategies for this population may benefit from focusing on perceived stress since this is an important modifiable risk factor.

A randomized controlled trial of combined exercise and psycho-education for low-SES women: short- and long-term outcomes in the reduction of stress and depressive symptoms.

Exercise may have both a preventive and a therapeutic impact on mental health problems. The Exercise without Worries intervention aims to reduce stress and depressive symptoms in low-SES women by means of a group-based program combining physical exercise and psycho-education. Between September 2005 and May 2008, 161 Dutch low-SES women with elevated stress or depressive symptom levels were randomly assigned to the combined exercise/psycho-education intervention (EP), exercise only (E) or a waiting list control condition (WLC). The E condition provided low to moderate intensity stretching, strength, flexibility, and body focused training as well as relaxation, while the EP program integrated the exercise with cognitive-behavioral techniques. Depressive symptoms (CES-D) and perceived stress (PSS) were measured before and immediately after the intervention and at 2, 6 and 12 month follow-up. Multilevel linear mixed-effects models revealed no differential patterns in reduction of CES-D or PSS scores between the EP, E and WLC groups on the short (post-test and 2 month follow-up) or long term (6 and 12 months follow-up). Depressive symptom outcomes were moderated by initial depressive symptom scores: women from the EP and E groups with fewer initial symptoms benefited from participation on the short term. Further, women in the EP and E groups with the lowest educational level reported more stress reduction at post-test than women with higher educational levels. In the overall target population of low-SES women, no indications were found that the Exercise without Worries course reduced depressive symptom and stress levels on the short or long term. The findings do suggest, however, that exercise alone or in combination with psycho-education may be a viable prevention option for certain groups of disadvantaged women. Especially those low-SES women with less severe initial problems or those with low educational attainment should be targeted for future depression prevention practice.

Psychosocial preventive interventions to reduce depressive symptoms in low-SES women at risk: a meta-analysis.

BACKGROUND: Women who have low socioeconomic status (SES) or live in disadvantaged circumstances are a vulnerable group at risk for depression. Little is known about the efficacy of preventive interventions to reduce depressive symptoms in low-SES women. The aim of this study is to provide an overview of controlled outcome studies and to investigate the overall efficacy and moderators of interventions targeted at reducing depressive symptoms in this population. METHODS: A systematic review and meta-analysis were conducted for 14 studies (N = 1396). The effect size of the studies was computed for outcomes assessing changes in depressive symptom levels using the standardized mean difference effect size. Study, target population, and intervention descriptors expected to influence effect size were analyzed using univariate subgroup and metaregression techniques with mixed-effects statistical models. RESULTS: The estimated overall effect size of 0.31 was significant; study sample characteristics, intervention characteristics and the research design of the studies did not moderate intervention effects. LIMITATIONS: Limitations to this study are the relatively limited number of well controlled studies that could be included in the analyses. CONCLUSIONS: A number of promising programs have been developed specifically for low-SES women, a population at high risk for developing major depression. On average these programs were found to reduce the level of depressive symptoms, with more than half of the studies showing medium to large effect sizes. This indicates that considerable mental health benefits can be gained among disadvantaged women.

Exploring recruitment, willingness to participate, and retention of low-SES women in stress and depression prevention.

BACKGROUND: Recruitment, willingness to participate, and retention in interventions are indispensable for successful prevention. This study investigated the effectiveness of different strategies for recruiting and retaining low-SES women in depression prevention, and explored which sociodemographic characteristics and risk status factors within this specific target group are associated with successful recruitment and retention. METHODS: The process of recruitment, willingness to participate, and retention was structurally mapped and explored. Differences between women who dropped out and those who adhered to the subsequent stages of the recruitment and retention process were investigated. The potential of several referral strategies was also studied, with specific attention paid to the use of GP databases. RESULTS: As part of the recruitment process, 12.1% of the target population completed a telephone screening. The most successful referral strategy was the use of patient databases from GPs working in disadvantaged neighborhoods. Older age and more severe complaints were particularly associated with greater willingness to participate and with retention. CONCLUSIONS: Low-SES women can be recruited and retained in public health interventions through tailored strategies. The integration of mental health screening within primary care might help to embed preventive interventions in low-SES communities.