Determinants of maternal antenatal state-anxiety in mid-pregnancy: Role of maternal feelings about the pregnancy.

BACKGROUND: The current state of research into antenatal anxiety is lacking in a comprehensive understanding of determinants. This study aims to expand knowledge in this area, with the main objective being to determine potential determinants of maternal antenatal state-anxiety. METHODS: Data used for this cross-sectional study were obtained from the Prenatal Health Project: a population cohort study of 2357 women in London, Ontario. 1992 women in their second trimester met inclusion criteria for this study. The primary hypothesis was that "feelings about the pregnancy" would be a determinant of antenatal state-anxiety after controlling for other potential covariates. The abbreviated version of the Spielberger State and Trait Anxiety Inventory (STAI) was used to measure state-anxiety. Univariate analyses and multiple linear regression were performed to identify variables predictive of state-anxiety. RESULTS: Stress, feeling unsure/unhappy about the pregnancy and having low self-esteem, low mastery and low social support from one's partner and family were statistically significant determinants of state-anxiety during the second trimester. In addition, anxiety was found to be inversely related to gestational age. LIMITATIONS: The two main limitations of the study were the use of a self-report screening tool (STAI) as the measure of anxious symptoms rather than a clinical diagnosis, and possible recall bias of feelings about the pregnancy. CONCLUSIONS: We concluded that how a woman feels about her pregnancy was a determinant of state-anxiety. This study contributes knowledge aiming to help women improve their mental health during pregnancy by identifying important determinants of state-anxiety.

Association between trajectories of maternal depression and subsequent psychological functioning in youth with and without chronic physical illness.

OBJECTIVES: The aim of this study was to determine if the presence of youth chronic illness moderates the association between trajectories of maternal depressive symptoms and psychological functioning in youths. METHODS: Data came from the National Longitudinal Survey of Children and Youth (N = 11,813). Using the 12-item version of the Center for Epidemiological Studies Depression Scale (CES-D), symptom trajectories were estimated by latent class growth modeling over 3 measurement occasions (when their children were 10-11, 12-13, and 14-15 years). The moderating effect of youth chronic illness on the association between maternal depression and youth psychological functioning at 16-19 years was tested using multiple regression. Three measures of psychological functioning were assessed: anger regulation (Bar-On Emotional Quotient Inventory), self-concept (Self-Determination Questionnaire), and depressive symptoms (CES-D). RESULTS: Four trajectories (low, decreasing, increasing, high) of maternal depression were identified. The association of maternal depressive symptoms on youth psychological functioning was modified by chronic illness; less favorable trajectories of maternal depression had a more pronounced detrimental association on youths with chronic illness compared to controls. CONCLUSIONS: Youths with chronic illness are particularly vulnerable to the negative psychological exposure of maternal depressive symptoms during the transition to adulthood. Family-centered transition of care programs in the medical setting may be beneficial in reducing the association between symptoms of maternal depression and youth psychological functioning.

Family Structure and Children's Socioeconomic Attainment: A Canadian Sample.

With the proliferation of different family forms in many western countries over the last few decades, research investigating the influence of family structure on children's socioeconomic status attainment has expanded dramatically, especially in the United States. The purpose of this study was to estimate the relative influence of family structure, maternal resources, and family mental health on predicting socioeconomic attainment in young adulthood. Data for this study were derived from a case-comparison, three-wave panel study of single-parent, and two-parent families living in London, Ontario, with interviews conducted in 1993 (wave 1), 1994 (wave 2), and between 2005 and 2008 (wave 3). There were virtually no differences in status attainment by family structure. Unexpectedly, however, we found that children raised in temporally stable single-parent families, and those whose mothers transitioned from a single-parent family to a two-parent family had higher socioeconomic status occupations for their longest job held than did children raised in temporally stable two-parent families. Maternal education was positively related to the likelihood that children would graduate from college/university. For those concerned with social policy, this implies that greater attention ought to be paid to addressing disparities in education and family income than to concerns with the kinds of families in which children grow up.

Have infant gross motor abilities changed in 20 years? A re-evaluation of the Alberta Infant Motor Scale normative values.

AIM: To compare the original normative data of the Alberta Infant Motor Scale (AIMS) (n=2202) collected 20 years ago with a contemporary sample of Canadian infants. METHOD: This was a cross-sectional cohort study of 650 Canadian infants (338 males, 312 females; mean age 30.9 wks [SD 15.5], range 2 wks-18 mo) assessed once on the AIMS. Assessments were stratified by age, and infants proportionally represented the ethnic diversity of Canada. Logistic regression was used to place AIMS items on an age scale representing the age at which 50% of the infants passed an item on the contemporary data set and the original data set. Forty-three items met the criterion for stable regression results in both data sets. RESULTS: The correlation coefficient between the age locations of items on the original and contemporary data sets was 0.99. The mean age difference between item locations was 0.7 weeks. Age values from the original data set when converted to the contemporary scale differed by less than 1 week. INTERPRETATION: The sequence and age at emergence of AIMS items has remained similar over 20 years and current normative values remain valid. Concern that the 'back to sleep' campaign has influenced the age at emergence of gross motor abilities is not supported.

Socioeconomic status and cumulative disadvantage processes across the life course: implications for health outcomes.

Given the complexity surrounding various interactions among health determinants and the challenge of being able to adequately describe the dynamic processes through which health determinants have their effects, the purpose of this paper is to provide a conceptual overview demonstrating the effects of socioeconomic status and cumulative disadvantage on producing health disparities across the life course. The idea underlying cumulative disadvantage is that socioeconomic-based health inequalities will increase across the life course, mostly because of differential exposure to risk factors and access to protective resources. The advantage of life course sociology is its consideration of early life experiences, and the social and historical context of their occurrences, as important contingencies in producing these systematic socioeconomic differences in health gradients.

Prevalence and trajectories of depressive symptoms in mothers of children with newly diagnosed epilepsy.

PURPOSE: To examine the prevalence, trajectories, and predictors of depressive symptoms (DS) in mothers of children with new-onset epilepsy. METHODS: A sample of 339 mothers was analyzed from the health-related quality of life in children with epilepsy study assessed four times during the first 24 months after diagnosis. Mothers' DS were measured using the Center for Epidemiological Studies Depression Scale. Trajectories of DS were investigated using group-based trajectory modeling, and maternal, child, and family factors were compared across groups using analysis of variance (ANOVA) and chi square tests. Multinomial logistic regression identified predictors of DS trajectories. KEY FINDINGS: A total of 258 mothers completed the study. Prevalence of depression ranged from 30-38% across four times within the first 24 months after their child's diagnosis. Four trajectories of DS were observed: low stable (59%), borderline (25%), moderate increasing (9%), and high decreasing (7%). Using the low stable group as the reference group, the borderline group was younger, had worse family functioning, and fewer family resources; the moderate increasing group was younger, had children with cognitive problems, worse family functioning, and more family demands; and the high decreasing group had less education and children with lower quality of life. SIGNIFICANCE: Risk for clinical depression is common among mothers of children with new-onset epilepsy. These mothers are not homogenous, but consist of groups with different trajectories and predictors of DS. Child's cognitive problems was the strongest predictor identified; epilepsy severity did not predict DS trajectory. Health care professionals should consider routinely assessing maternal depression during clinic visits for pediatric epilepsy.

The impact of maternal depressive symptoms on health-related quality of life in children with epilepsy: a prospective study of family environment as mediators and moderators.

PURPOSE: To examine the impact of maternal depressive symptoms (DS) on health-related quality of life (HRQL) in children with new-onset epilepsy and to identify family factors that moderate and mediate this relationship during the first 24 months after epilepsy diagnosis. METHODS: A sample of 339 mother-child dyads recruited from pediatric neurologists across Canada in the Health-related Quality of Life in Children with Epilepsy Study. Mothers' and neurologists' reports were collected at four times during the 24-month follow-up. Mothers' DS were measured using the Center for Epidemiological Studies Depression Scale (CES-D) and children's HRQL using the Quality of Life in Childhood Epilepsy (QOLCE). Data were modeled using individual growth curve modeling. KEY FINDINGS: Maternal DS were observed to have a negative impact on QOLCE scores at 24 months (ß = -0.47, p < 0.0001) and the rate of change in QOLCE scores during follow-up (ß = -0.04, p = 0.0250). This relationship was moderated by family resources (ß = 0.25, p = 0.0243), and the magnitude of moderation varied over time (ß = 0.09, p = 0.0212). Family functioning and demands partially mediated the impact of maternal DS on child HRQL (ß = -0.07, p = 0.0007; ß = -0.12, p = 0.0006). SIGNIFICANCE: Maternal DS negatively impact child HRQL in new-onset epilepsy during the first 24 months after diagnosis. This relationship is moderated by family resources and mediated by family functioning and demands. By adopting family centered approaches, health care professionals may be able to intervene at the maternal or family level to promote more positive outcomes in children.

Incorporating children's lives into a life course perspective on stress and mental health.

Emerging themes in demography, developmental medicine, and psychiatry suggest that a comprehensive understanding of mental health across the life course requires that we incorporate the lives of children into our research. If we can learn more about the ways in which the stress process unfolds for children, we will gain important insights into the factors that influence initial set points of trajectories of mental health over the life course. This will simultaneously extend the scope of the stress process paradigm and elaborate the life course perspective on mental health. Incorporating children's lives into the sociology of mental health will also extend the intellectual influence of the discipline on sociomedical and biomedical research on mental illness. I contend that sociology's greatest promise in understanding trajectories of mental health across the life course lies in a systematic analysis of the social and social-psychological conditions of children, the stressful experiences that arise out of these conditions, and the processes that mediate and moderate the stress process in childhood. In this regard, there are three major issues that sociologists could begin to address: (1) the identification of structural and institutional factors that pattern children's exposure to stress; (2) the construction of a stress universe for children; and (3) the identification of key elements of the life course perspective that may set or alter trajectories of mental health in childhood and adolescence.

Higher zinc intake buffers the impact of stress on depressive symptoms in pregnancy.

Prenatal depression is a public health concern. This study's objectives are to model associations involving dietary zinc intake, psychosocial stress, and sociodemographic factors as they interrelate in the development of depressive symptoms in a cohort of pregnant women from London, Ontario (Prenatal Health Project). We hypothesized that (1) psychosocial stress is intermediate in the causal pathway between sociodemographic factors and zinc intake and that (2) zinc intake serves as a partial mediator between sociodemographic factors, psychosocial stress, and the development of depressive symptoms. Depressive symptoms were measured using the Center for Epidemiologic Studies Depression Scale (CES-D). Psychosocial stress was measured by validated scales and summarized into a composite score. Zinc intake was quantified from food frequency questionnaire and nutrient supplement data. Regression methods were used. The Baron and Kenny method was applied to test mediation hypotheses. Stress-zinc interaction terms were added to the regression model predicting CES-D score to test a possible moderating role for zinc. Our analyses showed that social disadvantage, higher stress, and lower zinc intake were associated with higher CES-D score. Every 1-point increase in stress score was associated with a 1-point increase in CES-D score. Being in the lowest quintile of zinc intake was associated with a 1-point increase in CES-D score; although not clinically meaningful, the association was robust. Evidence was not in favor of the mediation hypotheses, but showed instead that zinc intake moderated the association between stress and depressive symptoms; being in the highest zinc quintile appeared to buffer the impact of stress.

Do depressive symptoms affect mothers' reports of child outcomes in children with new-onset epilepsy?

PURPOSE: To test whether elevated levels of depressive symptoms affect reports of child outcomes in a sample of mothers of children with new-onset epilepsy. METHODS: A sample of 339 mothers from the Health-related Quality of Life in Children with Epilepsy Study was used in the analysis. Mothers' depressive symptoms were measured using the Center for Epidemiological Studies Depression Scale (CES-D). To examine whether maternal mental health status moderated mothers' reports of each core domain of health-related quality of life (functional status, psychological functioning, social functioning, and disease state/symptoms), a series of multiple regression analyses was conducted. Interactions, depicted as product terms between CES-D scores and neurologist-reported measures, were used to determine the presence of depression distortion. RESULTS: Interactions in the regression models were not significant with one exception in the functional status domain of mothers' assessments of their child's energy/fatigue and its impact on daily activities [beta = 0.24 (0.06, 0.41)]. Mothers with high levels of depressive symptoms were shown to have reported higher scores for their child's energy/fatigue and its impact on daily activities. CONCLUSIONS: Results from this study do not suggest that the mental health status of mothers affects reporting on the domains of health-related quality of life for their children with new-onset epilepsy.

Genotype-environment interaction and sociology: contributions and complexities.

Genotype-environment interaction (G x E) refers to situations in which genetic effects connected to a phenotype are dependent upon variability in the environment, or when genes modify an organism's sensitivity to particular environmental features. Using a typology suggested in the G x E literature, we provide an overview of recent papers that show how social context can trigger a genetic vulnerability, compensate for a genetic vulnerability, control behaviors for which a genetic vulnerability exists, and improve adaptation via proximal causes. We argue that to improve their understanding of social structure, sociologists can take advantage of research in behavior genetics by assessing the impact of within-group variance of various health outcomes and complex human behaviors that are explainable by genotype, environment and their interaction. Insights from life course sociology can aid in ensuring that the dynamic nature of the environment in G x E has been accounted for. Identification of an appropriate entry point for sociologists interested in G x E research could begin with the choice of an environmental feature of interest, a genetic factor of interest, and/or behavior of interest. Optimizing measurement in order to capture the complexity of G x E is critical. Examining the interaction between poorly measured environmental factors and well measured genetic variables will overestimate the effects of genetic variables while underestimating the effect of environmental influences, thereby distorting the interaction between genotype and environment. Although the expense of collecting environmental data is very high, reliable and precise measurement of an environmental pathogen enhances a study's statistical power.

Depressive symptoms during pregnancy in relation to fish consumption and intake of n-3 polyunsaturated fatty acids.

An inverse association between depression and the n-3 fatty acids, eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), primarily obtained from fish consumption, is observed in both observational and experimental research and is biologically plausible. Study objectives were to examine whether prenatal depressive symptoms were associated with lower intakes of fish or EPA+DHA. Pregnant women (n = 2394) completed a telephone interview between 10 and 22 weeks' gestation in London, Ontario, 2002-05. Depressive symptoms were measured using the Center for Epidemiologic Studies - Depression Scale (CES-D). Intakes of fish and EPA+DHA were measured using a validated food-frequency questionnaire. Sequential multiple regression was used to examine associations of depressive symptoms with intake of fish and EPA+DHA, respectively, while controlling for sociodemographic, health and lifestyle variables. The mean CES-D score was 9.9 (SD 8.0). Intake of EPA+DHA was dichotomised at the median value of 85 mg/day. Fish consumption and intake of EPA+DHA were not associated with prenatal depressive symptoms after adjustment for confounders; however, depressive symptoms were significantly higher for lower intakes of EPA+DHA among current smokers and women of single/separated/divorced marital status. The adjusted difference in CES-D scores between intake categories of EPA+DHA was -2.4 [95% CI -4.2, -0.4] for current smokers and -2.8 [95% CI -5.2, -0.4] for women of single marital status. Although pregnant women may be at risk for low concentrations of EPA and DHA, an association between low intakes of EPA+DHA and increased depressive symptoms was only observed among current smokers and women of single marital status.

Family structure, stress, and psychological distress: a demonstration of the impact of differential exposure.

In this article, we evaluate the relative power of differential exposure and differential vulnerability to stressors to account for variations in psychological distress between single and married mothers. The data for this assessment are derived from a longitudinal survey of 518 single mothers and 502 married mothers living in London, Ontario, Canada. Both cross-sectional and longitudinal analyses clearly reveal that the higher levels of psychological distress experienced by single mothers compared to married mothers are almost entirely related to their greater exposure to stress and strain rather than to any group differences in vulnerability to stressful experiences. Across a number of different dimensions of social stressors, single mothers are consistently more exposed to these stressors than married mothers are. Moreover, this differential exposure persists over time. In contrast, there is no evidence that single mothers are more vulnerable or reactive to stressors than are married mothers. We discuss these findings in terms of their implications for the sociology of mental health and for primary prevention.

Fish consumption among pregnant women in London, Ontario: associations with socio-demographic and health and lifestyle factors.

BACKGROUND: Intake of fish and omega-3 fatty acids is inversely related to adverse health outcomes; however, these relationships may be confounded by socio-economic status and health behaviours. This study's purpose was to describe the socio-demographic, health and lifestyle correlates of fish consumption among pregnant women. METHODS: Pregnant women (n=2394) completed a telephone interview between 10-22 weeks' gestation (London, Ontario, 2002-5) containing questions on socio-demographic, health and lifestyle variables; dietary intake was measured using a 106-item validated food-frequency questionnaire. Unadjusted and adjusted risk ratios were obtained using a modified Poisson regression model. RESULTS: Infrequent fish consumption, <1/week, was reported by 32% of women. After adjusting for age and education, infrequent fish consumption was associated with education

Family structure, gender, and health in the context of the life course.

We estimate the effects of single parenthood on parental health and determine whether such effects are similar for all single parents or whether there are variations by gender among young, middle-aged, and older adults. The results of our analyses of the Canadian National Population Health Survey (NPHS) reveal that single parenthood is associated with elevated psychological distress and alcohol consumption among women, especially among those who are in younger age groups. Although we find no such differences among men, there is some indication of elevated distress among younger fathers. We discuss the implications of these findings for thinking about single parenthood at various life stages.

Status variations in stress exposure: implications for the interpretation of research on race, socioeconomic status, and gender.

Life events checklists have been the predominant method for estimating variations in stress exposure. It is unknown, however, whether such inventories are equally meaningful for estimating differences in exposure between men and women, African Americans and whites, and those in lower and higher socioeconomic categories. In this paper, we employ a wider range of measures of stress--recent life events, chronic stressors, lifetime major events, and discrimination stress--to examine the extent to which these dimensions collectively yield conclusions about status variations in stress exposure that are similar to or different from estimates based only on a life events checklist. Our analyses of data collected from 899 young men and women of African American and non-Hispanic white ancestry suggest that status differences in exposure to stress vary considerably by the measure of stress that is employed. Although women are more exposed to recent life events than men, males report more major events and discrimination stress than females. Our results also reveal that life event measures tend to substantially under-estimate differences between African Americans and non-Hispanic whites in exposure to stress. A similar pattern also holds for socioeconomic status. When stress is more comprehensively estimated, level of exposure profoundly affects ethnic differences in depressive symptomatology, accounting for almost half of the difference by socioeconomic status but contributing little to the explanation of the gender difference in distress. The implications of these findings for the debate over the relative mental health significance of exposure and vulnerability to stress are discussed.