Social Determinants Among Pregnant Clients With Perinatal Depression, Anxiety, Or Serious Mental Illness.

To characterize co-occurring social determinants of health for clients experiencing perinatal anxiety and depression (perinatal mood and anxiety disorders) or serious mental illness (SMI) in a diverse population receiving prenatal care in a safety-net health system, we conducted a latent class analysis, using data from a social determinants screener in pregnancy for the health system's clients during 2017-20. The sample included clients with positive screens for depression or anxiety or SMI diagnoses. Prenatal clients with a positive screen for perinatal mood and anxiety disorders or SMI comprised 13-30 percent of classes, characterized by more than two co-occurring social determinants (for example, co-occurring socioeconomic and interpersonal factors). The study findings highlight the salience of social determinants among prenatal patients experiencing perinatal mood and anxiety disorder and SMI and suggest the necessity of consistent screening for both social determinants and perinatal mental health. Policies to address social determinants within and beyond health care settings are critical.

Recruitment and Retention of Low-SES Ethnic Minority Couples in Intervention Research at the Transition to Parenthood.

Low-SES couples have limited resources to manage the chronic and acute stressors with which they are disproportionately faced. Although these couples are at greater risk for negative individual and relationship outcomes, evaluations of the impact of couple relationship education (CRE) in low-SES couples have been plagued by methodological problems, most notably challenges associated with recruitment and retention. We review the literature on challenges couples face associated with low-SES, as well as on recruitment, retention, and CRE in low-SES, ethnic minority populations. We illustrate some of these challenges in a case study of CRE for low-SES couples transitioning to parenthood. In this pilot study, 21 couples were recruited from a community health clinic and randomized to either an experimental treatment condition (EXP; N = 11) or a treatment-as-usual control condition (TAU; N = 10). This study sought to mitigate documented challenges with recruitment and retention: We leveraged community partnerships, attempted to build and maintain strong relationships with study participants, provided incentives for assessments as well as intervention meetings, and attempted to reduce potential barriers to enrollment and retention. Nonetheless, we had low rates of recruitment and retention. We integrate these findings and experiences with our review of previous work in this area. We make recommendations for future CRE research and practice that have potential implications for public policy in this area.

Motivation and perceived competence for healthy eating and exercise among overweight/obese adolescents in comparison to normal weight adolescents.

BACKGROUND: The current literature on determinants of behavior change in weight management lacks sufficient studies on type of motivation among children/adolescents, on perceived competence, and in relation to healthy eating. This study aimed to investigate type of motivation and levels of perceived competence for healthy diet and exercise, as well as general self efficacy among adolescents. We hypothesized that overweight/obese adolescents would demonstrate lower autonomous motivation and perceived competence regarding diet and exercise, and lower self-efficacy in general, and that the scores would be influenced by socioeconomic factors. METHODS: Normal weight (n = 40, body mass index < 85% for age and gender) and overweight or obese adolescents (n = 60, body mass index ≥ 85% for age and gender) aged 13-18 years were recruited from pediatric ambulatory clinics. Information was collected about demographics, socioeconomic factors, and lifestyle behaviors. The study subjects completed a survey including the Treatment Self-Regulation Questionnaire (TSRQ) and the Perceived Competence Scale (PCS) for healthy eating and exercise, and the General Self-Efficacy Scale (GSES). Composite scores for the three scales were compared between the two groups using the using the two-sample t-test (for normal data) or the Mann-Whitney U test (for non-parametric data). Relationships between the composite scores and patient characteristics were determined using Pearson or Spearman's correlations. RESULTS: The average age of the total cohort was 15.9 ± 1.9 years. 54% were female, and 82% identified as Latino/Hispanic. In comparison to normal weight subjects, overweight/obese adolescents exhibited higher scores for controlled motivation (mean ± standard deviation 28.3 ± 9.3 vs 18.1 ± 8.1) and higher perceived competence [median and 25-75% interquartile range 22.5 (19.0-26.0) vs 20.0 (15.5-25.0)] in relation to eating a healthy diet. These differences persisted after adjustment for age, sex, paternal education, and family income. CONCLUSIONS: Overweight/obese adolescents did not lack autonomous motivation but demonstrated higher controlled motivation and perceived competence for healthy eating in comparison to normal weight adolescents, independent of socioeconomic factors. In the clinical practice of weight management, providers should carefully assess adolescents for type of motivation and perceived competence, while accounting for potential barriers to behavior change.

Association of depression and anxiety in underserved women with and without urinary incontinence.

OBJECTIVES: Depression and anxiety are found in increasing rates in those with lower urinary tract disease. The manner in which this association further impacts underserved women has not been fully evaluated. METHODS: For this study, 429 patients were included from general gynecology and female pelvic medicine and reconstructive surgery clinics between the ages 18 and 80 years at a Los Angeles County teaching hospital. Patients who met the study criteria completed the following questionnaires: the Beck Depression Inventory-II (BDI-II), Beck Anxiety Inventory, Pelvic Floor Distress Inventory Short From, Pelvic Floor Impact Questionnaire Short Form, and the SF-12 Health Survey. Data analyses included descriptive statistics, tests of mean difference, correlations, and regression models to compare with categories of incontinent and continent women. RESULTS: Of the 429 patients, 71.8% were Hispanic with a mean age of 46.6 years (range, 18-80 years) and median parity of 2.83 (0-17). Among the patients with incontinence, 34.1% reported mild, moderate, or severe depression on the BDI-II compared with 21% patients without incontinence (P = 0.003). In addition, 20.4% of the incontinent group had severe depression (BDI-II, >20), whereas only 8.2% in the continent group had severe depression (P = 0.001). The higher Urinary Distress Inventory scores did correlate with the worsening Patient Health Questionnaire (r = 0.263; P = 0.0001), BDI-II (r = 0.209; P = 0.002), and SF-12 Health Survey mental scores (r = -0.140; P = 0.04). CONCLUSIONS: Current findings show that approximately one third of the women reporting incontinence in our sample had depression. Underserved patients seeking medical care for incontinence in publically funded hospitals may have depression and anxiety at rates higher than those reported in the general population.