1. Prevalence and Correlates of Depressive Symptoms in Pregnancy African American Women Nancy Jallo, PhD, FNP-BC, WHNP-BC Virginia Commonwealth University R. Jeanne Ruiz, PhD, WHNP-BC, Ohio State College of Nursing

2. Acknowledgements Research supported by grant number 5-F31- NR008977 and 5-K30-AT000060 from the NINR and NCCAM at the NIH. Podium presentation supported by NIH/NINR-P30- NR011403. Its contents are solely the responsibility of the author and do not necessarily represent the official views of NINR or NCCAM.

3. Overview of the Problem Prenatal depression is associated with adverse obstetrical, fetal and neonatal outcomes Disruption of the hypothalamic-pituitary-adrenal axis (HPA) is a proposed pathway linking depression to negative outcomes Pregnant African American women maybe at increase risk for depressive symptoms Limited evidence on the prevalence and correlates of depressive symptoms early in pregnancy in African American women

4. Biologic Pathways: Neuroendocrine (CRH) Biological and Behavioral Factors: Demographics Health Behaviors Relationships Medical Conditions Individual Characteristics Stress Perceptions Coping Threats to Maternal Wellbeing: Depressive Symptoms Stress, Anxiety, Birth Outcomes Maternal-Infant Relationship Child Well-being PNI Framework

5. Purpose The purpose of this study was to examine the prevalence and correlates of depressive symptoms in African American women at 14-17 weeks gestation

6. Methods Design – Secondary analysis – Baseline measure of cohort participating in 12 week intervention study Setting – Academic obstetrical service – Community obstetrical practice

7. Methods (cont’d) Participants – Inclusion – AA pregnant women between 18-40 yo – 14-17 weeks gestation – Ability to read, write and understand English – Verbalize a source of social support – Exclusion – History of thyroid, adrenal, cardiac, or chronic renal disease – Dissociative disorders, borderline personalities or psychotic psychology – Current use of corticosteroids – Multiple pregnancy – Cervical cerclage – Uterine or cervical abnormality – Current use of guided imagery

8. Methods (cont’d) Self Report Measures Demographic Questionnaire Health History Questionnaire Center for Epidemiologic Studies – Depression (CES-D) Perceived Stress Scale (PSS) Numeric Rating Scale of Stress (NRSS) State Anxiety Scale (STAI)

9. Methods (cont’d) Biological Measures CRH – Venipuncture, blood centrifuged and plasma separated – Kept in -80 degree freezer until ready for assay – CRH was extracted using methanol technique to separate the binding protein from the peptide, then run with a Radioimmunoassay – Interassay coefficient of variation was <15%

10. Procedure Office staff invited potential participants to discuss study with researcher 14-17 weeks – Informed Consent – Demographic and Health History – PSS, STAI, CES-D, NRSS – Blood drawn for plasma CRH

11. Data analysis Statistical Package for the Social Sciences (SPSS) 14 Level of significance 0.05 Assumptions tested Descriptive – Demographics, Self Report Mean Scores One sample t-test Pearson correlations Multiple Regression

12. Results Sample Characteristics (n=59) DemographicMean (SD) Age24.5 (4.95) Education12.33 (1.96) Gravida2.52 (1.69) EGA15.55 (1.32) Marital StatusNever Married 42 (71%) Married/Partner 14 (24%) Separated 3 (5%) EmploymentFull time 23 (39%) Part time 11 (19%) Unemployed 25 (42%)

13. Results

14. Results Predictors of Depressive Symptoms A significant regression equation was found (F(2,56) = 42.644, p <.001) with an R 2 of.604 Both PSS (stress) and STAI (anxiety) scores were predictors of depressive symptoms

15. 43210-2-3 Standardized Predicted Values from Regression of Stress and Anxiety 60 50 40 30 20 10 0 CES-D Scores Depressive Scores Related to Stress and Anxiety Results

16. Conclusions In pregnant African American women at 14-17 weeks gestation: – High prevalence of depressive symptoms – PSS and NRRS (stress) and STAI (anxiety) scores were correlated with CES-D (depressive symptoms) – PSS and STAI scores predicted CES-D scores (depressive symptoms)

17. Discussion/Implications Limitations High prevalence of depressive symptoms and strong correlations with psychosocial distress (stress and anxiety) in pregnant African American women early in the second trimester – Concept of maternal wellness/distress – Importance of early screening – Selection of screening tool Future Research – Interventions for modifiable variables – Psychological and Physiologic pathways