The impact of neighborhood quality, perceived stress, and social support on depressive symptoms during pregnancy in African American women

Abstract

Living in a lower-quality neighborhood is associated with higher levels of depressive symptoms in the general population as well as among pregnant and postpartum women. However, little is known of the important pathways by which this association occurs. We proposed a model in which perceived stress and social support mediated the effects of neighborhood quality on depressive symptoms during pregnancy (measured by the 20-item Center for Epidemiologic Studies-Depression, CES-D, scale) in a sample of 1383 African American women from the Detroit metropolitan area interviewed during their delivery hospitalization. Using structural equation modeling (SEM), we built a latent variable of neighborhood quality using 4 measures (neighborhood disorder, neighborhood safety/danger, walking environment, overall rating). We then tested two SEM mediation models. We found that lower neighborhood quality was associated with higher prevalence of depressive symptoms during pregnancy (standardized total effect=.16, p=.011). We found that perceived stress partially mediated the neighborhood quality association with depressive symptoms. Although the association of social support with depressive symptoms was negligible, social support mediated associations of neighborhood quality with perceived stress [standardized path coefficient=.38 (.02), p=.009]. Our results point to the need for public health, health care, as well as non-health related interventions (e.g. crime prevention programs) to decrease overall exposure to stressors, as well as stress levels of women living in poor quality neighborhoods. Interventions that increase the levels of social support of women during pregnancy are also needed for their potential to decrease stress and ultimately improve mental health at this important time in the life course.

The Relationship Between Household Socioeconomic Status and Mental Health in Women During Pregnancy: A Path Analysis

“…This finding was consistent with the results of many other studies like Giurgescu et al and Morikawa et al, they found that mothers who enjoyed adequate social support during pregnancy experienced have a healthier pregnancy compared to those who did not have (42,43). Family and husband support during pregnancy may effect on maternal and fetal health through unmeasured mediators such as improved maternal health behaviors (refraining from smoking and drinking, etc.…”

The impact of stress on fluctuations in relational humility as couples transition to parenthood

“…For example, researchers might adapt a self-directed humility workbook intervention developed for college students (Lavelock et al, 2014) for use with couples becoming new parents. Based on the results of our study, such an intervention might help couples cope with the stressors of transitioning into parenthood-including role changes, financial burden, and lower perceived social support (Giurgescu et al, 2015;Perren et al, 2005;Twenge et al, 2003)-in other-oriented rather than self-focused ways.…”

“…Both partners must adjust to having less time, energy, and cognitive capacity to remain responsive to each other's needs (Crnic & Low, 2002;Kluwer, 2010;Twenge, Campbell, & Foster, 2003). Typical stressors include (a) role changes when many women become the primary caregiver and many men carry more financial burden; (b) decreases in perceived freedom because parents responsibly focus on the infant; (c) decreases in sexual intimacy; (d) financial stress and medical conditions that impact the mother's health; and (e) lack of social support (Giurgescu et al, 2015;Perren, von Wyl, Bürgin, Simoni, & von Klitzing, 2005;Twenge et al, 2003).…”

The Frequency of PTSD and Subthreshold PTSD among African–American Women with Depressive Symptoms in a Disadvantaged Urban Neighborhood: Pilot Study

“…Disadvantaged urban neighborhood . African-American women Characteristics of a disadvantaged neighborhood, including poverty, unemployment, and violence, may lead to increased chronic stress [1,2], susceptibility to depression [3], and PTSD [4]. The rate of depression (36%) is at least twice as high [5,6] and the rate of post-traumatic stress disorder (PTSD) is higher (~23 vs. 10%) among women in disadvantaged neighborhoods than women from the general population [7,8].…”