Browsing by Author "Simmons, Leigh Ann"

Problem and Purpose: Arab adolescents are considered a particularly vulnerable population to depression. The substantial lack of mental health services and the stigma associated with mental illness on the one hand; and poverty, unemployment, and lack of reasonable hopes for a decent future in the context of corruption of regimes and perceived social injustice on the other, call for establishing committed and effective policies to tackle depression and its associated stigma among Arab adolescents at risk for or diagnosed with depression. However, there is a substantial lack of research that can inform the current profile of adolescent depression in the Arab region. We conducted two systematic reviews on Adolescent depression and mental illness stigma in the Arab region and found that there is currently no solid evidence available on the prevalence of depression among Arab adolescents and its potential associations with depression stigma and help-seeking beliefs and intentions. This gap in the literature makes it difficult to design, implement, and disseminate effective interventions to improve the prevention, diagnosis, and treatment of adolescent depression. Therefore, the overarching purpose of this study was to estimate a prevalence of depression symptoms among Arab adolescents, and determine relationships with depression stigma, depression etiologic beliefs, and likelihood to seek help for depression.

Methods: This study was conducted in Jordan, a Middle Eastern Arab country. A pilot study with a sample of 88 Jordanian adolescents was first conducted to assess the feasibility of collaboration and coordination with the proposed recruitment sites; assess proposed recruitment strategies; confirm the utility of the translated self-reported measures and examining their psychometric properties; and obtaining preliminary findings. Based on the lessons learned from this pilot study, we designed a nationally representative, school-based survey. Data were collected from 2,349 adolescents aged 12-17, using a packet of self-administered questionnaires that included measures on sociodemographic and health history, depression severity, depression stigma, depression etiologic beliefs, and likelihood to seek help for depression. A passive consenting procedure was used to obtain parental consents, while returning the survey questionnaires was considered a tacit assent for the adolescents. The study obtained the needed Institutional Review Board approvals from both Duke University and the University of Jordan. Participants represented all three regions in the country, with 34% from the northern (suburban) region, 43% from the central (urban) region, and 23% from the southern (rural) region.

Results: The majority of the adolescents were females (59%) and 15-17 years old (67%). Almost 14% reported having at least one chronic health problem, 15% reported having a mental health problem, 25% reported having academic difficulties, 8% reported that they had received a psychiatric diagnosis, and 22% reported that they had sought psychological help at some point in the past. The mean total depression score was 16.3 (SD=11.2, 95% CI=15.8 to 16.7), with 34% of the sample reporting moderate to severe depression. Depression was significantly higher among respondents who were female, ages 14-15 years, and living in families with monthly incomes less than JD300 (USD 423); and who reported having a chronic health problem, mental health problem, learning difficulty, a psychiatric diagnosis and/or seeking previous psychological help. Adolescents endorsed multiple etiological factors for depression. The most often reported factors were stressful events in one’s life (72%), social factors (65%), and one’s weak will (56%). On the other hand, the least reported factors were genetic or inherited problems (24%), chemical imbalance (30%), and punishment for wrong doings (35%). Adolescents were more likely to seek help for depression from a family member (57%), followed by a counselor (46%), psychiatrist (43%), religious leader (39%), and general practitioner (28%). In addition, 53% of the adolescents reported they will be willing to take medications for depression, while 50% expressed willingness to seek a therapy, and 25% of the adolescents reported they will not be willing to seek any professional help for depression. Almost half of the adolescents agreed on items that reflect stigmatizing attitudes towards depression. Adolescents reported higher rates of perceived depression stigma than personal depression stigma. Depression stigma was not significantly associated with the adolescent’s severity of depression, but with adolescent’s sex, age, region of residence, parents’ education, and history of mental health problem.

Conclusions: This study revealed alarming results in terms of the current high prevalence and social determinants of adolescent depression in Jordan. The study also shed light on how depression stigma manifests among Jordanian adolescents and how such stigma relates to their beliefs about depression and likelihood to seek professional psychological help. We discuss how healthcare providers, researchers, and educators can focus attention on developing effective and culturally appropriate screening, prevention, and intervention approaches using evidence-based guidelines to promote Jordanian adolescent mental health, particularly for depression. This approach will be important not only for Jordan, but for all of the Arab region, given that many of the Arab countries have been witnessing years of mass violence, armed conflicts, and war. The study also provides important recommendations on when, how, and why to utilize school settings for anti-depression stigma interventions. Overall, findings from this study provide a solid, culturally competent foundation from which to conduct future research to tackle depression and its associated stigma, and reflect the unique characteristics of Arab culture.

Black females experience disparate rates of hypertension and earlier decline in cardiovascular health (CVH) than other females in the U.S. To date, much of research has focused on health behaviors, but more research is needed to understand how adversities early in life and in the social environment may contribute to premature decline in CVH among young Black women. Studies show that early life stress in the form of adverse childhood experiences (ACEs), like family dysfunction and child maltreatment, are reported in higher numbers by women, and historically minoritized populations, and experiencing four or more adversities in childhood may independently double the odds of CVD. In addition, social adversities like racial discrimination, housing insecurity, and social isolation in young adulthood may also contribute to inequities in CVH. Many health behaviors, such as cigarette use and dietary intake, are used as a stress coping measure, further highlighting the importance of understanding the stressors and adversities that are commonly experienced by young adult Black women. However, much of research has focused on CVD as a disease of middle and older adults, but less is known about the CVH of young adult Black women.

Young adulthood is an important developmental period when women are busy launching careers, and establishing social roles such as intimate partnerships and parenting, and forming new health behavior patterns to accommodate these changes. Per the developmental origins of health and disease hypothesis, stress, adversity, and health behaviors in young adulthood not only affect the individual, but also that of future generations. Improving the CVH of young adult Black women is essential to reducing and eliminating health inequities, and requires an appreciation of the heterogeneity among Black women, and the use of innovative approaches to identify subgroups of women who are doing well.

This dissertation includes a systematic review of the published literature on ACEs and blood pressure among women in the United States, and a secondary analysis of The National Longitudinal Study of Adolescent to Adult Health (Add Health) to examine how adverse childhood and social experiences relate to the cardiovascular health (CVH) health of young adult Black women. The systematic search of three databases identified 1,640 articles, and ten met all established inclusion criteria. In our review ACEs were positively associated with blood pressure in six of the ten articles reviewed. The inconsistency in results may be related to self-report vs objective assessment of blood pressure. Racial and ethnic diversity was limited, with half of the articles consisting of samples that were majority White. Future research should incorporate diverse, population representative samples, with consideration for sex-or-race specific stressors, such as racism, and its potential impact on blood pressure and CVH.

Data presented in the remaining three chapters of the dissertation study are an observational, cross-sectional analysis of data from Black females, ages 24-32 who participated in the Add Health study at wave four. The first data based chapter examines if social adversities and sleep characteristics are indicators of increased risk of hypertension among young adult Black women. Of the five social adversities (social isolation, discrimination, high perceived stress, low subjective social status, child abuse) and four sleep characteristics examined (delayed sleep onset, poor sleep continuity, short sleep, long sleep, and snoring), only discrimination and poor sleep continuity were positively associated with higher odds of hypertension, adjusting for age and BMI. Since social adversities often co-exist, the next chapter examined patterns or latent classes of social adversity. Three latent classes were identified: (1) low stress, (2) high violence, and (3) high stress. In analyses adjusted for age, income, education and depression, the subclasses of social adversity were related to diet, and physical activity, but were not related to overall ideal CVH. Whereas chapters 3 and 4 both focused on stressors in young adulthood as predictors of CVH, chapter 5 added an additional life course perspective by considering the impact of adverse childhood experiences on CVH. This chapter also sought to advance the literature by examining the maternal relationship and religion and spirituality in adolescence and young adulthood as potential protective factors that may buffer the stress of childhood adversity. The results in chapter five suggest that a strong religious and spiritual connection in adolescence or young adulthood may promote CVH among young Black women, but it’s impact on CVH is diminished after taking into account other factors such as severity of ACEs, socioeconomic status, and mental health. The second proposed protective factor, maternal relationship, did not have a significant direct influence on CVH.

This study may be the first to explore CVH in a within-group, population-representative sample of young adult Black women in the United States. The present findings suggest there are critical differences in how social contributors influence health, and in fact, many of the social constructs measured had little influence on health. This suggests that the factors measured may not accurately reflect the underlying construct for different subpopulations. Moreover, there may be other social factors that are not well captured in existing scientific research that likely are impacting the health of Black women and need to be explored, to advance the American Heart Association’s goal of equitable improvements in CVH.