Avoidance as an obstacle to preventing depression among urban women at high risk for violent trauma

Michael Silverstein, Caroline Kistin, Megan Bair-Merritt, Shannon Wiltsey-Stirman, Emily Feinberg, Yaminette Diaz-Linhart, Jenna Sandler, Ning Chen, Howard Cabral

Research output: Contribution to journalArticlepeer-review

1 Scopus citations


The impact of depression interventions is often attenuated in women who have experienced trauma. We explored whether psychological avoidance could explain this phenomenon. We synthesized two pilot randomized trials of problem-solving education (PSE) among a total of 93 urban mothers. Outcomes included depressive symptoms and perceived stress. Mothers with avoidant coping styles experienced an average 1.25 episodes of moderately severe depressive symptoms over 3 months of follow-up, compared to 0.40 episodes among those with non-avoidant coping (adjusted incident rate ratio [aIRR] 2.18; 95 % CI 1.06, 4.48). PSE tended to perform better among mothers with non-avoidant coping. Among mothers with non-avoidant coping, PSE mothers experienced an average 0.24 episodes, compared to 0.58 episodes among non-avoidant controls (aIRR 0.27; 95 % CI 0.05, 1.34). Among mothers with avoidant coping, PSE mothers experienced an average 1.26 episodes, compared to 1.20 episodes among avoidant controls (aIRR 0.76; 95 % CI 0.44, 1.33). This trend toward differential impact persisted when avoidance was measured as a problem-solving style and among traumatized mothers with and without avoidant PTSD symptoms. Further research is warranted to explore the hypothesis that psychological avoidance could explain why certain depression treatment and prevention strategies break down in the presence of trauma.

Original languageEnglish (US)
Pages (from-to)63-70
Number of pages8
JournalArchives of Women's Mental Health
Issue number1
StatePublished - Feb 1 2016


  • Avoidance
  • Maternal depression
  • PTSD
  • Prevention

ASJC Scopus subject areas

  • Obstetrics and Gynecology
  • Psychiatry and Mental health


Dive into the research topics of 'Avoidance as an obstacle to preventing depression among urban women at high risk for violent trauma'. Together they form a unique fingerprint.

Cite this