TY - JOUR
T1 - Avoidance as an obstacle to preventing depression among urban women at high risk for violent trauma
AU - Silverstein, Michael
AU - Kistin, Caroline
AU - Bair-Merritt, Megan
AU - Wiltsey-Stirman, Shannon
AU - Feinberg, Emily
AU - Diaz-Linhart, Yaminette
AU - Sandler, Jenna
AU - Chen, Ning
AU - Cabral, Howard
N1 - Funding Information:
This work was funded by an NICHD R03 award (R03HD058075, PI Silverstein); Dr. Silverstein is currently supported in part by an NICHD K24 award (K24HD081057). We thank Barry Zuckerman for his advice in conceptualizing this work.
Publisher Copyright:
© 2015, Springer-Verlag Wien.
PY - 2016/2/1
Y1 - 2016/2/1
N2 - 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.
AB - 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.
KW - Avoidance
KW - Maternal depression
KW - PTSD
KW - Prevention
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U2 - 10.1007/s00737-015-0521-4
DO - 10.1007/s00737-015-0521-4
M3 - Article
AN - SCOPUS:84955688952
SN - 1434-1816
VL - 19
SP - 63
EP - 70
JO - Archives of Women's Mental Health
JF - Archives of Women's Mental Health
IS - 1
ER -