Comparison of Stress, Social Support, and Depression Across the Trimesters in a Multi-Ethnic Population

Sunday, June 16, 2013

Title: Comparison of Stress, Social Support, and Depression Across the Trimesters in a Multi-Ethnic Population

Ryman Hall B4 (Gaylord Opryland)
Lindsay Horlacher, MSN, FNP-C , UVA Department of OB/GYN, Charlottesville, VA
Yvonne Newberry, MSN, FNP-BC, AAHIVS , UVA Department of OB/GYN, Charlottesville, VA
Kristin Ashford, PhD, ARNP, RN , UK College of Nursing, Lexington, KY

Discipline: Advanced Practice (AP), Childbearing (CB), Women’s Health (WH)

Learning Objectives:
  1. Identify the adverse effects stress, poor social support, and depression have on pregnancy.
  2. Discuss at least one psychosocial difference that women of different race/ethnicity may experience during pregnancy.
  3. Discuss how psychosocial issues may vary across the trimesters.
Submission Description:
Objective: Depression during pregnancy has been associated with poor pregnancy outcomes.  Many risk factors have been identified to increase a women’s risk of depression during pregnancy, including stress and lack of social support.  There is limited research comparing stress, social support, and depression throughout pregnancy among different ethnic groups.  This study aims to describe the differences in stress, social support, and depression across the three trimesters in a group of Caucasian, African-American, and Hispanic women.

Design: A midpoint analysis in a prospective, longitudinal multi-center trial.  Analysis consisted of T-tests, repeated measures ANOVA, and descriptive statistics via SAS version 9.3.

Setting: Multi-Center

Sample: The sample (n=299) consisted of African American (n=45); Hispanic (n=54) and Caucasian (n=200) pregnant women with singleton gestation.

Methods: Women completed a psychosocial assessment during each trimester.  Depressive symptoms, stress, and social support were measured using valid instruments (Edinburg, Everyday Stressors, and Autonomy and Relatedness Inventory). 

Results:

DEPRESSIVE SYMPTOMS (Edinburgh)

In the 1st-trimester, Hispanic and African American women had significantly higher depressive symptom scores (DSS) when compared to Caucasian women (P < 001; respectively).   In the 2nd-trimester, only African American women had significantly higher DDS when compared to Caucasian women.  In the third trimester, no significant racial differences existed in DSS.  African American and Hispanic women DDS significantly decreased (p = .05; and <.001, respectively) from 1st to 3rd-trimester; whereas Caucasian women had a slight increase.

SOCIAL SUPPORT (AUTONOMY AND RELATEDNESS INDEX: ARI):

In the 1st trimester, significant social support differences existed among all groups, with Hispanic women having the lowest mean scores and Caucasian women reporting the highest support (98.74; 106.47; and 113.35). In the 2nd-3rd-trimesters, Hispanic woman consistently reported lowest support than African American and Caucasian women (p < .001, respectively).  No differences in social support existed between African American to Caucasian women in the 2nd or 3rd’trimesters.

SELF-REPORTED STRESS (EVERYDAY STRESSORS: ESS)

Among all groups, women consistently reported stress highest in the 1st-trimester; with significantly lower stress scores in the 3rd trimester (p < .001; respectively).  African American women had the highest mean stress scores, with Caucasian women reporting the least amount of stress throughout pregnancy.

Conclusion/Implications for nursing practice: Clear psychosocial differences exist among races and vary across trimesters. High stress, low social support, and depression negatively impact pregnancy outcome.    Culturally–sensitive and psychosocial-specific interventions delivered in the 1st trimester may improve pregnancy outcomes.

Keywords: Pregnancy, depression, social support

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