Effects of Interpersonal Psychotherapy on Postpartum Depression among Females at Tertiary Care Hospital Lahore
Sehrish Arshad1*, Muhammad Afzal2, Hajra Sarwar3
1Doctors Hospital College of Nursing and Allied Health Sciences, Lahore, Pakistan
2Director Academics Faculty of Allied Health Sciences, University of Lahore, Pakistan
3University of Lahore, Pakistan
Introduction: Postpartum depression (PPD) is a major public health issue among females after giving birth to the baby, characterized by low mood, feeling of guilt and suicide. When left untreated, it has the potential for a profound negative impact on mothers, children and families. The efficacy of interpersonal psychotherapy (IPT) in addressing depression has been well-documented. However, the impact of IPT on PPD remains inadequately substantiated, particularly within the context of Pakistan, where data pertaining to its effectiveness remains limited.
Objective: The aim of study was to assess the level of depression in postpartum females and evaluate the effects of IPT on PPD among females at tertiary care hospital Lahore.
Methods: A Randomized controlled trial (RCT) was conducted at the Services Hospital Lahore from September 2021 to the same month in 2023. Subjects (n=110) were screened using the hamilton depression rating scale (HDRS) and divided equally in intervention group and control group to get eight sessions of individual based IPT versus routine care. Data was analyzed using SPSS version 21, intergroup comparison was done by Mann Whitney U test for intra group comparison Wilcoxon Signed Rank test was used, with 95% Confidence Interval (CI) and 5% level of significance. Significance of result showed with p value <0.05.
Results: Prevalence of PPD among female was observed 82%. Upon receiving IPT, females exhibited a statistically significant reduction (p<0.001) in scores indicative of mild depression, from 48 (87.3%) to 5(9.1%), as well as for moderate depression, from 7(12.7%) to 1(1.8%). Furthermore, following the IPT sessions, marked improvements were noted within the intervention group across various domains including depressed mood p<0.001, CI (0.000, 0.027), feelings of guilt p<0.001, CI (0.000, 0.027), early night insomnia p<0.008, CI (0.000, 0.043), impaired work and activities p<0.05, CI (0.072, 0.200), and insight p<0.001, CI (0.000, 0.027). Conversely, the control group did not exhibit any significant alterations in these parameters.
Conclusion: The results indicate a concerning prevalence rate of PPD among the study sample with many cases remaining undiagnosed and untreated. More positively, the study demonstrates the potential of IPT as an effective method to mitigate mild to moderate PPD. This research suggests the incorporation of IPT into therapeutic models could result in timely, potentially preventive interventions and lessen the occurrence of severe complications.
DOI: 10.29245/2578-2959/2024/2.1301 View / Download PdfSex Differences in the Relationship Between Nucleus Accumbens Volume and Youth Tobacco or Marijuana Use Following Stressful Life Events
Shervin Assari1,2,3*, Payam Sheikhattari4
1Department of Internal Medicine, Charles R. Drew University of Medicine and Science, Los Angeles, CA, USA
2Department of Family Medicine, Charles R. Drew University of Medicine and Science, Los Angeles, CA, USA
3Department of Urban Public Health, Charles R. Drew University of Medicine and Science, Los Angeles, CA, USA
4Morgan State University, Baltimore, USA
Background: Exposure to stressful life events (SLEs) can upset balance and affect the healthy brain development of children and youths. These events may influence substance use by altering brain reward systems, especially the nucleus accumbens (NAc), which plays a key role in motivated behaviors and reward processing. The interaction between sensitization to SLEs, depression, and substance use might vary between male and female youths, potentially due to differences in how each sex responds to SLEs.
Aims: This study aims to examine the effect of sex on the relationship between SLEs, Nucleus Accumbens activity, and substance use in a nationwide sample of young individuals.
Methods: We utilized data from the Adolescent Brain Cognitive Development study (ABCD), a longitudinal study of pre-adolescents aged 9–10 years, comprising 11,795 participants tracked over 36 months. Structured interviews measuring SLEs were conducted using the Kiddie Schedule for Affective Disorders and Schizophrenia (K-SADS). Initial linear regression analyses explored if SLEs could predict volumes of the right and left NAc. Subsequently, Cox regression models were used to investigate how SLEs and NAc volume might predict the initiation of tobacco and marijuana use, with the analysis stratified by sex to address potential sex differences.
Results: Our findings reveal that SLEs significantly predicted marijuana use in males but not in females, and tobacco use was influenced by SLEs in both sexes. A higher number of SLEs was linked with decreased left NAc volume in males, a trend not seen in females. The right NAc volume did not predict substance use in either sex. However, volumes of both the right and left NAc were significant predictors of future tobacco use, with varying relationships across sexes. In females, an inverse relationship was observed between both NAc volumes and the risk of tobacco use. In contrast, a positive correlation existed between the left NAc volume and tobacco and marijuana use in males, with no such relationship for females.
Conclusion: This study underscores that the associations between SLEs, NAc volume, and subsequent substance use are influenced by a nuanced interplay of sex, brain hemisphere, and substance type.
DOI: 10.29245/2578-2959/2024/2.1305 View / Download PdfWhat is Common Becomes Normal; Black-White Variation in the Effects of Adversities on Subsequent Initiation of Tobacco and Marijuana During Transitioning into Adolescence
Shervin Assari1,2*, Babak Najand3, Payam Sheikhattari4,5,6
1Department of Internal Medicine, Charles R Drew University of Medicine and Science, Los Angeles, CA, USA
2Department of Urban Public Health, Charles R Drew University of Medicine and Science, Los Angeles, CA, USA
3Marginalization-related Diminished Returns Center, Los Angeles, CA, USA
4Center for Urban Health Disparities Research and Innovation, Morgan State University, Baltimore, MD, USA
5The Prevention Sciences Research Center, School of Community Health and Policy, Morgan State University, Baltimore, MD, USA
6Department of Behavioral Health Science, School of Community Health and Policy, Morgan State University, Baltimore, MD, USA
Background: While adversities across domains of finance, race, family, and life may operate as risk factors for initiation of substance use in adolescents, the influence of these factors may vary across racial groups of youth. Unfortunately, the existing knowledge is minimal about racial differences in the types of adversities that may increase the risk of subsequent substance use initiation during the transition into adolescence.
Aim: To compare racial groups for the effects of adversities across domains of finance, race, family, and life on subsequent substance use initiation among pre-adolescents transitioning into adolescence.
Methods: In this longitudinal study, we analyzed data from 6003 non-Latino White and 1562 non-Latino African American 9-10-year-old children transitioning into adolescence. Data came from the Adolescent Brain Cognitive Development (ABCD) study. Participants were followed for up to thirty-six months as they transitioned to adolescence. The independent variables were adversities related to the domains of finance, race, family, and life. The primary outcomes were time to first tobacco or marijuana use. Age, puberty, and gender were confounders. Cox regression models were used for data analysis.
Results: For White youth, tobacco use was under influence of having two parents in the household (HR = .611; 95% CI = .419-.891), parental education (HR = .900; 95% CI = .833-.972), household income (HR = .899; 95% CI = .817-.990), racial stress (HR = 1.569; 95% CI = 1.206-2.039), and life stress (HR =1.098 ; 95% CI = 1.024-1.178) and marijuana use was under influence of neighborhood income (HR = .576; 95% CI = .332-.999) and financial stress (HR =4.273; 95% CI = 1.280-17.422). No adverse condition predicted tobacco or marijuana use of African American youth.
Conclusion: The effects of adversities on substance use depend on race. While various types of adversities tend to increase subsequent initiation of tobacco and marijuana, such factors may be less influential for African American adolescents, who experience more of such adversities. What is common may become normal.
DOI: 10.29245/2578-2959/2024/1.1300 View / Download PdfDiagnosing Human Trafficking Victims: A Mini-Review and Perspective
Sheldon X. Zhang1, Rumi Kato Price2*
1School of Criminology and Criminal Justice Studies, University of Massachusetts at Lowell, Lowell, Massachusetts, USA
2Department of Psychiatry, School of Medicine, Washington University in St. Louis, St. Louis, Missouri, USA
The global campaign against human trafficking, also known as trafficking in persons, has gained much momentum in the past two decades. Although psychiatric and physical illness sequela of human trafficking are well documented, the research community continues to struggle over such foundational questions as what specific activities or experiences count as trafficking-in-persons victimization and how best to obtain representable and generalizable data on experiences of people who are trafficked. We provide a brief review of major efforts to define trafficking in persons to establish prevalence estimates to date. We argue for consensus on key clinical and public health indicators, resembling the Diagnostic and Statistical Manual (DSM) approach to enable common and systematic knowledge building and comparability across studies.
DOI: 10.29245/2578-2959/2024/1.1292 View / Download PdfImmigration, Educational Attainment, and Subjective Health in the United States
Rifath Ara Alam Barsha1, Babak Najand2, Hossein Zare3,4, Shervin Assari5,6,7*
1School of Community Health & Policy, Morgan State University, Baltimore, MD, USA
2Marginalization Related Diminished returns, Los Angeles, CA, USA
3Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
4University of Maryland Global Campus, Health Services Management, Adelphi, Maryland, USA
5Department of Family Medicine, Charles R Drew University of Medicine and Science, Los Angeles, CA, USA
6Department of Internal Medicine, Charles R Drew University of Medicine and Science, Los Angeles, CA, USA
7Department of Urban Public Health, Charles R Drew University of Medicine and Science, Los Angeles, CA, USA
Objectives: Although educational attainment is a major social determinant of health, according to Marginalization-related Diminished Returns (MDRs), the effect of education tends to be weaker for marginalized groups compared to the privileged groups. While we know more about marginalization due to race and ethnicity, limited information is available on MDRs of educational attainment among US immigrant individuals.
Aims: This study compared immigrant and non-immigrant US adults aged 18 and over for the effects of educational attainment on subjective health (self-rated health; SRH).
Methods: Data came from General Social Survey (GSS) that recruited a nationally representative sample of US adults from 1972 to 2022. Overall, GSS has enrolled 45,043 individuals who were either immigrant (4,247; 9.4%) and non-immigrant (40,796; 90.6%). The independent variable was educational attainment, the dependent variable was SRH (measured with a single item), confounders were age, gender, race, employment and marital status, and moderator was immigration (nativity) status.
Results: Higher educational attainment was associated with higher odds of good SRH (odds ratio OR = 2.08 for 12 years of education, OR = 2.81 for 13-15 years of education, OR = 4.38 for college graduation, and OR = 4.83 for graduate studies). However, we found significant statistical interaction between immigration status and college graduation on SRH, which was indicative of smaller association between college graduation and SRH for immigrant than non-immigrant US adults.
Conclusions: In line with MDRs, the association between educational attainment and SRH was weaker for immigrant than non-immigrant. It is essential to implement two sets of policies to achieve health inequalities among immigrant populations: policies that increase educational attainment of immigrants and those that increase the health returns of educational attainment for immigrants.
DOI: 10.29245/2578-2959/2024/1.1299 View / Download PdfCommentary: Black Mothers in Racially Segregated Neighborhoods Embodying Structural Violence: PTSD and Depressive Symptoms on the South Side of Chicago
DOI: 10.29245/2578-2959/2024/1.1291 View / Download PdfLoren Henderson1*, Ruby Mendenhall2, Meggan J Lee3
1The School of Public Policy, University of Maryland, Baltimore County, Baltimore, MD, USA
2Department of Sociology, Department of African American Studies, Carle Illinois College of Medicine, IL, USA
3Carle Illinois College of Medicine, Urbana, IL, USA
Exposure to Adverse Life Events among Children Transitioning into Adolescence: Intersections of Socioeconomic Position and Race
Shervin Assari1,2,3*, Babak Najand4, Alexandra Donovan1
1Department of Internal Medicine, Charles R Drew University of Medicine and Science, Los Angeles, CA, USA
2Department of Family Medicine, Charles R Drew University of Medicine and Science, Los Angeles, CA, USA
3Department of Urban Public Health, Charles R Drew University of Medicine and Science, Los Angeles, CA, USA
4Marginalization related Diminished Returns Center, Los Angeles, CA, USA
Background: Racism is shown to diminish the protective effects of family socioeconomic position (SEP) resources for racial minorities compared to the majority groups, a pattern called minorities’ diminished returns. Our existing knowledge is minimal about diminished returns of family SEP indicators on reducing exposure to adverse life events among children transitioning into adolescence. Aim: To compare diverse racial groups for the effects of family income and family structure on exposure to adverse life events of pre-adolescents transitioning to adolescence.
Methods: In this longitudinal study, we analyzed data from 22,538 observations belonging to racially diverse groups of American 9–10-year-old children (n = 11,878) who were followed while transitioning to adolescence. The independent variables were family income and family structure. The primary outcome was the number of stressful life events with impact on adolescents, measured by the Life History semi-structured interview. Mixed-effects regression models were used for data analysis to adjust for data nested to individuals, families, and centers.
Results: Family income and married family structure had an overall inverse association with children’s exposure to adverse life events during transition to adolescence. However, race showed significant interactions with family income and family structure on exposure to adverse life events. The protective effects of family income and married family structure were weaker for African American than White adolescents. The protective effect of family income was also weaker for mixed/other race than White adolescents.
Conclusion: While family SEP is protective against children’s exposure to adverse life events, this effect is weaker for African American and mixed/other race compared to White youth.
DOI: 10.29245/2578-2959/2024/1.1293 View / Download Pdf