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Thesis
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Psychological Interventions for Pregnant Black Women and Latinas with Depression or Anxiety

Ponting, Carolyn
Advisor(s): Chavira, Denise A

UCLA Electronic Theses and Dissertations (2022)

This dissertation is a three-paper investigation of psychological interventions for pregnant ethnic and racial minority women with anxiety and depression. Study 1 reviews the treatment outcome literature for pregnant Black women and Latinas with depressive and anxious symptoms, including their efficacy, mode of delivery (i.e., provider of intervention, setting), and the presence of cultural adaptations. Results revealed that treatment outcome studies for Latinas and Black women are lacking, and often do not result in favorable outcomes for depression or anxiety. Though CBT and IPT are the intervention modalities most often tested to treat depression, they require additional trials to be considered efficacious. No intervention trials have achieved favorable outcomes with regard to anxiety reduction in Latinas and Black women.

Study 2 used data from a randomized controlled trial of a cognitive behavioral stress management intervention delivered to Black women and Latinas to test its efficacy for prenatal anxiety (i.e., state and pregnancy specific). We also tested whether change targets of the intervention from pre- to post-treatment might mediate the relationship between intervention group and anxiety change at follow up timepoints. Findings revealed that while the intervention was not efficacious for reducing prenatal anxiety, women who completed the intervention showed significantly fewer state anxiety symptoms at post-treatment than did women in the control condition—effects that were not lasting. Changes in the potential mediators tested did not explain the relationship between intervention group and subsequent changes in anxiety.

Study 3 investigated pregnant Latinas’ acceptability of exposure therapy to treat prenatal anxiety using a deductive qualitative design. Using an existing theoretical framework of treatment acceptability, we interviewed women about seven domains of treatment acceptability. Results of a qualitative content analysis show that culture, family, and pregnancy status are factors that can serve as relevant exposure acceptability enhancers or challenges and provide insights for tailoring psychoeducation about exposure therapy prenatally. Collectively, these studies further the treatment outcome literature for pregnant Latinas and Black women, whose outcomes in available psychological interventions have been presumed to be equivalent to those of white women.

Cover page: Psychological Interventions for Pregnant Black Women and Latinas with Depression or Anxiety

Article
Peer Reviewed

Psychological Interventions for Prenatal Anxiety in Latinas and Black Women: A Scoping Review and Recommendations

UCLA Previously Published Works (2022)

Anxiety symptoms are common among pregnant women worldwide. In the United States, prenatal anxiety symptoms tend to be elevated among Black and Latin American women as compared to non-Latina White women. Despite the high prevalence of anxiety and associations with adverse maternal and offspring outcomes, interventions have not been developed or tailored sufficiently to Black women or Latinas who need efficacious treatment. This article provides a scoping review of articles published since 2017 that test the effects of randomized and non-randomized psychological interventions designed to reduce prenatal anxiety in samples comprised primarily of ethnic/racial minority women. We also review published protocols of planned psychological interventions to reduce prenatal anxiety in order to highlight novel approaches. In addition to summarizing intervention efficacy and participant acceptability, we highlight gaps in the literature which, if addressed, could improve perinatal mental health equity. Finally, we discuss future directions in prenatal anxiety intervention science beginning preconception including intervention design and prevention models.

Cover page: Psychological Interventions for Prenatal Anxiety in Latinas and Black Women: A Scoping Review and Recommendations

Article
Peer Reviewed

Cognitive Behavioral Stress Management Effects on Prenatal Anxiety Among Low-Income Women

UCLA Previously Published Works (2022)

Objective

Few studies have tested cognitive behavioral therapy to reduce prenatal anxiety despite substantial empirical support among individuals seeking treatment for anxiety symptoms. We examined whether a brief cognitive behavioral intervention delivered to low-income pregnant women would be efficacious for reducing prenatal anxiety.

Method

A sample of 100 primarily ethnic and racial minority pregnant women with subclinical anxiety (74% Latina, 18% Black; M_age = 26.5) were randomized to an 8-week cognitive behavioral stress management (CBSM) intervention (n = 55), or to an attentional control condition (n = 45). Two forms of anxiety (state and pregnancy-specific) were measured at baseline, post-treatment, and at follow-up in the postpartum using the State-Trait Personality Inventory-State and the Pregnancy Related Anxiety scale, respectively. Intent-to-treat (ITT) and completer analyses were conducted using linear mixed models to test mean differences in both forms of anxiety by group assignment and by intervention completion (< 7 vs. ≥ 7 sessions) at post-treatment and follow-up timepoints.

Results

ITT results revealed no intervention Group × Time interactions for state, F(3, 356) = .51, p = .68, or pregnancy-specific anxiety, F(2, 184.39) = .75, p = .47, indicating no intervention effect post-treatment or at follow-up. Completer analyses showed that women who received all intervention content (34.5%) had significantly less state anxiety at post-treatment compared to women who had not completed the intervention, (65.5%; M_sessions = 3.62); F(6, 270.67) = 2.35, p = .03, and those in the control condition.

Conclusions

While we did not find support for the use of CBSM to treat prenatal anxiety among low-income women, those who received a full dose benefited in state anxiety immediately postintervention. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Cover page: Cognitive Behavioral Stress Management Effects on Prenatal Anxiety Among Low-Income Women

Article
Peer Reviewed

Addressing Adverse Childhood and Adult Experiences During Prenatal Care

UC San Francisco Previously Published Works (2023)

Adverse childhood and adult experiences can affect health outcomes throughout life and across generations. The perinatal period offers a critical opportunity for obstetric clinicians to partner with patients to provide support and improve outcomes. This article draws on stakeholder input, expert opinion, and available evidence to provide recommendations for obstetric clinicians' inquiry about and response to pregnant patients' past and present adversity and trauma during prenatal care encounters. Trauma-informed care is a universal intervention that can proactively address adversity and trauma and support healing, even if a patient does not explicitly disclose past or present adversity. Inquiry about past and present adversity and trauma provides an avenue to offer support and to create individualized care plans. Preparatory steps to adopting a trauma-informed approach to prenatal care include initiating education and training for practice staff, prioritizing addressing racism and health disparities, and establishing patient safety and trust. Inquiry about adversity and trauma, as well as resilience factors, can be implemented gradually over time through open-ended questions, structured survey measures, or a combination of both techniques. A range of evidence-based educational resources, prevention and intervention programs, and community-based initiatives can be included within individualized care plans to improve perinatal health outcomes. These practices will be further developed and improved by increased clinical training and research, as well as through broad adoption of a trauma-informed approach and collaboration across specialty areas.

Cover page: Addressing Adverse Childhood and Adult Experiences During Prenatal Care

Article
Peer Reviewed

Psychological interventions for depression and anxiety in pregnant Latina and Black women in the United States: A systematic review

UCLA Previously Published Works (2020)

Black women and Latinas have more symptoms of depression and anxiety during pregnancy than do their non-Latina White counterparts. Although effective interventions targeting internalizing disorders in pregnancy are available, they are primarily tested with White women. This article reviews randomized controlled trials and non-randomized studies to better understand the effectiveness of psychological interventions for anxiety and depression during pregnancy in Latinas and Black women. Additionally, this review summarizes important characteristics of interventions such as intervention format, treatment modality, and the use of cultural adaptations. Literature searches of relevant research citation databases produced 68 studies; 13 of which were included in the final review. Most studies were excluded because their samples were not majority Latina or Black women or because they did not test an intervention. Of the included studies, three interventions outperformed a control group condition and showed statistically significant reductions in depressive symptoms. An additional two studies showed reductions in depressive symptoms from pretreatment to post-treatment using non-controlled designs. The remaining eight studies (seven randomized and one non-randomized) did not show significant intervention effects. Cognitive behavioral therapy was the modality with most evidence for reducing depressive symptoms in pregnant Black and Latina women. No intervention was found to reduce anxiety symptoms, although only two of the 13 measured anxiety as an outcome. Five studies made cultural adaptations to their treatment protocols. Future studies should strive to better understand the importance of cultural modifications to improve engagement and clinical outcomes with pregnant women receiving treatment for anxiety and depression.

Cover page: Psychological interventions for depression and anxiety in pregnant Latina and Black women in the United States: A systematic review

Article
Peer Reviewed