Giurgescu Carmen, Zenk Shannon N, Templin Thomas N, Engeland Christopher G, Dancy Barbara L, Park Chang Gi, Kavanaugh Karen, Dieber William, Misra Dawn P
College of Nursing, Wayne State University, Detroit, Michigan.
College of Nursing, University of Illinois at Chicago, Chicago, Illinois.
Womens Health Issues. 2015 May-Jun;25(3):294-302. doi: 10.1016/j.whi.2015.02.001. Epub 2015 Mar 31.
Although depressive symptoms during pregnancy have been related to negative maternal and child health outcomes such as preterm birth, low birth weight infants, postpartum depression, and maladaptive mother-infant interactions, studies on the impact of neighborhood environment on depressive symptoms in pregnant women are limited. Pregnant women residing in disadvantaged neighborhoods reported higher levels of depressive symptoms and lower levels of social support. No researchers have examined the relationship between neighborhood environment and avoidance coping in pregnant women. Guided by the Ecological model and Lazarus and Folkman's transactional model of stress and coping, we examined whether social support and avoidance coping mediated associations between the neighborhood environment and depressive symptoms in pregnant African-American women.
Pregnant African-American women (n = 95) from a medical center in Chicago completed the instruments twice during pregnancy between 15 and 25 weeks and between 25 and 37 weeks. The self-administered instruments measured perceived neighborhood environment, social support, avoidance coping, and depressive symptoms using items from existing scales. Objective measures of the neighborhood environment were derived using geographic information systems.
Perceived neighborhood environment, social support, avoidance coping, and depressive symptoms were correlated significantly in the expected directions. Objective physical disorder and crime were negatively related to social support. Social support at time 1 (20 ± 2.6 weeks) mediated associations between the perceived neighborhood environment at time 1 and depressive symptoms at time 2 (29 ± 2.7 weeks). An increase in avoidance coping between times 1 and 2 also mediated the effects of perceived neighborhood environment at time 1 on depressive symptoms at time 2.
Pregnant African-American women's negative perceptions of their neighborhoods in the second trimester were related to higher levels of depressive symptoms in the third trimester. If these results are replicable in prospective studies with larger sample sizes, intervention strategies could be implemented at the individual level to support pregnant women in their ability to cope with adverse neighborhood conditions and ultimately improve their mental health.
尽管孕期的抑郁症状与母婴健康的负面结果相关，如早产、低体重儿、产后抑郁以及母婴适应不良的互动，但关于邻里环境对孕妇抑郁症状影响的研究有限。居住在弱势社区的孕妇报告称其抑郁症状水平较高，社会支持水平较低。尚无研究人员考察邻里环境与孕妇回避应对之间的关系。在生态模型以及拉扎勒斯和福克曼的应激与应对交互模型的指导下，我们考察了社会支持和回避应对是否介导了邻里环境与非裔美国孕妇抑郁症状之间的关联。
来自芝加哥一家医疗中心的95名非裔美国孕妇在孕期15至25周以及25至37周期间两次完成相关量表。这些自填式量表使用现有量表中的条目来测量感知到的邻里环境、社会支持、回避应对以及抑郁症状。邻里环境的客观测量数据通过地理信息系统得出。
感知到的邻里环境、社会支持、回避应对以及抑郁症状在预期方向上显著相关。客观的身体紊乱和犯罪与社会支持呈负相关。第1次测量时（20±2.6周）的社会支持介导了第1次测量时感知到的邻里环境与第2次测量时（29±2.7周）的抑郁症状之间的关联。第1次和第2次测量期间回避应对的增加也介导了第1次测量时感知到的邻里环境对第2次测量时抑郁症状的影响。
非裔美国孕妇在孕中期对邻里环境的负面认知与孕晚期较高水平的抑郁症状相关。如果这些结果能够在更大样本量的前瞻性研究中得到重复验证，那么可以在个体层面实施干预策略，以支持孕妇应对不利邻里环境的能力，并最终改善她们的心理健康。
