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Głaz S. Religious Experience as a Predictor of the Meaning in Life and Life Satisfaction in the Lives of Polish Women after a Stillbirth. JOURNAL OF RELIGION AND HEALTH 2023; 62:839-858. [PMID: 36418755 PMCID: PMC10042945 DOI: 10.1007/s10943-022-01698-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 11/13/2022] [Indexed: 06/16/2023]
Abstract
Many researchers have demonstrated the relationship of religiosity with dimensions of mental health such as searching for meaning in life, the presence of meaning in life, and life satisfaction. Hence, this study attempts to link such aspects of religiosity with the experience of the presence and/or absence of God with the search for and presence of meaning in life and satisfaction with life among a group of Polish women who have experienced a stillbirth in the past five years. The study included 64 women who lost a baby through stillbirth after the 22nd week of gestation. All the women were born into Christian families and declared themselves to be Christians and actively practicing their faith. Women's ages ranged from 29 to 47 years. The research results showed that the experience of God's presence and absence have a positive and significant relationship with the search for meaning in life and the presence of meaning in life, as well as with the satisfaction with life in the lives of women after stillbirth. The strongest relationship was between the presence of meaning in life and life satisfaction (r = .72; p < .01), God's presence and life satisfaction (r = .66; p < .01), as well as the presence of meaning in life and the search for meaning in life (r = .57; p < .01). The structural equation model showed that the experience of God's presence and God's absence have a significant, direct impact on the search for meaning in life and the presence of meaning in life, and the satisfaction with life. These also have an indirect impact on the satisfaction with life in the lives of women who have lost a child to stillbirth.
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Affiliation(s)
- Stanisław Głaz
- Jesuit University Ignatianum in Krakow, Ul. Kopernika 26, 31-501, Kraków, Poland.
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Pal A, Mukhopadhyay P, Datta S, Pal ND. Effect of an online mindfulness program on stress in Indian adults during COVID-19 pandemic: A randomized controlled preliminary study. Indian J Psychiatry 2022; 64:401-407. [PMID: 36060713 PMCID: PMC9435616 DOI: 10.4103/indianjpsychiatry.indianjpsychiatry_4_21] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2021] [Revised: 01/20/2022] [Accepted: 06/05/2022] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND The Indian population is suffering from a high prevalence of mental stress and the situation has been worsened by the COVID-19 pandemic. Mindfulness, which can also be conducted online, has been used as a stress-relieving therapy in the Western world. There is not much experience with mindfulness in the Indian population. The COVID-19 pandemic demands the development of alternative therapies which can reach out to the masses at a minimal cost, avoiding direct personal contact. The researchers wanted to explore the potential of mindfulness as a stress-relieving therapy. AIM To note any improvement in perceived stress of the participants compared to the controls. METHODS Ninety apparently healthy adults were randomized into group M (all of whom participated in an online mindfulness program) and group C (all of whom attended placebo sessions), with 45 participants each. Final sample size was n = 42 (group M) and n = 38 (group C). The perceived stress was measured using the perceived stress scale before and after the program. Qualitative data was collected in the form of written responses to the question "Which aspect of mindfulness meditation appealed to you the most for stress relief?" and some themes were formed. RESULTS There was a significant decrease in perceived stress scale scores on completion of the program in group M. "Positive mental state" and "non-judgmental" were the most prominent emergent themes suggested by the participants, as per the qualitative data analysis. CONCLUSION This preliminary study sees potential in an online mindfulness program as an alternative stress-relieving therapy. Further research is suggested to substantiate the results and optimize the implementation.
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Affiliation(s)
- Anirban Pal
- Department of Anaesthesia and Pain Medicine, Apollo Gleneagles Hospitals, Kolkata, West Bengal, India
| | | | - Soma Datta
- Department of Psychiatry, Derbyshire Healthcare NHS Foundation Trust, Derbyshire, England
| | - Nidhi Dawar Pal
- Department of Stress Management, Harmony Meditation Center, Kolkata, West Bengal, India
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Roberts LR, Solomon S, Renati SJ, Montgomery S. Exploring Mental Health during the Initial COVID-19 Lockdown in Mumbai: Serendipity for Some Women. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:12542. [PMID: 34886267 PMCID: PMC8656519 DOI: 10.3390/ijerph182312542] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Revised: 11/21/2021] [Accepted: 11/22/2021] [Indexed: 11/17/2022]
Abstract
Background: This study explored how low-income women already distressed by reproductive challenges were affected during the initial lockdown conditions of the COVID-19 pandemic in Mumbai, India. Methods: Women with reproductive challenges and living in established slums participated in a longitudinal mixed-methods study comparing their mental health over time, at pre-COVID-19 and at one and four-months into India's COVID-19 lockdown. Results: Participants (n = 98) who presented with elevated mental health symptoms at baseline had significantly reduced symptoms during the initial lockdown. Improvements were associated with income, socioeconomic status, perceived stress, social support, coping strategies, and life satisfaction. Life satisfaction explained 37% of the variance in mental health change, which was qualitatively linked with greater family time (social support) and less worry about necessities, which were subsidized by the government. Conclusions: As the pandemic continues and government support wanes, original mental health issues are likely to resurface and possibly worsen, if unaddressed. Our research points to the health benefits experienced by the poor in India when basic needs are at least partially met with government assistance. Moreover, our findings point to the critical role of social support for women suffering reproductive challenges, who often grieve alone. Future interventions to serve these women should take this into account.
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Affiliation(s)
- Lisa R. Roberts
- School of Nursing, Loma Linda University, Loma Linda, CA 92350, USA
| | - Shreeletha Solomon
- Department of Psychology, Martin Luther Christian University, Shillong 793006, Meghalaya, India;
| | - Solomon J. Renati
- Department of Psychology, Veer Wajekar Arts Science and Commerce College, University of Mumbai, Mumbai 400032, Maharashtra, India;
| | - Susanne Montgomery
- School of Behavioral Health, Loma Linda University, Loma Linda, CA 92350, USA;
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Roberts L, Renati SJ, Solomon S, Montgomery S. Stillbirth and infant death: mental health among low-income mothers in Mumbai. BMC Pregnancy Childbirth 2021; 21:292. [PMID: 33838663 PMCID: PMC8037900 DOI: 10.1186/s12884-021-03754-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 03/24/2021] [Indexed: 02/26/2023] Open
Abstract
Background India has the highest number of stillbirths and the highest neonatal death rate in the world. In the context of its pronatalist society, women who experience perinatal loss often encounter significant social repercussions on top of grief. Furthermore, even when pregnancy outcomes were favorable, adverse life circumstances put some women at risk for postnatal depression. Therefore, perinatal loss and postnatal depression take a heavy toll on women’s mental health. The purpose of this study is to assess mental health among a sample of Mumbai slum-dwelling women with a history of recent childbirth, stillbirth, or infant death, who are at risk for perinatal grief, postnatal depression, or mental health sequelae. Methods We conducted a mixed method, cross-sectional study. A focus group discussion informed the development of a comprehensive survey using mainly internationally validated scales. After rigorous forward and back-translation, surveys were administered as face-to-face structured interviews due to low literacy and research naiveté among our respondents. Interviews were conducted by culturally, linguistically, gender-matched, trained research assistants. Results Of our reproductive age (N = 260) participants, 105 had experienced stillbirth, 69 had a history of infant death, and 25 had experienced both types of loss. Nearly half of the sample met criteria for postnatal depression, and 20% of these women also met criteria for perinatal grief. Anxiety and depression varied by subgroup, and was highest among women desiring an intervention. Conclusions Understanding factors contributing to women’s suffering related to reproductive challenges in this pronatalist context is critically important for women’s wellbeing.
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Affiliation(s)
- Lisa Roberts
- School of Nursing, Loma Linda University, Loma Linda, USA.
| | - Solomon J Renati
- Veer Wajekar A. S. & C. College, University of Mumbai, Mumbai, India
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Roberts LR, Renati SJ, Solomon S, Montgomery S. Perinatal Grief Among Poor Rural and Urban Women in Central India. Int J Womens Health 2021; 13:305-315. [PMID: 33727864 PMCID: PMC7955753 DOI: 10.2147/ijwh.s297292] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Accepted: 02/22/2021] [Indexed: 11/23/2022] Open
Abstract
PURPOSE Given the pressures surrounding women's reproductive role in India, and persistent high rates of perinatal death, the purpose of this study is to describe and compare poor rural and urban Indian women's experiences of perinatal grief. PARTICIPANTS AND METHODS Two cross-sectional studies were compared on shared quantitative variables. Poor rural (N = 217) and urban, slum-dwelling (N = 149) Central Indian women with a history of stillbirth, and/or infant death were recruited with the aid of local community health workers. Trained, local, gender, and linguistically matched research assistants conducted the structured interviews. Shared quantitative variables include demographics, Social Provision Scale, Shortened Ways of Coping-Revised, Perinatal Grief Scale, social norms and autonomy. RESULTS While similar with respect to SES, age, number of living sons and perinatal loss experiences, these samples of poor women differed significantly across many variables, most notably women's household position, joint family living, number of live daughters, religious coping, autonomy, and degrees of perinatal grief. While perinatal grief was significantly associated with many variables bi-variably, most lost their relative influence in our stepwise multivariable modeling within site (rural/urban), with only social norms and social support remaining significant for rural (31% of variance) and wishful thinking and social norms for urban participants (38.4% of variance). In the combined sample household position, social support and social norms remained significant and explained 53.6% of the adjusted variance. CONCLUSION In both samples, perinatal grief was high following perinatal loss. Both groups of women with perinatal loss have increased risk of mental health sequelae. Notably, the context affected how they experienced perinatal grief, with rural women's grief being higher and more affected by their societal pressures and isolation. Such nuances are important considerations for much-needed tailored approaches to future interventions.
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Affiliation(s)
- Lisa R Roberts
- School of Nursing, Loma Linda University, Loma Linda, CA, 92350, USA
| | - Solomon J Renati
- Psychology Department, Veer Wajekar A. S. & C. College, University of Mumbai, Navi Mumbai, 400702, India
| | | | - Susanne Montgomery
- School of Behavioral Health, Director of Research, Behavioral Health Institute, Loma Linda University, Loma Linda, CA, 92350, USA
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Das MK, Arora NK, Gaikwad H, Chellani H, Debata P, Rasaily R, Meena KR, Kaur G, Malik P, Joshi S, Kumari M. Grief reaction and psychosocial impacts of child death and stillbirth on bereaved North Indian parents: A qualitative study. PLoS One 2021; 16:e0240270. [PMID: 33503017 PMCID: PMC7840017 DOI: 10.1371/journal.pone.0240270] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Accepted: 12/10/2020] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Grief following stillbirth and child death are one of the most traumatic experience for parents with psychosomatic, social and economic impacts. The grief profile, severity and its impacts in Indian context are not well documented. This study documented the grief and coping experiences of the Indian parents following stillbirth and child death. METHODS This exploratory qualitative study in Delhi (India) included in-depth interviews with parents (50 mothers and 49 fathers), who had stillbirth or child death, their family members (n = 41) and community representatives (n = 12). Eight focus group discussions were done with community members (n = 72). Inductive data analysis included thematic content analysis. Perinatal Grief Scale was used to document the mother's grief severity after 6-9 months of loss. RESULTS The four themes emerged were grief anticipation and expression, impact of the bereavement, coping mechanism, and sociocultural norms and practices. The parents suffered from disbelief, severe pain and helplessness. Mothers expressed severe grief openly and some fainted. Fathers also had severe grief, but didn't express openly. Some parents shared self-guilt and blamed the hospital/healthcare providers, themselves or family. Majority had no/positive change in couple relationship, but few faced marital disharmony. Majority experienced sleep, eating and psychological disturbances for several weeks. Mothers coped through engaging in household work, caring other child(ren) and spiritual activities. Fathers coped through avoiding discussion and work and professional engagement. Fathers resumed work after 5-20 days and mothers took 2-6 weeks to resume household chores. Unanticipated loss, limited family support and financial strain affected the severity and duration of grief. 57.5% of all mothers and 80% mothers with stillbirth had severe grief after 6-9 months. CONCLUSIONS Stillbirth and child death have lasting psychosomatic, social and economic impacts on parents, which are usually ignored. Sociocultural and religion appropriate bereavement support for the parents are needed to reduce the impacts.
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Affiliation(s)
| | | | - Harsha Gaikwad
- Department of Obstetrics and Gynaecology, Safdarjung Hospital and Vardhman Mahavir Medical College, New Delhi, India
| | - Harish Chellani
- Department of Pediatrics, Safdarjung Hospital and Vardhman Mahavir Medical College, New Delhi, India
| | - Pradeep Debata
- Department of Pediatrics, Safdarjung Hospital and Vardhman Mahavir Medical College, New Delhi, India
| | - Reeta Rasaily
- Division of Division of Reproductive Biology Maternal and Child Health, Indian Council of Medical Research, New Delhi, India
| | - K. R. Meena
- Department of Pediatrics, Safdarjung Hospital and Vardhman Mahavir Medical College, New Delhi, India
| | | | | | - Shipra Joshi
- The INCLEN Trust International, New Delhi, India
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Roberts L, Renati S, Solomon S, Montgomery S. Women and Infertility in a Pronatalist Culture: Mental Health in the Slums of Mumbai. Int J Womens Health 2020; 12:993-1003. [PMID: 33192102 PMCID: PMC7654515 DOI: 10.2147/ijwh.s273149] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Accepted: 10/12/2020] [Indexed: 01/07/2023] Open
Abstract
Background Infertility is a global problem, with high prevalence in India. As a pronatalist society, infertility is particularly problematic in India, causing stigma, shame, and blame especially for women. Infertility consequences for women include discrimination, social exclusion, and abandonment, putting them at high risk for mental health distress. Furthermore, mental health is highly stigmatized and specialized care is largely unavailable. Despite the cultural importance of childbearing, research on infertility distress and resulting mental health sequelae is lacking, particularly among low-income women. The purpose of this study is to assess mental health, using validated scales, among Mumbai slum-dwelling women with a history of infertility. Methods We conducted a mixed-method, cross-sectional study. A focus group discussion with community health workers (n = 7) informed the development of a comprehensive survey. The survey consisted of validated scales whenever possible, in addition to questions pertaining to women’s sociodemographic and reproductive history. After rigorous forward and back translation, the surveys were conducted as face-to-face structured interviews due to low literacy levels and the research naiveté of our respondents. Interviews were conducted by culturally, linguistically, gender-matched, trained research assistants. Results Mumbai slum-dwelling women of reproductive age suffering from infertility (N = 74) participated. Most (85%) women and their husbands (66%) reported previous infertility testing. Participants had elevated mental health distress (anxiety and depression symptomology) largely explained by general health, length of marriage, and coping strategy employed. Conclusion Women facing the double stigma of mental health and infertility need innovative programs to address their challenges.
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Affiliation(s)
- Lisa Roberts
- School of Nursing, Loma Linda University, Loma Linda, CA 92350, USA
| | - Solomon Renati
- Department of Psychology, Veer Wajekar A. S. & C. College, Navi Mumbai 400702, India
| | | | - Susanne Montgomery
- School of Behavioral Health, Behavioral Health Institute, Loma Linda University, Loma Linda, CA 92350, USA
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Huberty J, Sullivan M, Green J, Kurka J, Leiferman J, Gold K, Cacciatore J. Online yoga to reduce post traumatic stress in women who have experienced stillbirth: a randomized control feasibility trial. BMC Complement Med Ther 2020; 20:173. [PMID: 32503517 PMCID: PMC7275350 DOI: 10.1186/s12906-020-02926-3] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2019] [Accepted: 04/14/2020] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND About 1 in every 150 pregnancies end in stillbirth. Consequences include symptoms of post traumatic stress disorder (PTSD), depression, and anxiety. Yoga has been used to treat PTSD in other populations and may improve health outcomes for stillbirth mothers. The purpose of this study was to determine: (a) feasibility of a 12-week home-based, online yoga intervention with varying doses; (b) acceptability of a "stretch and tone" control group; and (c) preliminary efficacy of the intervention on reducing symptoms of PTSD, anxiety, depression, perinatal grief, self-compassion, emotional regulation, mindfulness, sleep quality, and subjective health. METHODS Participants (N = 90) were recruited nationally and randomized into one of three groups for yoga or exercise (low dose (LD), 60 min per week; moderate dose (MD), 150 min per week; and stretch-and-tone control group (STC)). Baseline and post-intervention surveys measured main outcomes (listed above). Frequency analyses were used to determine feasibility. Repeated measures ANCOVA were used to determine preliminary efficacy. Multiple regression analyses were used to determine a dose-response relationship between minutes of yoga and each outcome variable. RESULTS Over half of participants completed the intervention (n = 48/90). Benchmarks (≥70% reported > 75% satisfaction) were met in each group for satisfaction and enjoyment. Participants meeting benchmarks (completing > 90% of prescribed minutes 9/12 weeks) for LD and MD groups were 44% (n = 8/18) and 6% (n = 1/16), respectively. LD and MD groups averaged 44.0 and 77.3 min per week of yoga, respectively. The MD group reported that 150 prescribed minutes per week of yoga was too much. There were significant decreases in PTSD and depression, and improvements in self-rated health at post-intervention for both intervention groups. There was a significant difference in depression scores (p = .036) and grief intensity (p = .009) between the MD and STC groups. PTSD showed non-significant decreases of 43% and 56% at post-intervention in LD and MD groups, respectively (22% decrease in control). CONCLUSIONS This was the first study to determine the feasibility and preliminary efficacy of an online yoga intervention for women after stillbirth. Future research warrants a randomized controlled trial. TRIAL REGISTRATION ClinicalTrials.gov. NCT02925481. Registered 10-04-16.
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Shakespeare C, Merriel A, Bakhbakhi D, Baneszova R, Barnard K, Lynch M, Storey C, Blencowe H, Boyle F, Flenady V, Gold K, Horey D, Mills T, Siassakos D. Parents' and healthcare professionals' experiences of care after stillbirth in low- and middle-income countries: a systematic review and meta-summary. BJOG 2018; 126:12-21. [PMID: 30099831 DOI: 10.1111/1471-0528.15430] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/29/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND Stillbirth has a profound impact on women, families, and healthcare workers. The burden is highest in low- and middle-income countries (LMICs). There is need for respectful and supportive care for women, partners, and families after bereavement. OBJECTIVE To perform a qualitative meta-summary of parents' and healthcare professionals' experiences of care after stillbirth in LMICs. SEARCH STRATEGY Search terms were formulated by identifying all synonyms, thesaurus terms, and variations for stillbirth. Databases searched were AMED, EMBASE, MEDLINE, PsychINFO, BNI, CINAHL. SELECTION CRITERIA Qualitative, quantitative, and mixed method studies that addressed parents' or healthcare professionals' experience of care after stillbirth in LMICs. DATA COLLECTION AND ANALYSIS Studies were screened, and data extracted in duplicate. Data were analysed using the Sandelowski meta-summary technique that calculates frequency and intensity effect sizes (FES/IES). MAIN RESULTS In all, 118 full texts were screened, and 34 studies from 17 countries were included. FES range was 15-68%. Most studies had IES 1.5-4.5. Women experience a broad range of manifestations of grief following stillbirth, which may not be recognised by healthcare workers or in their communities. Lack of recognition exacerbates negative experiences of stigmatisation, blame, devaluation, and loss of social status. Adequately developed health systems, with trained and supported staff, are best equipped to provide the support and information that women want after stillbirth. CONCLUSIONS Basic interventions could have an immediate impact on the experiences of women and their families after stillbirth. Examples include public education to reduce stigma, promoting the respectful maternity care agenda, and investigating stillbirth appropriately. TWEETABLE ABSTRACT Reducing stigma, promoting respectful care and investigating stillbirth have a positive impact after stillbirth for women and families in LMICs.
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Affiliation(s)
- C Shakespeare
- School of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.,Department of Women and Children's Health, The Chilterns, Southmead Hospital, Bristol, UK
| | - A Merriel
- School of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.,Department of Women and Children's Health, The Chilterns, Southmead Hospital, Bristol, UK
| | - D Bakhbakhi
- School of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.,Department of Women and Children's Health, The Chilterns, Southmead Hospital, Bristol, UK
| | - R Baneszova
- 2nd Department of Obstetrics and Gynaecology, Faculty of Medicine, University Hospital Bratislava, Comenius University, Bratislava, Slovakia
| | - K Barnard
- Library and Knowledge Service, Southmead Hospital, North Bristol NHS Trust, Bristol, UK
| | - M Lynch
- Department of Women and Children's Health, The Chilterns, Southmead Hospital, Bristol, UK
| | - C Storey
- International Stillbirth Alliance, Bristol, UK
| | - H Blencowe
- London School of Hygiene and Tropical Medicine, London, UK
| | - F Boyle
- Centre of Research Excellence in Stillbirth, Mater Research Institute, University of Queensland, South Brisbane, Qld, Australia
| | - V Flenady
- Centre of Research Excellence in Stillbirth, Mater Research Institute, University of Queensland, South Brisbane, Qld, Australia
| | - K Gold
- Department of Medicine, Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI, USA
| | - D Horey
- La Trobe University, Bundoora, Vic., Australia
| | - T Mills
- School of Nursing, Midwifery and Social Work, University of Manchester, Manchester, UK
| | - D Siassakos
- School of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.,Department of Women and Children's Health, The Chilterns, Southmead Hospital, Bristol, UK
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Oman D, Bormann JE. Eknath Easwaran’s Mantram and Passage Meditation as Applied Indian Psychology: Psycho-Spiritual and Health Effects. PSYCHOLOGICAL STUDIES 2018. [DOI: 10.1007/s12646-018-0448-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Huberty J, Matthews J, Leiferman J, Cacciatore J, Gold KJ. A study protocol of a three-group randomized feasibility trial of an online yoga intervention for mothers after stillbirth (The Mindful Health Study). Pilot Feasibility Stud 2017; 4:12. [PMID: 28694991 PMCID: PMC5501104 DOI: 10.1186/s40814-017-0162-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Accepted: 06/15/2017] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND In the USA, stillbirth (in utero fetal death ≥20 weeks gestation) is a major public health issue. Women who experience stillbirth, compared to women with live birth, have a nearly sevenfold increased risk of a positive screen for post-traumatic stress disorder (PTSD) and a fourfold increased risk of depressive symptoms. Because the majority of women who have experienced the death of their baby become pregnant within 12-18 months and the lack of intervention studies conducted within this population, novel approaches targeting physical and mental health, specific to the needs of this population, are critical. Evidence suggests that yoga is efficacious, safe, acceptable, and cost-effective for improving mental health in a variety of populations, including pregnant and postpartum women. To date, there are no known studies examining online-streaming yoga as a strategy to help mothers cope with PTSD symptoms after stillbirth. METHODS The present study is a two-phase randomized controlled trial. Phase 1 will involve (1) an iterative design process to develop the online yoga prescription for phase 2 and (2) qualitative interviews to identify cultural barriers to recruitment in non-Caucasian women (i.e., predominately Hispanic and/or African American) who have experienced stillbirth (N = 5). Phase 2 is a three-group randomized feasibility trial with assessments at baseline, and at 12 and 20 weeks post-intervention. Ninety women who have experienced a stillbirth within 6 weeks to 24 months will be randomized into one of the following three arms for 12 weeks: (1) intervention low dose (LD) = 60 min/week online-streaming yoga (n = 30), (2) intervention moderate dose (MD) = 150 min/week online-streaming yoga (n = 30), or (3) stretch and tone control (STC) group = 60 min/week of stretching/toning exercises (n = 30). DISCUSSION This study will explore the feasibility and acceptability of a 12-week, home-based, online-streamed yoga intervention, with varying doses among mothers after a stillbirth. If feasible, the findings from this study will inform a full-scale trial to determine the effectiveness of home-based online-streamed yoga to improve PTSD. Long-term, health care providers could use online yoga as a non-pharmaceutical, inexpensive resource for stillbirth aftercare. TRIAL REGISTRATION NCT02925481.
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Affiliation(s)
- Jennifer Huberty
- School of Nutrition and Health Promotion, Arizona State University, 500 N. 3rd St, Phoenix, AZ 85004 USA
| | - Jeni Matthews
- School of Nutrition and Health Promotion, Arizona State University, 500 N. 3rd St, Phoenix, AZ 85004 USA
| | - Jenn Leiferman
- Colorado School of Public Health, University of Colorado Denver, 13001 E. 17th Place, B119, Bldg 500, Room E3341, Anschutz Medical Campus, Aurora, CO 80045 USA
| | - Joanne Cacciatore
- School of Social Work, Arizona State University, 411 N. Central, 8th Floor, Phoenix, AZ 85004 USA
| | - Katherine J Gold
- Department of Family Medicine, Department of Obstetrics & Gynecology, University of Michigan, 1018 Fuller Street, Ann Arbor, MI 48104-1213 USA
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Roberts L, Montgomery S, Ganesh G, Kaur HP, Singh R. Addressing Stillbirth in India Must Include Men. Issues Ment Health Nurs 2017; 38:590-599. [PMID: 28350492 DOI: 10.1080/01612840.2017.1294220] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Millennium Development Goal 4, to reduce child mortality, can only be achieved by reducing stillbirths globally. A confluence of medical and sociocultural factors contribute to the high stillbirth rates in India. The psychosocial aftermath of stillbirth is a well-documented public health problem, though less is known of the experience for men, particularly outside of the Western context. Therefore, men's perceptions and knowledge regarding reproductive health, as well as maternal-child health are important. METHODS Key informant interviews (n = 5) were analyzed and 28 structured interviews were conducted using a survey based on qualitative themes. RESULTS Qualitative themes included men's dual burden and right to medical and reproductive decision making power. Wives were discouraged from expressing grief and pushed to conceive again. If not successful, particularly if a son was not conceived, a second wife was considered a solution. Quantitative data revealed that men with a history of stillbirths had greater anxiety and depression, perceived less social support, but had more egalitarian views towards women than men without stillbirth experience. At the same time fathers of stillbirths were more likely to be emotionally or physically abusive. Predictors of mental health, attitudes towards women, and perceived support are discussed. CONCLUSIONS Patriarchal societal values, son preference, deficient women's autonomy, and sex-selective abortion perpetuate the risk for future poor infant outcomes, including stillbirth, and compounds the already higher risk of stillbirth for males. Grief interventions should explore and take into account men's perceptions, attitudes, and behaviors towards reproductive decision making.
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Affiliation(s)
- Lisa Roberts
- a School of Nursing, Loma Linda University , Loma Linda , California , USA
| | - Susanne Montgomery
- b School of Behavioral Health, Behavioral Health Institute, Loma Linda University , Loma Linda , California , USA
| | - Gayatri Ganesh
- c Christian Hospital Mungeli , Mungeli , Chhattisgarh , India
| | - Harinder Pal Kaur
- d Summer Institute Intern, School of Behavioral Health, Loma Linda University , Loma Linda , California , USA
| | - Ratan Singh
- c Christian Hospital Mungeli , Mungeli , Chhattisgarh , India
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Murphy S, Cacciatore J. The psychological, social, and economic impact of stillbirth on families. Semin Fetal Neonatal Med 2017; 22:129-134. [PMID: 28214156 DOI: 10.1016/j.siny.2017.02.002] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
This article reviews the current state of psychological, social, and economic research into the impact of stillbirth on families. We argue that whereas the knowledge we have of the experiential aspects of stillbirth is increasing, there is still much that remains to be uncovered especially in respect of the impact that seeing the baby may have on mental health. Moreover, the experience of particular social groups merits further work, most notably regarding same-sex couples and surrogates, mothers and fathers drawn from Black and Minority Ethnic groups as well as those from lower socio-economic groups. Particular attention needs to be paid to the economic impact of stillbirth on families, whether this is from a perspective that focuses on the family or the wider society in which they live.
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Affiliation(s)
- Samantha Murphy
- Faculty of Health and Social Care, The Open University, Milton Keynes, UK.
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Roberts LR, Montgomery SB. Mindfulness-Based Intervention for Perinatal Grief in Rural India: Improved Mental Health at 12 Months Follow-Up. Issues Ment Health Nurs 2016; 37:942-951. [PMID: 27911141 DOI: 10.1080/01612840.2016.1236864] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Stillbirth is a significant global health problem that frequently results in perinatal grief with compound negative psychosocial impact. In low-resource settings with exceedingly high stillbirth rates, such as rural Chhattisgarh, India, it is vital to utilize low-cost, effective interventions. Mindfulness-based stress reduction is an evidence-based intervention utilized for a broad range of physical and mental health problems, and is adaptable to specific populations. The objective of this study was to explore the sustained effectiveness of a shortened, culturally adapted mindfulness-based intervention (MBI) designed to address complex grief after stillbirth. We used an observational, mixed-methods pre-post study design with 6-week and 12-month follow-up assessments among women with a history of stillbirth (N = 22). Analyses explored study outcomes and continued use of mindfulness skills. Pretest results showed elevated psychological symptoms and high levels of perinatal grief. General linear modeling repeated measures was used to explore 6-week and 12-month follow-up changes from baseline, controlling for significantly correlated demographic variables. Longitudinal results indicated significant reductions in perinatal grief and psychological symptoms; four of the five facets of mindfulness changed in the desired direction; and resilience scores indicated thriving. The shortened, culturally adapted, MBI pilot brought about sustained, significant reductions of perinatal grief and mental health symptoms, and participants reported use of mindfulness skills in day-to-day life. This study shows that the significant mental health needs among rural women of various castes and ethnicities in Chhattisgarh following stillbirth were successfully addressed by a promising MBI with potential scalability and sustainability.
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Affiliation(s)
- Lisa R Roberts
- a Loma Linda University, School of Nursing , Loma Linda , California , USA
| | - Susanne B Montgomery
- b Loma Linda University, Behavioral Health Institute , Loma Linda , California , USA
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Bhargava R, Kumar N, Gupta A. Indian Perspective on Psychotherapy: Cultural Issues. JOURNAL OF CONTEMPORARY PSYCHOTHERAPY 2016. [DOI: 10.1007/s10879-016-9348-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Oman D, Singh NN. Combining Indian and Western Spiritual Psychology: Applications to Health and Social Renewal. PSYCHOLOGICAL STUDIES 2016. [DOI: 10.1007/s12646-016-0362-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Huberty JL, Matthews J, Leiferman J, Hermer J, Cacciatore J. When a Baby Dies: A Systematic Review of Experimental Interventions for Women After Stillbirth. Reprod Sci 2016; 24:967-975. [DOI: 10.1177/1933719116670518] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
- Jennifer L. Huberty
- School of Nutrition and Health Promotion, Arizona State University, Phoenix, AZ, USA
| | - Jeni Matthews
- School of Nutrition and Health Promotion, Arizona State University, Phoenix, AZ, USA
| | - Jenn Leiferman
- Colorado School of Public Health, University of Colorado at DenverAnschutz Medical Campus, Aurora, CO, USA
| | - Janice Hermer
- ASU library, Arizona State University, Phoenix, AZ, USA
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Paris GF, Montigny FD, Pelloso SM. Factors associated with the grief after stillbirth: a comparative study between Brazilian and Canadian women. Rev Esc Enferm USP 2016; 50:546-553. [DOI: 10.1590/s0080-623420160000500002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2015] [Accepted: 07/23/2016] [Indexed: 11/22/2022] Open
Abstract
Abstract OBJECTIVE To verify the association between complicated grief and sociodemographic, reproductive, mental, marital satisfaction, and professional support characteristics in women after stillbirth. METHOD Cross-sectional study with 26 women who had stillbirth in 2013, living in the city of Maringá, Brazil, and eight women who attended the Centre d'Études et de Rechercheen Intervention Familiale at the University of Quebec en Outaouais, in Canada. The instrument was administered as an interview to a small number of mothers of infants up to three months (n=50), who did not participate in the validation study. RESULTS By applying the short version of the Perinatal Grief Scale, the prevalence of complicated grief in Brazilian women was found to be higher (35%) in relation to Canadian women (12%).Characteristics of the Brazilian women associated with the grief period included the presence of previous pregnancy with live birth, absence of previous perinatal loss, postpartum depression, and lack of marital satisfaction. For the Canadians it was observed that 80% of the women presenting no grief made use of the professional support group. In both populations the occurrence of complicated grief presented a higher prevalence in women with duration of pregnancy higher than 28 weeks. CONCLUSION The women that must be further investigated during the grief period are those living in Brazil, making no use of a professional support group, presenting little to no marital satisfaction, having no religion, and of a low educational level.
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Roberts LR, Jadalla A, Jones-Oyefeso V, Winslow B, Taylor EJ. Researching in Collectivist Cultures. J Transcult Nurs 2016; 28:137-143. [DOI: 10.1177/1043659615623331] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Commonalities are presented from the experiences of U.S. nurse researchers who conducted studies in India, Jordan, Aotearoa/New Zealand, and Trinidad and Tobago. While planning research, it is important to engage collaborators who are members of the culture to be studied to understand what are culturally appropriate aims and methods. It is also vital to observe cultural etiquette, especially while gaining entrée and collecting data. Issues related to data collection include timing it around local holidays and events, and adapting individualist methods for obtaining consent and data to be more respectful for those in a collectivist culture. Care must be taken to give back, to sharing findings, and insure sustainability for future research in the host culture. Based on these and other reflections, recommendations are offered to support investigators planning research in a culture that is not their own.
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Lever Taylor B, Cavanagh K, Strauss C. The Effectiveness of Mindfulness-Based Interventions in the Perinatal Period: A Systematic Review and Meta-Analysis. PLoS One 2016; 11:e0155720. [PMID: 27182732 PMCID: PMC4868288 DOI: 10.1371/journal.pone.0155720] [Citation(s) in RCA: 97] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2015] [Accepted: 05/03/2016] [Indexed: 12/20/2022] Open
Abstract
Perinatal mental health difficulties are associated with adverse consequences for parents and infants. However, the potential risks associated with the use of psychotropic medication for pregnant and breastfeeding women and the preferences expressed by women for non-pharmacological interventions mean it is important to ensure that effective psychological interventions are available. It has been argued that mindfulness-based interventions may offer a novel approach to treating perinatal mental health difficulties, but relatively little is known about their effectiveness with perinatal populations. This paper therefore presents a systematic review and meta-analysis of the effectiveness of mindfulness-based interventions for reducing depression, anxiety and stress and improving mindfulness skills in the perinatal period. A systematic review identified seventeen studies of mindfulness-based interventions in the perinatal period, including both controlled trials (n = 9) and pre-post uncontrolled studies (n = 8). Eight of these studies also included qualitative data. Hedge's g was used to assess uncontrolled and controlled effect sizes in separate meta-analyses, and a narrative synthesis of qualitative data was produced. Pre- to post-analyses showed significant reductions in depression, anxiety and stress and significant increases in mindfulness skills post intervention, each with small to medium effect sizes. Completion of the mindfulness-based interventions was reasonable with around three quarters of participants meeting study-defined criteria for engagement or completion where this was recorded. Qualitative data suggested that participants viewed mindfulness interventions positively. However, between-group analyses failed to find any significant post-intervention benefits for depression, anxiety or stress of mindfulness-based interventions in comparison to control conditions: effect sizes were negligible and it was conspicuous that intervention group participants did not appear to improve significantly more than controls in their mindfulness skills. The interventions offered often deviated from traditional mindfulness-based cognitive therapy or mindfulness-based stress reduction programmes, and there was also a tendency for studies to focus on healthy rather than clinical populations, and on antenatal rather than postnatal populations. It is argued that these and other limitations with the included studies and their interventions may have been partly responsible for the lack of significant between-group effects. The implications of the findings and recommendations for future research are discussed.
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Affiliation(s)
| | - Kate Cavanagh
- School of Psychology, University of Sussex, Brighton, United Kingdom
| | - Clara Strauss
- Sussex Partnership NHS Foundation Trust, Brighton, United Kingdom
- School of Psychology, University of Sussex, Brighton, United Kingdom
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Roberts L, Montgomery S. Mindfulness-based Intervention for Perinatal Grief Education and Reduction among Poor Women in Chhattisgarh, India: a Pilot Study. INTERDISCIPLINARY JOURNAL OF BEST PRACTICES IN GLOBAL DEVELOPMENT 2016; 2:1. [PMID: 28357415 PMCID: PMC5367631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
INTRODUCTION Stillbirth is a significant public health problem in low-to-middle-income countries and results in perinatal grief, often with negative psychosocial impact. In low-resource settings, such as Chhattisgarh, India, where needs are high, it is imperative to utilize low-cost, effective interventions. Mindfulness-based stress reduction (MBSR) is an empirically sound intervention that has been utilized for a broad range of physical and mental health problems, and is adaptable to specific populations. The main objective of this pilot study was to explore the feasibility and effectiveness of a shortened, culturally adapted mindfulness-based intervention to address complex grief after stillbirth. METHODS We used an observational, pre-post-6-week post study design. The study instrument was made up of descriptive demographic questions and validated scales and was administered as a structured interview due to low literacy rates. We used a community participatory approach to culturally adapt the five-week mindfulness-based intervention and delivered it through two trained local nurses. Quantitative and qualitative data analyses explored study outcomes as well as acceptability and feasibility of the intervention. RESULTS 29 women with a history of stillbirth enrolled, completed the pretest and began the intervention; 26 completed the five-week intervention and post-test (89.7%), and 23 completed the six-week follow-up assessment (88.5%). Pretest results included elevated psychological symptoms and high levels of perinatal grief, including the active grief, difficulty coping, and despair subscales. General linear modeling repeated measures was used to explore posttest and six-week follow up changes from baseline, controlling for significantly correlated demographic variables. These longitudinal results included significant reduction in psychological symptoms; four of the five facets of mindfulness changed in the desired direction, two significantly; as well as significant reduction in overall perinatal grief and on each of the three subscales. DISCUSSION The shortened, culturally adapted, mindfulness-based intervention pilot study was well received and had very low attrition. We also found significant reductions of perinatal grief and mental health symptoms over time, as well as a high degree of practice of mindfulness skills by participants. This study not only sheds light on the tremendous mental health needs among rural women of various castes who have experienced stillbirth in Chhattisgarh, it also points to a promising effective intervention with potential to be taken to scale for wider delivery.
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Abstract
Infertility and perinatal loss are common, and associated with lower quality of life, marital discord, complicated grief, major depressive disorder, anxiety disorders, and post-traumatic stress disorder. Young women, who lack social supports, have experienced recurrent pregnancy loss or a history of trauma and / or preexisting psychiatric illness are at a higher risk of experiencing psychiatric illnesses or symptoms after a perinatal loss or during infertility. It is especially important to detect, assess, and treat depression, anxiety, or other psychiatric symptoms because infertility or perinatal loss may be caused or perpetuated by such symptoms. Screening, psychoeducation, provision of resources and referrals, and an opportunity to discuss their loss and plan for future pregnancies can facilitate addressing mental health concerns that arise. Women at risk of or who are currently experiencing psychiatric symptoms should receive a comprehensive treatment plan that includes the following: (1) proactive clinical monitoring, (2) evidence-based approaches to psychotherapy, and (3) discussion of risks, benefits, and alternatives of medication treatment during preconception and pregnancy.
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Affiliation(s)
- Amritha Bhat
- Department of Psychiatry, University of Washington, Box 35650, Seattle, WA, 98195, USA.
| | - Nancy Byatt
- Departments of Psychiatry and Obstetrics and Gynecology, UMass Medical School, Worcester, MA, USA
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Depression, a Hidden Mental Health Disparity in an Asian Indian Immigrant Community. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2015; 13:ijerph13010027. [PMID: 26703654 PMCID: PMC4730418 DOI: 10.3390/ijerph13010027] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/17/2015] [Revised: 09/26/2015] [Accepted: 10/12/2015] [Indexed: 12/22/2022]
Abstract
Cultural influences are deeply rooted, and continue to affect the lives of Asian-Indian (AI) immigrants living in Western culture. Emerging literature suggests the powerful nature of traditions and culture on the lives, mental and physical health of AI immigrants, particularly women. The purpose of this study was to explore depression among AI women in Central California (CC). This mixed-methods research was conducted in collaboration with the CC Punjabi community and the support of local religious leaders. All interviews were conducted in Punjabi and English. Whenever possible we utilized validated scales aligned with emerging themes from the qualitative data, which also provided contextualization to survey responses. In all we conducted 11 key informant interviews, four focus groups (n = 47) and a rigorously developed anonymous survey (n = 350). Social dynamics and traditional expectations including gendered roles significantly affected mental health among women participants. Subgroups along the lines of language choice (Punjabi vs. English) experience and report depression differently in part due to the highly stigmatized nature of mental health issues in this model minority community. The findings of this study highlight the importance of utilizing mixed methods to access hard to reach populations regarding sensitive topics such as mental health.
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