Alcorn State Effects of Social Support on Low Socioeconomic Status Pregnant Women

Alcorn State Effects of Social Support on Low Socioeconomic Status Pregnant Women Alcorn State Effects of Social Support on Low Socioeconomic Status Pregnant Women Please read the following article provided in the link above. Complete the following assignment. Read the assigned article and provide responses to the following questions. Please be sure to check for grammar. Include a title page and a reference page that adheres to APA style. Include each of the following areas, as well as your responses. This assignment is worth 100 points and should be 1-2 pages. NO LATE ASSIGNMENTS WILL BE ACCEPTED. Each assignment will be checked for plagiarism. Be sure to cite all information correctly in the assignment and on the reference page. Any suspected plagiarism will result in a grade of ZERO. This assignment is due by 5 PM on Sunday, 10/27/19. Please answer each of the following items specifically in paragraph-format. 1. 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Massey, MS Department of Psychology, Oklahoma State University, Stillwater, Oklahoma, USA Abstract This study identified how close relationships are related to low-income pregnant women’s ability to cope and overall health. Previous research has shown that stress during pregnancy is related to long-term negative physical and psychological health outcomes for both the mother and the infant. Lower socioeconomic status has been related to higher morbidity and mortality across the lifespan. Women typically rely on close relationships for social support to help reduce stress. However, stress levels can be elevated when women engage in co-rumination. Co-rumination is defined as excessive problem discussion with negative-affect focus. Thirty-one low-income pregnant women from central Oklahoma, USA, reported their daily stressors, social support, communication habits with friends and family, and general health in a series of questionnaires at a prenatal visit. The results revealed that daily stressors, co-rumination with friends, and the relationship with the baby’s father were related to physical pain and depressive symptoms. The results suggested that specific social support dynamics, such as co-rumination, during pregnancy have implications for the health of lowincome mothers and their infants. Key words co-rumination, depression, prenatal health, prenatal stress, social support, socioeconomic status. INTRODUCTION Pregnancy is a time of increased vulnerability to biological and psychosocial demands (Parcells, 2010). Chronic stress during pregnancy is a major health concern for both the mother and developing fetus. Overall, in the general population, chronic stress can be a risk factor for a variety of illnesses, including autoimmune disorders, mental illness, hypertension, digestion problems, irritable bowel syndrome, muscle atrophy, fatigue, and increased morbidity (Sapolsky, 2004). Elevated maternal stress, in particular, increases susceptibility to prenatal depression, which in turn increases the risk for preterm birth (Turner et al., 1990; Talge et al., 2007; Buss et al., 2009; Li et al., 2009), and obesity, coronary disease, and psychiatric disorders to her offspring (Fowden et al., 2006). Social support can be a powerful buffer of stress and resulting consequences, particularly for women (Taylor et al., 2000). Social support can be seen as emotional support, problem-solving support, practical and material support, and social integration (Sommer, 1990). Previous research has shown that positive supportive relationships, in which the person is given encouragement and acceptance, can act as a protective factor from mortality, especially involving the Correspondence address: Jennifer Byrd-Craven, Department of Psychology, Oklahoma State University, 116 North Murray, Stillwater, OK 74078, USA. Email: [email protected] Received 19 July 2012; revision received 29 December 2012; accepted 9 January 2013. © 2013 Wiley Publishing Asia Pty Ltd. cardiovascular, endocrine, and immune systems (Uchino et al., 1999). In addition, the level of family social support can buffer the effects of other negative social interactions to some degree. Alcorn State Effects of Social Support on Low Socioeconomic Status Pregnant Women Positive family support includes experienced assistance and understanding. Turner et al. (1990) found that pregnant teens living at home and having supportive parents had the lowest levels of depressive symptoms. They found lack of experienced support to have an adverse effect on the infants’ birth weight. Some types of social support, however, can actually elevate the stress response, depending on the specific interpersonal dynamics (Byrd-Craven et al., 2008). Co-rumination, most commonly occurs in friendships of girls and women, and is characterized by excessive problem discussion with a predominant negative-affect focus, typically in the context of a high-quality friendship (Rose, 2002; Rose et al., 2007). Disruption of social networks during pregnancy substantially alters neonatal outcomes, impacting stress responses, and subsequently, birth weight, cognitive development and even infant mortality (Vrekoussis et al., 2010). Disruption of social support during this time can include segregation from others or negative social interactions. For many pregnant women, a primary means of social support is the father of the baby. Pregnant women reporting significant stressful life events, such as job loss, physical discomfort, difficulty performing physical work, and increased economic needs, had increased depressive symptoms (assessed via the Beck Depression Inventory) if their partners were unsupportive or unconnected, but did not report such symptoms if they had doi: 10.1111/nhs.12043 Lean on me high levels of support from their partners (Chapman et al., 1997). Greater partner support, in the form of aid and attachment, has been linked to lower anxiety levels and stronger attachment to the infant (Zachariah, 2009), and to lower emotional distress postpartum and less distressed infants to novel stimuli or situations (Stapelton et al., 2012). Women of lower socioeconomic status (SES) are likely to have more daily and cumulative stressors, and are more likely to have lower family and partner support compared with higher SES women (Earls & Buka, 2000; Shonkoff & Phillips, 2000). These stressors are often seen in the form of economic needs and safety, but can also include negative social interactions. Lower SES is related to lower overall amounts of social support and less diverse social networks, as well as higher basal cortisol levels and greater cumulative physiological effects of stress (Seeman et al., 2010). Importantly, women are particularly at risk of the negative effects of low or disrupted social support during and directly after pregnancy when, due to the demands of caring for a newborn, their need for social support increases (Turner et al., 1990; Yim et al., 2009). The limited amount or dysfunctional social support that lower SES women have is often characterized by negative interactions that can precipitate depression (Gianarous et al., 2008). In addition, prenatal complications have been seen in low SES women reportedly due to state anxiety and low total functional support (Zachariah, 2009).Alcorn State Effects of Social Support on Low Socioeconomic Status Pregnant Women Due to lack of partner and social support, lower SES women might be more likely to rely on friendships as a primary source of social support, rather than relying on partner support. One social support dynamic with potentially negative consequences is co-rumination. Co-rumination, extensively discussing and revisiting problems, speculating about problems, and focusing on negative feelings, is known to have tradeoffs (Rose, 2002). Girls and women engaging in this type of dyadic self-disclosure with friends typically report higher feelings of intimacy and closeness with friends, but also increased depressive and anxiety symptoms (Rose, 2002; Rose et al., 2007). A potential explanation for this paradox is that this type of social dynamic fails to reduce stress system activity (assessed via cortisol levels during affiliation), a hallmark of affiliative interactions, especially in women (Taylor, 2006). In fact, physiological stress markers (cortisol and a-amylase) are elevated when women engage in co-rumination, particularly focusing on negative affect, even when they perceive these interactions to be supportive (Byrd-Craven et al., 2008). Thus, examining the specific dynamics of friendship interactions is important in determining whether or not these interactions serve as protective or risk factors. Women with low levels of social support in other domains (e.g. partner or family support) might attempt to compensate by using friendships as a primary means of social support, particularly during a transitional, vulnerable, and unpredictable time, such as pregnancy (Taylor, 2006; Flinn et al., 2007). To the authors’ knowledge, the impact of co-rumination as a social interaction style has not been examined in pregnant women, particularly those experiencing life stressors. Related specifically to pregnancy, social support in general is linked to health behaviors, such as nutritional 375 intake, such that the higher the perceived social support, the more health behaviors women engaged in (Canella, 2006; Fowles et al., 2011). This has been shown in low-income women who partake in more fast-food consumption and have increased caloric intake, which might result in excessive gestational weight gain and more depressive symptoms (Fowles et al., 2011). The current study examined the relationship between social support dynamics, specifically co-rumination, and support from the baby’s father, of low SES women, and the maternal health and emotional outcomes. We predicted that daily stressors would be related to engaging in co-rumination with friends, and that co-rumination would have negative health consequences. We also predicted that the absence and lack of interaction with the baby’s father would be related to depressive symptoms, and that depressive symptoms would in turn be related to physical symptoms, such as bodily pain during pregnancy. METHODS Participants This study was approved by the Institutional Review Board at Oklahoma State University (Stillwater, OK, USA).Alcorn State Effects of Social Support on Low Socioeconomic Status Pregnant Women Participants included 31 low-income (mean annual income: < $US15,000) pregnant women, in their second or third trimester (Mage = 22.9, SD = 5.81, range = 17–39), from central Oklahoma in the USA. The ethnic composition of the sample was variable, with 58% Caucasian, 16% Native American, 10% African American, 3% Hispanic, 3% Asian American, and 10% other. All participants were English speaking. Fiftytwo percent were single, 32% married, 13% cohabitating, and 3% were divorced. They were recruited from two obstetrician–gynecologist clinics during prenatal visits, and qualified for the study if they were currently on governmentassisted health insurance. They received $US5 for their participation. Procedures Participants were approached at the clinics after being identified by the office staff as Medicare recipients. They were then asked if they were willing to answer questionnaires about their relationships, daily stressors, and health. If the participants agreed, they were taken to a private room to complete the questionnaires. Measures Participants reported demographic information, such as age, education, and income level, and the current status of their relationship with their baby’s father. This variable ranged from married, in a committed relationship with plans to marry, cohabitating with uncertain future plans, in a relationship but not cohabitating, to no current relationship. Co-rumination Questionnaire The participants then completed the 27-item Co-Rumination Questionnaire (Rose, 2002) that assessed co-rumination with © 2013 Wiley Publishing Asia Pty Ltd. 376 friends using a five-point scale. Items assessed the extent to which they discussed problems excessively, rehashed problems, speculated about the causes and consequences of problems, engaged in mutual encouragement of problem discussion, and focused on negative affect in their discussions. Items assessed a more extreme form of problem discussion than items typically used to assess normative self-disclosure (e.g. “When we talk about a problem that one of us has, we usually talk about that problem every day, even if nothing new has happened”). Reported co-rumination scores were the mean rating across the items (a = 0.92). RAND-36 Next, they completed the RAND-36 Item Health Inventory that assesses physical and emotional well-being over a period of the preceding two weeks, with high internal consistency (a = 0.81) and test–retest reliability (a = 0.89) (Brouwer et al., 2007). Depressive symptoms were taken from a total of nine items, and included questions such as “How often have you felt so down in the dumps that nothing could cheer you up?” and “How often have you felt downhearted and blue?”. Items asked participants to rate on a 1–6 scale, ranging from 1 (“all of the time”) to 6 (“none of the time”). Daily Stress Inventory The Daily Stress Inventory assesses the stressors experienced in the past 24 , and participants then rate the severity of that stressor on seven-point Likert-type scale (1 = not severe, 7 = severe). Example items are “hurried to meet a deadline” and “had money problems.” RESULTS A series of regression analyses was conducted to determine the relationship between stress, co-rumination, and health outcomes. Total scores from the Daily Stress Inventory predicted the level of co-rumination with friends (F[1,30] = 11.63, b = 0.56, P < 0.01). More severe ratings of daily stressors were related to higher frequencies of co-ruminating.Alcorn State Effects of Social Support on Low Socioeconomic Status Pregnant Women Co-rumination, in turn, predicted reports of pain interfering with daily activities from the RAND-36 Item Health Inventory (F[1,30] = 6.92, b = 0.46, P < 0.05). Relationship with the baby’s father predicted depressive symptoms from the RAND-36 Item Health Inventory (F[1,30] = 5.63, b = -0.42, P < 0.05). The more distant the relationship with the baby’s father (e.g. no current relationship), the higher the depressive symptoms were reported to be. Finally, depressive symptoms predicted bodily pain scores from the RAND 36-Item Health Inventory (F [1,30] = 7.43, b = 0.47, P < 0.01). Higher depressive symptoms were associated with higher pain scores. DISCUSSION The results of the current study help show how relationships can impact the physical and psychological health of pregnant women, especially in low SES contexts. A major © 2013 Wiley Publishing Asia Pty Ltd. J. Byrd-Craven and A. R. Massey limitation of the study is its low sample size. Thus, results should be interpreted with extreme caution. The results revealed that total stress levels were related to a higher frequency of co-rumination. Co-rumination predicted reports of bodily pain that interfered with daily activities. These women, in attempting to cope with high frequencies of daily stressors, appeared to be utilizing their friendships as a way of coping, especially given the low amount of partner support. However, these underlying dynamics (excessive problem discussion) appeared to be serving as a risk, rather than a protective factor. Although co-rumination is related to having friends, and perhaps quality social support, the tradeoff is that it is also related to internalizing problems (Rose, 2002; Rose et al., 2007). Co-rumination has been seen to significantly increase stress hormones, cortisol, and a-amylase in women (Byrd-Craven et al., 2011). This increase in stress hormones, particularly if co-rumination occurs on a consistent basis, as the women in our study reported it to be, might be responsible for the link between co-rumination and reports of pain interfering with daily activities. Some social dynamics have also been shown to impact the cardiovascular, endocrine, and immune systems (Uchino et al., 1996). Thus, co-rumination, as a social support dynamic, appears to be precipitated by daily stressors and lack of paternal support, and might be especially problematic during pregnancy due to the health risks associated with chronically-high cortisol levels during pregnancy to both the mother and her developing fetus (Buss et al., 2009; Li et al., 2009; Parcells, 2010). In addition, the results showed that the commitment level of the baby’s father was related to depressive symptoms, and depressive symptoms in turn were related to reports of bodily pain. A higher commitment level of the baby’s father was related to the greater emotional well-being of the mother. For many women, a primary means of social support is the father of the baby. This supports current literature that states that social support, particularly partner support, during pregnancy can impact the health and stress of the mother (Campos et al., 2008; Zachariah, 2009). Paternal support has also been shown to be an extremely important factor in chronic stress during pregnancy (Ghosh et al., 2010). Lower SES women, such as those in this sample, are not only especially likely to have little or no paternal support, but are also at high risk for preterm birth (Schetter, 2009). The finding of depressive symptoms being associated with bodily pain is consistent with the idea that the stress associated with lacking partner support might qualify as a chronic stressor, leading to increased cortisol secretion, dysregulating inflammatory control processes, and the experience of bodily pain (McEwen, 1998). This study showed that the dynamics of social support was indeed an important factor to examine for pregnant women, but it was not without limitations. One such limitation of the current study was the sample size, as mentioned earlier. We were unable to get a larger sample size due to limited funding for participant payment, and difficulty recruiting in this population. Although we chose a location in which low-income women were receiving prenatal care, many were unable to participate due to reliance on others Lean on me as a mode of transportation and limited available time. This might be better viewed as a pilot study that shows that follow-up studies in this area are needed. In addition, the study of social support dynamics, both partner and friendship support, during pregnancy should also be examined in higher SES women. We chose to examine low SES women because they have more cumulative life stressors, and often have lower or disrupted social support. Possible differences in results might be obtained in varying cultures. In Western cultures, small family units are typically responsible for the care of children, and social support for parents typically comes primarily from within the parental relationship. Other cultures in which alloparenting, care by individuals other than parents (e.g. grandparents or other relatives), is common might allow for larger means of support, with or without the father present (Flinn et al., 2007). While this study and future studies could help develop interventions for pregnant women to reduce stress through changing the dynamics in their social support systems, it would be important to include a higher SES comparison group. Although more work is needed, these results are important in determining the role of specific dynamics of social support, such as co-rumination and paternal involvement, in pregnancy outcomes for high-risk women, and could have important implications for future interventions for at-risk pregnant women. Specifically, interventions could focus on training women to direct their problem discussions within their friendships toward solutions and problem solving, and away from focus on negative affect. ACKNOWLEDGMENTS The authors would like to acknowledge the following individuals for assistance with various aspects of the project, including recruitment of participants and data collection: Ms Katie Starr Cox, Ms Caitlin Sharp, and Ms Lindsey Shreve. We would like to thank Dr Betsy Babler-Shrader for assistance with the study design and facility recruitment, and Dr Shelia Kennison, for her comments and guidance on previous drafts of this manuscript. CONTRIBUTIONS Study design: JBC, AM. Data collection & analysis: JBC, AM. Manuscript writing: JBC, AM. REFERENCES Brouwer CNM, Schilder AGM, van Stel JF, Rovers M et al. Reliability and validity of functional heal status and health-related quality of life questionnaires in children with recurrent acute otitis media. Qual Life Res. 2007; 16: 1357–1373. Buss C, Entriger S, Reyes JF, Chicz-DeMet A, Sandman CA, Waffarn F, Wadhwa P. The maternal cortisol awakendin response in human pregnancy is assocated with the length of gestation. 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