Access Type

Open Access Dissertation

Date of Award

January 2017

Degree Type

Dissertation

Degree Name

Ph.D.

Department

Nursing

First Advisor

Carmen Giurgescu

Abstract

Purpose and Background/Significance: Postpartum depression (PPD) affects 12-20% of U.S. mothers. The PPD rates for women of Arabic descent are even higher (up to 37%). Higher acculturative stress and acculturation and lack of social support have been related to higher risk for PPD symptoms among immigrant women. No published research has investigated the relationship between acculturative stress, social support, and/ or acculturation and PPD symptoms among U.S. immigrant women of Arabic descent. Therefore, the purpose of this dissertation research was to examine the impact of acculturative stress, social support, and acculturation on PPD symptoms among these women. The specific aims of this study were: Specific Aim 1. Examine the relationships among acculturative stress, social support, acculturation, and PPD symptoms among U.S. immigrant women of Arabic descent;

Specific Aim 2. Examine if social support moderates the associations between acculturative stress and PPD symptoms among U.S. immigrant women of Arabic descent; and

Specific Aim 3. Examine if acculturation variables mediate the associations between acculturative stress and PPD symptoms among U.S. immigrant women of Arabic descent. Theoretical/ conceptual framework: This study was guided by Berry’s (1997) Acculturation Framework which identified acculturation as the process of cultural and psychological change that results after contact between cultures. According to Berry, acculturation refers to the process of adapting and adjusting beliefs, behaviors, and values as a result of interacting with other cultural groups. There are four acculturation strategies: (a) integration, a strong identification and deep involvement with the host society with the desire to maintain the original ethnic identity and culture; (b) assimilation, a positive relation with the host society and relinquish of all ties to their own culture; (c) separation, the tendency to focus exclusively on maintaining individual's own cultural values and the practices of their ethnic group, with little or no desire to be a part of the host society; and (d) marginalization, the loss or absence of contact with both the culture of origin and that of the dominant society.

Method: Using a cross-sectional correlational descriptive design, a sample of 115 U.S. immigrant women of Arabic descent were enrolled from clinics in Dearborn, MI. Participants completed a demographic questionnaire, the Multi-dimensional Acculturative Stress Inventory, the Acculturation Rating Scale for Arabic Americans-II, the Multidimensional Scale of Perceived Social Support, and the Edinburgh Postnatal Depression Scale between 1-12 months postpartum. Data were analyzed using correlational and multiple linear regression analyses.

Results: Women had a mean age of 29±5 years and were 5±4 months postpartum. Women have been in the U.S. for 7±6 years and had a mean education of 12±4 years. The majority of women had an annual household income of less than $40,000 (88%), were unemployed (80%), and preferred Arabic language for interview (68%).

Specific Aim 1: Higher levels of acculturative stress (p= .003) and lower levels of social support (p<.0001) predicted PPD symptoms while controlling for years of education, gestational age at birth, and antenatal anxiety. Using stepwise multiple linear regression analysis with all of the variables in the equation to determine if acculturative stress, social support, and acculturation variables [attraction to American Culture (AAmC) , attraction to Arabic Culture (AArC), and marginalization) were predictors of PPD symptoms after controlling for covariates. In the optimal model, higher levels of education (p<.0001), higher reports of antenatal anxiety (p=.02), and lack of social support (p<.0001) predicted PPD symptoms. The model explained 50% of variance in PPD symptoms (R2=.501, p<.0001 for the optimal model).

Specific Aim 2: Social support predicted PPD symptoms (p= .014). However, acculturative stress and the interaction term between acculturative stress and social support were not statistically significant. Thus, the moderating effect of social support on the association between acculturative stress and PPD symptoms was not supported.

Specific Aim 3: First we examined if acculturative stress predicted PPD symptoms. Acculturative stress was a significant predictor for PPD symptoms (p= .004). We then examined if acculturative stress predicted acculturation (AAmc, AArC and marginalization). Acculturative stress was a significant predictor for AAmC and AArC; however, acculturative stress did not predict marginalization, therefore marginalization was excluded from the mediation analysis. Next we examined if acculturation (AAmC and AArC) predicted PPD symptoms. AAmC and AArC did not predict PPD symptoms. We examined the mediating effect of AAmC and AArC on the association between acculturative stress and PPD symptoms. The mediation analysis was found not significant. Thus, the results of the study did not support the hypothesis that acculturation is a mediator on the association between acculturative stress and PPD symptoms.

Conclusions: Lack of social support, higher level of education, and antenatal anxiety predicted PPD symptoms in U.S. immigrant women of Arabic descent. Future research is needed to examine acculturative stress and acculturation among immigrant women of Arabic descent in different settings. Longitudinal studies and utilizing diagnostic assessment of PPD is highly recommended. Nurses need to screen immigrant women for anxiety and depression during antenatal visits and develop evidence-based interventions targeted to improve social support and mental health during pregnancy and postpartum for these women.

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