title: Avoidance as an obstacle to preventing depression among urban women at high risk for violent trauma.
abstract: The impact of depression interventions is often attenuated in women who have experienced trauma. We explored whether psychological avoidance could explain this phenomenon. We synthesized two pilot randomized trials of problem-solving education (PSE) among a total of 93 urban mothers. Outcomes included depressive symptoms and perceived stress. Mothers with avoidant coping styles experienced an average 1.25 episodes of moderately severe depressive symptoms over 3 months of follow-up, compared to 0.40 episodes among those with non-avoidant coping (adjusted incident rate ratio [aIRR] 2.18; 95 % CI 1.06, 4.48). PSE tended to perform better among mothers with non-avoidant coping. Among mothers with non-avoidant coping, PSE mothers experienced an average 0.24 episodes, compared to 0.58 episodes among non-avoidant controls (aIRR 0.27; 95 % CI 0.05, 1.34). Among mothers with avoidant coping, PSE mothers experienced an average 1.26 episodes, compared to 1.20 episodes among avoidant controls (aIRR 0.76; 95 % CI 0.44, 1.33). This trend toward differential impact persisted when avoidance was measured as a problem-solving style and among traumatized mothers with and without avoidant PTSD symptoms. Further research is warranted to explore the hypothesis that psychological avoidance could explain why certain depression treatment and prevention strategies break down in the presence of trauma.
authors.affiliation: Department of Pediatrics, Boston University School of Medicine, Boston, MA, USA. michael.silverstein@bmc.org.|Department of Pediatrics, Boston Medical Center, Vose Hall 3, One Boston Medical Center Place, Boston, MA, 02118, USA. michael.silverstein@bmc.org.
authors.forename: Michael
authors.initials: M
authors.lastname: Silverstein
authors.affiliation: Department of Pediatrics, Boston University School of Medicine, Boston, MA, USA.|Department of Pediatrics, Boston Medical Center, Vose Hall 3, One Boston Medical Center Place, Boston, MA, 02118, USA.
authors.forename: Caroline
authors.initials: C
authors.lastname: Kistin
authors.affiliation: Department of Pediatrics, Boston University School of Medicine, Boston, MA, USA.|Department of Pediatrics, Boston Medical Center, Vose Hall 3, One Boston Medical Center Place, Boston, MA, 02118, USA.
authors.forename: Megan
authors.initials: M
authors.lastname: Bair-Merritt
authors.affiliation: National Center for PTSD, Department of Veterans Affairs, Boston Veterans Administration Hospital, Boston, MA, USA.|Department of Psychiatry, Boston University School of Medicine, Boston, MA, USA.
authors.forename: Shannon
authors.initials: S
authors.lastname: Wiltsey-Stirman
authors.affiliation: Department of Pediatrics, Boston University School of Medicine, Boston, MA, USA.|Department of Community Health Sciences, Boston University School of Public Health, Boston, MA, USA.
authors.forename: Emily
authors.initials: E
authors.lastname: Feinberg
authors.affiliation: Department of Pediatrics, Boston Medical Center, Vose Hall 3, One Boston Medical Center Place, Boston, MA, 02118, USA.
authors.forename: Yaminette
authors.initials: Y
authors.lastname: Diaz-Linhart
authors.affiliation: Department of Pediatrics, Boston Medical Center, Vose Hall 3, One Boston Medical Center Place, Boston, MA, 02118, USA.
authors.forename: Jenna
authors.initials: J
authors.lastname: Sandler
authors.affiliation: Department of Pediatrics, Boston Medical Center, Vose Hall 3, One Boston Medical Center Place, Boston, MA, 02118, USA.
authors.forename: Ning
authors.initials: N
authors.lastname: Chen
authors.affiliation: Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA.
authors.forename: Howard
authors.initials: H
authors.lastname: Cabral
mesh_terms: D000223:Adaptation, Psychological; D000328:Adult; D001362:Avoidance Learning; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D003863:Depression / Q000517:prevention & control* / Q000523:psychology; D019052:Depression, Postpartum / Q000517:prevention & control* / Q000523:psychology; D003866:Depressive Disorder / Q000517:prevention & control / Q000523:psychology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008016:Life Change Events; D009035:Mothers / Q000193:education / Q000523:psychology*; D010353:Patient Education as Topic / Q000379:methods*; D010865:Pilot Projects; D018794:Problem-Based Learning / Q000379:methods*; D013315:Stress, Psychological / Q000523:psychology; D016896:Treatment Outcome; D014505:Urban Population; D014754:Violence / Q000517:prevention & control* / Q000523:psychology
keywords: Avoidance; Maternal depression; PTSD; Prevention
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