Skip to main content
SpringerLink
Log in

Avoidance as an obstacle to preventing depression among urban women at high risk for violent trauma

  • Original Article
  • Published:
Archives of Women's Mental Health Aims and scope Submit manuscript

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  • (2008) The National Institute of Mental Health Strategic Plan. Retrieved July 12, 2014, from http://www.nimh.nih.gov/about/strategic-planning-reports/index.shtml-strategic-objective3

  • (2015). IDS/QIDS: Instruments in English and Multiple Translations. Retrieved February 22, 2015, from http://www.ids-qids.org/

  • American Psychiatric Association (1994) Diagnostic and Statistical Manual of Mental Disorders (DSM-IV). American Psychiatric Press, Washington

    Google Scholar 

  • Barry MJ (2011) Helping patients make better personal health decisions: the promise of patient-centered outcomes research. JAMA 306(11):1258–1259

    Article  CAS  PubMed  Google Scholar 

  • Carver CS (1997) You want to measure coping but your protocol’s too long: consider the brief COPE. Int J Behav Med 4:92–100

    Article  CAS  PubMed  Google Scholar 

  • Coffey SF, Dansky BS, Falsetti SA, Saladin ME, Brady KT (1998) Screening for PTSD in a substance abuse sample: psychometric properties of a modified version of the PTSD Symptom Scale Self-Report. Posttraumatic stress disorder. J Trauma Stress 11(2):393–399

    Article  CAS  PubMed  Google Scholar 

  • Cohen S, Kamarck T, Mermelstein R (1983) A global measure of perceived stress. J Health Soc Behav 24(4):385–396

    Article  CAS  PubMed  Google Scholar 

  • Coker AL, Smith PH, McKeown RE, King MJ (2000) Frequency and correlates of intimate partner violence by type: physical, sexual, and psychological battering. Am J Public Health 90(4):553–559

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  • Conway PH, Clancy C (2009) Comparative-effectiveness research—implications of the Federal Coordinating Council’s report. N Engl J Med 361(4):328–330

    Article  CAS  PubMed  Google Scholar 

  • D’Zurilla TJ, Nezu AM, Maydeu-Olivares AB (2002) Social Problem-Solving Inventory-Revised (SPSI-R). Multi-Health Systems, Inc., North Tonawanda

    Google Scholar 

  • Ehlers A, Clark DM, Hackmann A, Grey N, Liness S, Wild J, Manley J, Waddington L, McManus F (2010) Intensive cognitive therapy for PTSD: a feasibility study. Behav Cogn Psychother 38(4):383–398

    Article  PubMed Central  PubMed  Google Scholar 

  • England MJ, Sim L (2009) Depression in parents, parenting, and children: opportunities to improve identification, treatment, and prevention. National Research Council and Institute of Medicine, National Academy Press, Washington

    Google Scholar 

  • Feinberg E, Augustyn M, Fitzgerald E, Sandler J, Ferreira-Cesar Suarez Z, Chen N, Cabral H, Beardslee W, Silverstein M (2014) Improving maternal mental health after a child’s diagnosis of autism spectrum disorder: results from a randomized clinical trial. JAMA Pediatr 168(1):40–46

    Article  PubMed  Google Scholar 

  • Foa EB, Rothbaum BO (1998) Treating the trauma of rape: cognitive-behavioral therapy for PTSD. Guilford Press, New York

    Google Scholar 

  • Green BL, Krupnick JL, Chung J, Siddique J, Krause ED, Revicki D, Frank L, Miranda J (2006) Impact of PTSD comorbidity on one-year outcomes in a depression trial. J Clin Psychol 62(7):815–835

    Article  PubMed  Google Scholar 

  • Hegel MT, Unutzer J, Tang L, Arean PA, Katon W, Noel PH, Williams JW Jr, Lin EH (2005) Impact of comorbid panic and posttraumatic stress disorder on outcomes of collaborative care for late-life depression in primary care. Am J Geriatr Psychiatr 13(1):48–58

    Article  Google Scholar 

  • Holtzheimer PE 3rd, Russo J, Zatzick D, Bundy C, Roy-Byrne PP (2005) The impact of comorbid posttraumatic stress disorder on short-term clinical outcome in hospitalized patients with depression. Am J Psychiatry 162(5):970–976

    Article  PubMed  Google Scholar 

  • Krause ED, Kaltman S, Goodman LA, Dutton MA (2008) Avoidant coping and PTSD symptoms related to domestic violence exposure: a longitudinal study. J Trauma Stress 21(1):83–90

    Article  PubMed  Google Scholar 

  • Kroenke K, Spitzer RL, Williams JB (2003) The Patient Health Questionnaire-2: validity of a two-item depression screener. Med Care 41(11):1284–1292

    Article  PubMed  Google Scholar 

  • Kuehn BM (2009) Institute of Medicine outlines priorities for comparative effectiveness research. JAMA 302(9):936–937

    Article  CAS  PubMed  Google Scholar 

  • Localio AR, Berlin JA, Ten Have TR, Kimmel SE (2001) Adjustments for center in multicenter studies: an overview. Ann Intern Med 135(2):112–123

    Article  CAS  PubMed  Google Scholar 

  • Mushlin AI, Ghomrawi H (2010) Health care reform and the need for comparative-effectiveness research. N Engl J Med 362(3):e6

    Article  PubMed  Google Scholar 

  • Nixon RD, Resick PA, Nishith P (2004) An exploration of comorbid depression among female victims of intimate partner violence with posttraumatic stress disorder. J Affect Disord 82(2):315–320

    Article  PubMed Central  PubMed  Google Scholar 

  • O’Donnell ML, Creamer M, Pattison P (2004) Posttraumatic stress disorder and depression following trauma: understanding comorbidity. Am J Psychiatry 161(8):1390–1396

    Article  PubMed  Google Scholar 

  • Oxman TE, Hegel MT, Hull JG, Dietrich AJ (2008) Problem-solving treatment and coping styles in primary care for minor depression. J Consult Clin Psychol 76(6):933–943

    Article  PubMed Central  PubMed  Google Scholar 

  • Rayburn NR, Wenzel SL, Elliott MN, Hambarsoomians K, Marshall GN, Tucker JS (2005) Trauma, depression, coping, and mental health service seeking among impoverished women. J Consult Clin Psychol 73(4):667–677

    Article  PubMed  Google Scholar 

  • Resick PA, Schincke MK (1996) Cognitive processing therapy for rape victims. Sage Publications, Newbury Park

    Google Scholar 

  • Rush AJ, Trivedi MH, Ibrahim HM, Carmody TJ, Arnow B, Klein DN, Markowitz JC, Ninan PT, Kornstein S, Manber R, Thase ME, Kocsis JH, Keller MB (2003) The 16-item Quick Inventory of Depressive Symptomatology (QIDS), clinician rating (QIDS-C), and self-report (QIDS-SR): a psychometric evaluation in patients with chronic major depression. Biol Psychiatry 54(5):573–583

    Article  PubMed  Google Scholar 

  • Shalev AY, Freedman S, Peri T, Brandes D, Sahar T, Orr SP, Pitman RK (1998) Prospective study of posttraumatic stress disorder and depression following trauma. Am J Psychiatry 155(5):630–637

    Article  CAS  PubMed  Google Scholar 

  • Sherbourne CD, Stewart AL (1991) The MOS social support survey. Soc Sci Med 32(6):705–714

    Article  CAS  PubMed  Google Scholar 

  • Silverstein M, Augustyn M, Cabral H, Zuckerman B (2006) Maternal depression and violence exposure: double jeopardy for child school functioning. Pediatrics 118(3):e792–e800

    Article  PubMed  Google Scholar 

  • Silverstein M, Feinberg E, Cabral H, Linhart YD, Sandler J, Hegel M, Appugliese DP, Beardslee W (2011a) Potential impact of trauma on the ability to prevent depression among low-income mothers. Depress Anxiety 28(6):478–484

    Article  PubMed Central  PubMed  Google Scholar 

  • Silverstein M, Feinberg E, Cabral H, Sauder S, Egbert L, Schainker E, Kamholz K, Hegel M, Beardslee W (2011b) Problem-solving education to prevent depression among low-income mothers of preterm infants: a randomized controlled pilot trial. Arch Womens Ment Health 14(4):317–324

    Article  PubMed  Google Scholar 

  • Street AE, Gibson LE, Holohan DR (2005) Impact of childhood traumatic events, trauma-related guilt, and avoidant coping strategies on PTSD symptoms in female survivors of domestic violence. J Trauma Stress 18(3):245–252

    Article  PubMed  Google Scholar 

  • Vanderbilt D, Bushley T, Young R, Frank DA (2009) Acute posttraumatic stress symptoms among urban mothers with newborns in the neonatal intensive care unit: a preliminary study. J Dev Behav Pediatr 30(1): 50–56

  • Vest JR, Catlin TK, Chen JJ, Brownson RC (2002) Multistate analysis of factors associated with intimate partner violence. Am J Prev Med 22(3):156–164

    Article  PubMed  Google Scholar 

  • Washington AE, Lipstein SH (2011) The Patient-Centered Outcomes Research Institute—promoting better information, decisions, and health. N Engl J Med 365(15):e31

    Article  PubMed  Google Scholar 

  • Yonkers KA, Ramin SM, Rush AJ, Navarrete CA, Carmody T, March D, Heartwell SF, Leveno KJ (2001) Onset and persistence of postpartum depression in an inner-city maternal health clinic system. Am J Psychiatry 158(11):1856–1863

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgements

This work was funded by an NICHD R03 award (R03HD058075, PI Silverstein); Dr. Silverstein is currently supported in part by an NICHD K24 award (K24HD081057). We thank Barry Zuckerman for his advice in conceptualizing this work.

Author information

Authors and Affiliations

  1. Department of Pediatrics, Boston University School of Medicine, Boston, MA, USA

    Michael Silverstein, Caroline Kistin, Megan Bair-Merritt & Emily Feinberg

  2. Department of Pediatrics, Boston Medical Center, Vose Hall 3, One Boston Medical Center Place, Boston, MA, 02118, USA

    Michael Silverstein, Caroline Kistin, Megan Bair-Merritt, Yaminette Diaz-Linhart, Jenna Sandler & Ning Chen

  3. National Center for PTSD, Department of Veterans Affairs, Boston Veterans Administration Hospital, Boston, MA, USA

    Shannon Wiltsey-Stirman

  4. Department of Psychiatry, Boston University School of Medicine, Boston, MA, USA

    Shannon Wiltsey-Stirman

  5. Department of Community Health Sciences, Boston University School of Public Health, Boston, MA, USA

    Emily Feinberg

  6. Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA

    Howard Cabral

Authors
  1. Michael Silverstein
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Caroline Kistin
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Megan Bair-Merritt
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Shannon Wiltsey-Stirman
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Emily Feinberg
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Yaminette Diaz-Linhart
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Jenna Sandler
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Ning Chen
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Howard Cabral
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Michael Silverstein.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Silverstein, M., Kistin, C., Bair-Merritt, M. et al. Avoidance as an obstacle to preventing depression among urban women at high risk for violent trauma. Arch Womens Ment Health 19, 63–70 (2016). https://doi.org/10.1007/s00737-015-0521-4

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00737-015-0521-4

Keywords

Search

Navigation