Johns Hopkins Nursing Research News—September-October 2012

Newswise — Studies at the Johns Hopkins University School of Nursing are on the cutting edge of community-based research addressing healthcare and health disparities among African Americans and other medically underserved groups.

Defeating Depression—While African Americans are less likely than Whites to have a depressive disorder, when they do, it tends to be chronic and more severe, and less likely to be diagnosed and treated. The effects can be damaging for individuals and families. Exploring the impact of social support and depression on African-American mothers-to-be, postdoctoral fellow Jeanne L. Alhusen, PhD, CRNP, RN; professors Deborah Gross, DNSc, RN; and Phyllis Sharps, PhD, RN, CNE; and others found that during pregnancy, insufficient social support (e.g., an engaged partner) can heighten feelings of depression. The two factors can then interfere with bonding during pregnancy and other healthy behaviors. Alhusen says, “We found depression compromises a woman’s ability to emotionally attach to her unborn child. That finding has important implications for neonatal and childhood outcomes.” Sharps adds, “The findings highlight the need for health providers to assess pregnant women for depression and to intervene, particularly in women at increased risk for adverse birth outcomes.” [The role of mental health on maternal-fetal attachment in low-income women,” Journal of Obstetric, Gynecological and Neonatal Nursing, online July 2012.] Professor Laura N. Gitlin, PhD, and colleagues sought to clarify how beliefs about depression act as barriers to care among older African Americans, another undertreated population. Writing in “Identification of and beliefs about depressive symptoms and preferred treatment approaches among community-living older African Americans,” they report that most of the study’s 153 participants recognized depressive symptoms. Gender and the presence of symptoms, however, influenced differences in attitudes and beliefs. Half of women but only a third of men believed depression to be a normal part of aging, and more men identified depression as a sign of personal weakness. More women than men found solace in faith and prayer. Moreover, most were fearful that others might learn of their depression, suggesting that stigma is strong and may deter seeking care. Gitlin says, “Studies like this help us better tailor mental health services to this growing population for whom depression remains poorly detected and undertreated. Our findings are building a roadmap to improved community education about depression, reduced stigma, and appropriate treatment programs.” [American Journal of Geriatric Psychiatry, online, May 2012.] Gitlin and colleagues explore other issues in depression diagnosis and care in minority older adults in “A community-integrated home-based depression intervention for older African Americans” [BMC Geriatrics, Vol. 12, 2012] and in “Comparison of three societally derived health-state classification values among older African Americans with depressive disorders” [Quality of Life Research, online September 2012].

Promoting Health—In the October 2012 Geriatric Nursing, associate professor Sarah L. Szanton, PhD, CRNP, RN; associate professor Elizabeth K. Tanner, PhD, RN, FNGNA; research nurse Jill Roth, BSN, RN; instructor Carmalyn D. Dorsey, MSN, RN; and others describe the nurses’ role in an interprofessional collaboration testing methods to reduce disability. Through the CAPABLE project, they are determining if a community-based program involving a nurse, an occupational therapist, and a handyman can help save lives and reduce health care costs, particularly among African Americans and other low-income elders living at home. According to Szanton, “How you are able to live affects where you live. Living in poverty and a sub-par environment with chronic illness often leads frail elders to the hospital. We are testing how CAPABLE could help grant them a future of greater dignity and better health at home, instead of in a home.” [“Nursing strategies for promoting and maintaining function among community-living older adults: The CAPABLE Intervention”]

Confronting Cancer—African Americans, 13% of our population, experience the shortest cancer survival rates and highest death rates of any U.S. group. Assistant professor Jennifer Wenzel, PhD, RN, CCM; doctoral candidate Rachel Klimmek, BSN, RN, OCN; nursing director at the Johns Hopkins Kimmel Comprehensive Cancer Center Sharon Krumm, PhD, RN; and others explored service needs among older African-American cancer patients in an effort to improve their care and support. One salient finding was the reticence of minority older adults to broach topics such as difficulty managing treatment-related costs, leaving the issue unrecognized and potentially unmet. According to Wenzel, “Support during cancer diagnosis and treatment allows patients to focus on recovering and on rebuilding their lives after cancer.” [“Cancer support and resource needs among African-American older adults,” [Clinical Journal of Oncology Nursing, August 2012.] Improving communication was also the focus of a pilot study of African-American families with school-age children in which a parent was diagnosed with cancer. Writing in “A culturally adapted family intervention for African-American families coping with parental cancer,” Psycho-Oncology [September 2012], assistant professor Nancy Hodgson, PhD, RN, and colleagues describe how a culturally adapted interactive program for parents with cancer and their children improved family communication. Hodgson says interventions like this need to be “delivered by culturally informed, racially matched clinicians to facilitate a greater sense of community among the participants.” She and others explored that aspect in the July 2012 Journal of Cancer Education [“Lessons learned in developing a culturally adapted intervention for African-American families coping with parental cancer.”]

In Other Nursing Research NewsMore information at hospital discharge may help patients with serious mental illnesses and their families fare better and lower the risk of rehospitalization according to Linda D. Gerson, PhD, RN, and a colleague. [“Needs of persons with serious mental illness following discharge from inpatient treatment,” Archives of Psychiatric Nursing, August 2012.] Jacquelyn C. Campbell, PhD, RN, and others explore commonalities and differences in factors leading nonimmigrant and immigrant women to quit abusive relationships. [“Immigrant and nonimmigrant women: Factors that predict leaving an abusive relationship.” Violence Against Women, August 2012.] In an American Journal of Psychiatry editorial, Laura N. Gitlin, PhD, highlights dementia research showing that family-focused psychosocial interventions can reduce patient symptoms and family stress. [“Good news for dementia care,” September, 2012.] Gitlin and a colleague suggest ways to move evidence-rich science into clinical practice. [“How do we change practice when we have the evidence?”, American Journal of Occupational Therapy, September/October 2012.] Douglas A. Granger, PhD, Sarah L. Szanton, PhD, CRNP, and colleagues show saliva sampling can be an alternative to diagnostic blood draws. [“Incorporating salivary biomarkers into nursing research,” Biological Research for Nursing, September 2012.] Granger and others explore how high levels of stress hormones may affect childhood learning. [“Salivary alpha amylase and cortisol in infancy and toddlerhood,” Psychoneuroendocrinology, October 2012.]