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  • 00:04

    [Researching Black Mothers' Symptoms of PTSD & DepressionUsing Cluster Analysis & Logistic Regresstion]Hi.My name is Ruby Mendenhall and I'm an Associate Professorin the Departments of Sociology and African-American Studiesat the University of Illinois, Urbana-Champaign,[Ruby Mendenhall, Associate Professor,Departments of Sociology and African American StudiesUniversity of Illinois Urbana Champaign]and then I also have appointments in Urban

  • 00:25

    and Regional Planning and Social Work,and I'm an affiliate with the Woese Institute for GenomicBiology, and the Institute for Computing in the Humanities,Arts, and Social Sciences.And so my research examines how stress and racially segregatedneighborhoods affect mental health over the life course,and I'm also interested in how stress gets under the skin

  • 00:49

    to affect health, and if you can get stress outfrom under the skin with stress reduction activities.The title of this case study is Tired to the Bone :Researching Black Mothers' Symptoms of PTSD and DepressionUsing Cluster Analysis and Logistic Regression.[Case Study Introduction] In terms of the case study,

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    we're going to look at how living in neighborhoodswith high levels of violence affect black mothersmental health.We're going to look at how they protect their mental healthin these situations, and we'll talk about someof the challenges that we discoveredas we were doing the research.[Aims & Objectives] In terms of objectives,

  • 01:37

    I want to describe the Hidden America that David Ford talksabout from ABC News, I want to identify the harmful effectsof the Hidden America, and then to understand how mothers copewith living inside the Hidden America with the high levelsof violence.So in terms of the first objective,I want to highlight aspects of the Hidden America

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    that are places where low income single mothers, oftenblack mothers, are raising childrenin areas with high levels of violencethat David Ford talks about are unfathomable to mostpeople in the country.And meaning that they can't reallyimagine the level of violence and the level of stress that'sassociated with those contexts.

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    In terms of the second objective,we want to identify the harmful effects of livingin these neighborhoods.And that has to do with issues of physical survival every dayof the mothers and their children and other familymembers.And then for the third objective,looking at how they cope-- how theytry to create an equilibrium in situations

  • 02:40

    that are life threatening and certainly mentally exhausting.[Cluster Analysis & Logistic Regressions]So for these objectives we use cluster analysisand logistic regression.Cluster analysis is the statistical classificationtechnique that groups similar cases or data together and put

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    cases that are very different in other groups.So really we're looking to group the mothersinto different categories.And then we use logistic regression.And that's a statistical analysiswhere you try to find out how several independent variablesaffect the dependent variable by using an equation for a lineor curve and the outcome is dichotomous,

  • 03:24

    so often zero one outcomes.And so the questions that we'll exploreis how living in neighborhoods with high levels of violenceaffect black mother's mental health.The hypothesis is that as mothers struggle with issuesof safety for themselves and their children,it will be associated with higherlevels of mental distress.Another question is, what's the relationship

  • 03:46

    between mental health and feelingtrapped in your neighborhood or areas of the Hidden America?And feeling trapped is when motherswant to move because of the level of violence,but they can't afford to move.And we hypothesized that these mothers will representa unique group in our data.And then we also are interested in how motherscope with such extreme context.

  • 04:07

    And the expectations is that mothersneed to engage in more coping mechanismsfor optimal functioning and often deadly surroundings.And again when we talk about developing a balanceor equilibrium, and again we expectfor them to have a need for higherlevels of coping mechanisms.And in this study we use principlesfrom community-based participatory action research.

  • 04:29

    And these principles include having the community identifythe problem.And they identified violence as a problem, the safetyof their children as a problem.Also one of the principles of community-based participatoryaction research is looking at the strength of the populationthat you study, so we took a strength-based approach.

  • 04:51

    And then also this idea of sharing power and I'lltalk about that when we talk about the challenges.And we also used the transformative emancipatoryworldview that includes critical and black feminist theoriesthat critique existing social inequalitiesand promote social change.With black feminist theory, we seek

  • 05:11

    to marry theory and practice by using our research findingsto promote social change around poverty and other interlockinginequalities, such as racism and sexism.And so we used a mixed methods approach,collecting multi- level data, and welooked at risk and protective factors on the community level,

  • 05:32

    on the family level, on the individual level,and then also on the genomic level,where we collected blood from the mothers.And so we're interested in the role of social structuresin shaping health and other life course outcomes.So one example of the methods that weused to capture aspects of the Hidden Americais Google Street View, where what you see on the screen

  • 05:54

    is the view that a mother has when she looks outof her apartment or her house.And as you can see from the image,there are one, two, three abandoned buildings.And that creates an issue of safetyif children are playing outside or if theycome home after dark.And so that's a key component of whatwe're interested in trying to capture.

  • 06:17

    So for the current study, we looked at the Patient HealthQuestionnaire for determining depressive symptoms.We also looked at the Post-Traumatic Stress Disorderchecklist and the Africultural Coping Systems Inventory.And then we took survey questions looking at difficultlife situations-- the level of stress,how concerned they were about their neighborhood--

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    and the sample size for this study is 87 black mother's.This chart that you see represents an SPSSdatabase that has our independent and dependentvariables that we looked at for the black mothers well-beingand their health indicators.[Challenges] And so in terms of challenges for the study,

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    there are two major challenges.One has to deal with sharing power with the community,and the other is the small sample size and missing data.It's important to think about how you want to share powerwith the community once you have your dataand once you have the interviews, the surveys,the blood samples.It's important as you begin the analysisand writing out the manuscripts to think about the role

  • 07:27

    that the community will play.So for our study we are coauthoringwith people from the community, and we also plan to go backand to share the findings and to get their feedback.And during that time we will alsoask if people are interested in coauthoring or future work.It is important to build future contact into your IRB proposal

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    so that you can go back and have this conversation about power,about writing, about the findingswith community participants.And it's also important, even if they don't feel comfortablewriting, to let them know that they'reworking with you side by side and you can help them.And that way, that increases their engagement.And it's important, once you have the findings,

  • 08:09

    to engage the community, but also policymakers.Because again, with black feminist theoryand marrying theory and practice,you want to engage policymakers and see howsocial change can take place.So the second challenge regarding sample sizeand missing data-- there were other analysesthat we wanted to conduct but we couldn't because

  • 08:29

    of the small sample size, and we added some questions lateto the survey.For instance, mothers would talk about the number of childrenthat they knew who were killed or who were shotand they would just mention it during interviews,so we went back and we added that to the survey.But that meant that everyone didn't answer that question.So that was an issue of having a lot of missing data.

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    And so some of the numbers that they talked about in termsof people-- adults and children--that they knew who were shot were sometimes in the 30sand then other mothers said that there were too many to count.And so that was hard in terms of methodsbecause-- what number do you give it?You don't really know when they say too many to count,you just know that that's a very sad statistic

  • 09:13

    or very sad information.And so this large amount of death, shootings, trauma,and grief is another aspect of the Hidden Americathat we don't discuss a lot.And again, that many people don't understand.[Findings] For a findings summary, we had two clusters.

  • 09:34

    For cluster 1, the odds of mothers reporting PTSD symptomswere two times greater than the odds of mothers in cluster 2.And then again in cluster 1, the oddsof mothers reporting depressive symptomswere almost 1 and 1/2 times more likely than mothersin cluster 2.And then mothers in cluster 1 reported digestive problems

  • 09:55

    from the stress, and we'll talk about that, too.The first cluster consists of mothers who want to leavetheir neighborhoods, overwhelminglybecause of the violence, but they cannot afford to leave.And then mothers in this cluster alsoreport using what Utsey and colleagues referto as Africultural coping strategies that includespirituality, collective coping, and other efforts

  • 10:18

    to deal with crises and stressors in the environment.Mothers in cluster 2 do not reportwanting to leave their neighborhoodsdue to the violence, and they alsoreport using less coping skills as well.So I believe that the use of Africultural copingin the first cluster of mothers who want to leave but cannotindicate that they see themselves in extreme

  • 10:40

    circumstances-- deadly even-- and must engage in more copingstrategies to survive than mothers who do not feel trappedinside their neighborhoods.[Logistic Regressions] After establishing the clusters,we then used logistic regression to examine

  • 11:00

    whether the women in cluster 1, whowanted to leave their neighborhoods but could not,would have higher levels of PTSD symptomsand depressive symptoms than motherswho did not report wanting to leave their neighborhoods.This chart shows that the odds of mothers in cluster 1 havingPTSD symptoms are almost two times greaterthan the odds of mothers who are not in this cluster.

  • 11:23

    This number is statistically significanteven after controlling for age, employment status, and highestlevel of education.The second logistic regression examines the relationshipbetween cluster membership and mild to severe levelsof depressive symptoms.Again, we find that being in cluster 1is a significant predictor of increased

  • 11:45

    odds of depressive symptoms.The odds of mothers in cluster 1 havingmild to severe depressive symptomsare almost 1 and 1/2 times greaterthan mothers in cluster 2, even with the controlled variables.We also asked the mothers about digestive issues.The odds of mothers in cluster 1 having digestive issues

  • 12:05

    were almost 2 times greater than the oddsof mothers in cluster 2.However, when adding our control variables,the significant relationship no longer existed.[Significance of Findings] When youthink about the significance of these findings,it's important to think about the role of stress, poverty,

  • 12:26

    health, and even death in the Hidden Americain terms of black mothers' mental and physical health.And so here we see poverty rates for single women headof households.Today, almost half of black and Latino families headed by womenare low-income, and the numbers are 26% to 33% for Asianand white single women head of households, respectively.

  • 12:49

    The strain of joblessness and low income can affect health.Today many scholars are concernedregarding persistent and even increasing health disparities.Between 2009 and 2011, black maternal mortalityincreased from 36 deaths to 42.8 deaths per 100,000 live births.

  • 13:09

    White maternal mortality remained almost the same,going from 12 to 12.5 deaths per 100,000 live births.It's important to understand black excess death,and that's when more people die than whatthey predict should die from disease,old age, and other conditions.In 2008, the documentary Unnatural Causes:

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    Is Inequality Making Us Sick?talked about 83,000 excess deaths among African-Americans,and it said that's the equivalentof a plane full of African-Americans falling outof the sky every day, every year.[Conclusion] In summary, we talked

  • 13:51

    about high levels of traumatic experiencesin the Hidden America.We talked about the need for black mothersto employ extra coping mechanisms in termsof maintaining equilibrium.And also, we thought about this idea of fight or flight--that you encounter danger you may want to leave itbut mothers talked about that theyfeel that they can't leave because they

  • 14:12

    can't afford to leave, and we talked about thatas feeling trapped.And then we also saw that cluster 1 has increasedodds of having PTSD symptoms and then also depressive symptoms.And cluster 1, again, were the mothers who talked aboutwanting to leave but couldn't.When you think about these findings,it's important to think about structural changes,

  • 14:33

    and that may include investment in jobs and communitiesand even, perhaps, it's time to consider a jobs program.On the individual level, it's important to support motherswho are raising children in neighborhoodswith high levels of violence with holistic resources thatrange from money to stress reduction activities that

  • 14:54

    protect their mental and physical health,so that they won't be tired to the bone.In terms of reflective questions,what else might be going on that clustersof mothers with high levels of Africultural copinghave the most mental distress?Because in some ways that may be counter-intuitive.And then the second reflective question--

  • 15:15

    is it realistic to have an expectation of sharing powerwith research participants?

Abstract

Dr. Ruby Mendenhall presents her research into how the stress of living in violent, segregated neighborhoods affects black mothers. Her study found a clear connection between PTSD and/or depression and feeling trapped in these neighborhoods.

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Researching Black Mothers' Symptoms of PTSD & Depression Using Cluster Analysis & Logistic Regression

Dr. Ruby Mendenhall presents her research into how the stress of living in violent, segregated neighborhoods affects black mothers. Her study found a clear connection between PTSD and/or depression and feeling trapped in these neighborhoods.

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