Relationships Among Strong Black Woman Belief, Culturally Relevant Coping Behaviors, Perceived Social Support, and Psychological Distress Symptoms for Black Mothers After Stillbirth Open Access

Abstract

Psychological distress symptoms (depression, anxiety, and post-traumatic stress) are common following stillbirth. Black women are less likely to seek support than White women after stillbirth, consistent with the Strong Black Women (SBW) construct, which instructs Black women to tolerate stress and trauma independently. Black women are underrepresented in healthcare research, despite being more likely than White women to suffer negative health outcomes and trauma. We conducted a cross-sectional study to examine the relative contributions of SBW belief, perceived social support, and culturally relevant coping behaviors to psychological distress symptoms in Black mothers bereaved by stillbirth. We also investigated differences between Black women recruited via mail vs. social media. We used mailed letters and social media posts to recruit 91 Black women who had a stillbirth in the three years prior to study participation. Our online survey measured SBW belief, culturally relevant coping behaviors, perceived social support, and psychological distress symptoms along with sociodemographics, pregnancy history, and stillbirth characteristics. We compared participants recruited via mail vs. social media for age, marital status, education, employment, income, gestational age of stillbirth, and time since stillbirth. We used stepwise selection in linear regression to determine the relative contributions of SBW belief, perceived social support, and culturally relevant coping behaviors to measures of psychological distress symptoms. Participants recruited via mail were more likely to report annual household income ≥$50,000, but otherwise were similar to those recruited via social media. Increasing SBW belief and collective coping (coping behaviors involving other people), and decreasing perceived social support predicted increases in all three measures of psychological distress symptoms, controlling for age and other traumatic events. It may be important to include SBW belief, perceived social support, and culturally relevant coping behaviors in interventions to mitigate psychological distress for Black mothers after stillbirth.

Table of Contents

Table of Contents

Introductory Literature Review………………………………………………………………..1

  Black Mothers Experience Significantly Higher Risk of Stillbirth………………………...2

  Long-Term Consequences of Stillbirth……………………………………………………....2

  Black Mothers’ Coping Behaviors Following Stillbirth………………………………….....3

  Strong Black Woman Construct……………………………………………………………...4

  Relationships Among Strong Black Woman Construct, Coping Behaviors, Perceived

  Social Support, and Psychological Distress Symptoms in Black Women………………......5

  Conclusion and Conceptual Framework…………………………………………………......6

  Figure 1: Conceptual Framework of the Study……………………………………………...8

Paper 1: Use of the Strong Black Woman Construct in Research: An Integrative Review...9  Abstract…………………………………………………………………………………….…....10

  Introduction…………………………………………………………………………….……..11

  Materials and Methods……………………………………………………………….………11

     Literature Search…………………………………………………………………….…….....11

     Data Abstraction…………………………………………………………………….…….....12

  Results…………………………………………………………………………………………12

     Sample Characteristics………………………………………………………….………........12

     Data Synthesis………………………………………………………………….………….....13

        Experiences the SBW Construct was Used to Study………………………….……............13

        Health Conditions or Health Outcomes Associated with SBW……………….………........15

        Other Constructs Associated with SBW Belief……………………………….……….........16

        Assessment of SBW…………………………………………………………….……..........17

  Discussion…………………………………………………………………………………......18

  Conclusion.................................................................................................................................21

  Table 1: Uses of the SBW Construct in Included Studies……………………………….....22

Paper 2: Similarities and Differences in Characteristics of Black Women Recruited by Mail vs. Social Media After Stillbirth…………………………………………………………….....46

  Abstract……………………………………………………………………………………......47

  Background…………………………………………………………………………………...49

  Methods……………………………………………………………………………………......50

  Results………………………………………………………………………………………....52

  Discussion………………………………………………………………………………….….54

  Conclusion……………………………………………………………………………….……56

  Figure 1: Recruitment Flow Chart……………………………………………………..……57

  Table 1: Differences Between Letter Recipients and Social Media Responders……….…58

Paper 3: Relationships Among Strong Black Woman Belief, Coping Behaviors, Social

Support, and Psychological Distress for Black Mothers After Stillbirth…………...………59

  Abstract……………………..…………………………………………………………………60  Background…………………………………………………………………………………..…61

  Methods…………………………………………………………………………………….…63

     Study Design and Population………………………………………………………………...63

     Procedures……………………………………………………………………………………63

     Measures………………………………………………………………………..……………64

        Sociodemographic and Clinical Covariates………………………………….…………....65

           Substance abuse disorders……………………………………………………………….65

           Lifetime trauma………………………………………………………….……………….65

        Strong Black Woman Belief……………………………………………….……………….66

        Perceived Social Support………………………………………………….……………….66

        Culturally Relevant Coping Behaviors…………………………………….………………67

        Depressive Symptoms and Anxiety…………………………………………..……………..68

        Post-Traumatic Stress……………………………………………………….……………..68

     Data Analysis…………………………………………………………………...……………68

  Results…………………………………………………………………………………………69

     Sample Characteristics………………………………………………………….……………69

     Correlations With SBW Belief………………………………………………………………70

     Correlations Among Perceived Social Support, Coping Behaviors, and Psychological

     Distress Symptoms……………………………………………………………………..……71

        Associations With Psychological Distress Symptoms…………………………………..….71

        Perceived Social Support and Africultural Coping Behaviors………………………….....71

     Sociodemographic and Clinical Covariates Correlated With Psychological Distress……….71

     Relative Contributions of SBW Belief, Coping, and Perceived social support to

     Psychological Distress……………………………………………………………………….72

  Discussion………………………………………………………………………………..……72

  Limitations………………………………………………………………………………….…76

  Implications for Practice and Research……………………………………………….…….77

  Table 1: Participant Characteristics…………………………………………………….…..79

  Table 2: Instrument Scores and Bivariate Correlations………………………………...…81

  

  Table 3: Summary of Linear Regression Models for Symptoms of Depression, Anxiety,

  and Post-Traumatic Stress…………….………………………………………..……………82

Dissertation Summary and Synthesis…………………………………………………………84

  Introduction………………………………………………………………………..………….85

  The Strong Black Woman Construct…………………………………………….………….85

  Recruitment Experience and Differences Between Participants Recruited via Letters and

  Social Media………………………………………………………………………..…………85

  Relationships Among Variables of Interest………………………………………..………..86

  Clinical Relevance……………………………………………………………………...……..87

  Future Research Directions………………………………………………………………….88

     The SBW Construct………………………………………………………………...………..88

     Recruiting Black Women for Research…………………………………………….………..88

     Coping Behaviors and Social Support………………………………………………….……88

  Figure 1: Conceptual Framework...........................................................................................90

References………………………………………………………………………………………91

Figures and Tables

Introductory Literature Review Figure 1………………………………………………………8

Paper 1 Table 1………………………………………………………………………………….22

Paper 2 Figure 1……………………………………………………………………………...…57

Paper 2 Table 1……………………………………………………………………………...…..58

Paper 3 Table 1……………………………………………………………………………….....79

Paper 3 Table 2………………………………………………………………………………….81

Paper 3 Table 3………………………………………………………………………………….82

Dissertation Summary and Synthesis Figure 1……………………………………………….90

About this Dissertation

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School	Laney Graduate School
Department	Nursing
Degree	Ph.D.
Submission	Dissertation
Language	English
Research Field	Health Sciences, Nursing Health Sciences, Mental Health Health Sciences, Obstetrics and Gynecology
Keyword	Psychological Distress Health Disparities Strong Black Woman Stillbirth Women's Health
Committee Chair / Thesis Advisor	Mi-Kyung Song, Emory University
Committee Members	Rasheeta D. Chandler, Emory University Lauren Christiansen-Lindquist, Emory University Ursula Kelly, Emory University Sudeshna Paul, Emory University Anne L. Dunlop, Emory University

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