Fysisk aktivitet ger flertalet positiva fysiologiska hälsoeffekter och har vid ett antal studier även visat sig bidra till positiva hälsoeffekter avseende psykisk hälsa. Det finns dock studier som inte kunnat påvisa effekterna på psykisk hälsa. Syftet med uppsatsen var att undersöka samband mellan fysisk aktivitet och depression, stress, och välmående, med kontroll för eventuellt samvarierande demografiska faktorer. Urvalet bestod av 357 (ålder 25-80år, 49.3% kvinnor) deltagare från Betulastudien. Välmående undersöktes med två frågor som skattades 0-10. Depressiva symtom undersöktes med The Center for Epidemiologic Studies Depression Scale. Stress undersöktes med Perceived Stress Questionnaire. Mängd fysisk aktivitet undersöktes genom tre frågor som efterfrågade mängd fysisk aktivitet: (1) de senaste 12 månaderna, (2) en vanlig vecka och (3) jämfört med andra. Samband undersöktes med hierarkisk regression, med kontroll för civilstånd, kön, utbildning och ålder. Fysisk aktivitet var svagt associerat med Välmående (ΔR² = .023) och endast aktivitet i jämfört med andra (β = .132) var signifikant. Fysisk aktivitet var positivt associerat med välmående men förklarade endast en liten del i variansen. Avsaknad av statistiskt signifikanta samband mellan fysisk aktivitet, depression och stress skiljer sig från tidigare populationsbaserade studier. Dessa skillnader i resultat skulle kunna förklaras med kulturella och metodologiska skillnader. Ytterligare forskning på sambandet mellan fysisk aktivitet och psykisk hälsa behövs. / Physical activity contributes to several positive physiological health benefits and has also, in a number of studies, proven to contribute to psychological health. There are nonetheless studies which have not been able to prove the positive effects on psychological health. The goal of the paper was to investigate correlations between physical activity and depression, stress, and wellbeing, while controlling for the influence of demographical factors. The sample was from the Betula study and consisted of 357 participants aged 25-80, with 49.3% women. Wellbeing was assessed by ratings (0-10) in response to two questions. Depressive symptoms were measured by the Center for Epidemiologic Studies Depression Scale. Stress was measured by Perceived Stress Questionnaire. Amount of physical activity was investigated through three questions which asked for the amount of physical activity: (1) in the last 12 months, (2) a normal week, and (3) compared to others. Relationships between activity level and aspects of psychological health were investigated through hierarchical regression analysis, controlling for civil status, gender, education, and age. Physical activity was weakly associated with Wellbeing (ΔR² = .023) and only activity compared to others (β = .132) was significant. Physical activity had a positive association with wellbeing, but only accounts for a small amount of the variance. The absence of statistical significant relationship between physical activity, depression and stress is not in line with previous population-based studies. These differences could possibly be explained by cultural and methodological difference between studies. Additional studies on the correlation between physical activity and mental health is needed.

Poor adherence is an issue in clinical trials with a striking magnitude and negative impact. Recent studies indicate that two widely used clinical screening tools, Short Form (SF-36) Health Survey and Center for Epidemiologic Studies Depression Scale (CES-D) can be used as risk stratifiers to identify participants who require extra interaction to stay adherent in specific population. There is, however, little evidence to support the implication of these tools in elderly individuals with mobility limitations. These individuals may be particularly vulnerable to the risks of poor adherence in the context of a demanding interventional scheme. This study fulfills this gap by analyzing the quality of life and adherence data from the VIVE2 study, which is a double-blinded randomized explanatory clinical trial assessing the benefits of nutritional supplements and daily exercises to elderly patients with mobility limitation. The preliminary results showed that in clinical studies targeting elderly population with mobility limitations, the summary scores of SF-36 trended to have weak and nonsignificant association with a decreased risk of poor adherence to both exercise completion and product consumption while CES-D has no association.

Background Cardiovascular disease (CVD) remains the number one killer even after years of advances and preventative measures. Identifying and reducing modifiable risk factors is a health care priority. CVD Risk assessments are calculated using several traditional risk factors including age, gender, race, blood pressure, cholesterol, history of diabetes, and smoking to estimate a persons’ risk of developing CVD (heart disease or stroke) in the next 10-years. In addition to the traditional risk factors for CVD, there is increasing evidence of metabolic disorders, depressive symptoms, inflammation and sleep quality posing a greater risk for CVD. However, these factors are not included in the current risk prediction models including the Framingham Risk Score, Reynolds Risk Score, and Pooled Cohort Risk Equations. Therefore, this study examined the effect of depressive symptoms, inflammation, and sleep quality on the independent risk for CVD. Objective The primary objective of this study was to evaluate the independent relationships between traditional cardiac risk factors, depressive symptoms, inflammation, and sleep quality, on long-term risk of major adverse cardiovascular events (MACE). The secondary objective was to evaluate whether gender modifies the relationships between depressive symptoms, inflammation, and sleep quality on long-term risk of MACE. Design A secondary analysis was conducted on data obtained from the Longitudinal prospective cohort study Heart Strategies Concentrating on Risk Evaluation (Heart SCORE) conducted by the University of Pittsburgh. The ongoing Heart SCORE study has been prospectively examining cardiovascular disease (CVD) risk factors and CVD events on an initial cohort of 2,000 enrolled adults ages 45 to 75 at study entry. A Cox proportional-hazard model was used to evaluate the relationship between traditional risk factors as well as independently and collectively for depressive symptoms, inflammation and sleep quality and risk of MACE. Models were reanalyzed adding gender as an interaction term and in stratified analyses to evaluate whether gender modifies the relationships between sleep quality, depressive symptoms, and inflammation and long-term risk of MACE. Results The participants (N= 1,895) included in this study were, 1256 females (66%), 639 males (34%), ranging from 45 to 75 years of age with a median age of 60 years, 42% Blacks, 55% Whites and 3% other race. Six percent, (n =113) of the participants experienced a major cardiac event during a mean of nearly 10 year follow up. Results indicated that men as compared with women with high levels of interleukin-6 had particularly high risk for CVD, as defined by two separate definitions of MACE, MACE1: Hazard Ratio (HR) 3.44 vs. 1.72 for males and females, respectively, MACE6: HR 2.51 vs. 1.69 for males and females, respectively. These results suggest the high inflammation in men is strongly associated with future risk of CVD. The addition of depressive symptoms to the initial traditional risk factor model was associated with a modest increase in the risk of both definitions of MACE (HR range from 1.20 to 1.68) with similar results observed by gender. Sleep quality/Insomnia was not associated with long-term risk of MACE overall or when evaluated separately by gender. Conclusion Primary prevention with early identification of potential modifiable risk factors is a key strategy in planning interventions to reduce the risk of CVD. Results from this study suggest that depression and inflammation (e.g. IL-6) should be studied in other populations to estimate their independent predictive value in risk stratification. Whereas sleep quality was not associated with long-term risk of CVD in this analysis, future studies should consider the use of objective measures of sleep quality, such as actigraphy in addition to standard use of self-report measures and sleep diaries.

This dissertation study was designed to examine measurement equivalence of the Center for Epidemiological Studies Depression (CES-D) Scale across White, African American, and Mexican American elders. Specific aims were to identify race/ethnicity-, sociodemographic-, and acculturation and instrument language-related measurement bias in the CES-D. Three studies were conducted in this dissertation to accomplish these aims. Two existing national datasets were used: the New Haven Established Populations for Epidemiologic Studies of the Elderly (EPESE) for the White and African American samples and the Hispanic Established Populations for Epidemiologic Studies of the Elderly (H-EPESE) for the Mexican-American sample. Differential item functioning (DIF) analyses were conducted using both confirmatory factor analysis (CFA) and item response theory (IRT) methods. Study 1 focused on the role of race/ethnicity on the measurement bias in the CES-D. Results from Study 1 showed a lack of measurement equivalence of the CES-D among Mexican Americans in the comparison with both Whites and Blacks. Race/ethnicity-specific items were also identified in Study 1: two interpersonal relation items in Blacks and four positive affect items in Mexican Americans. Study 2 focused on identifying sociodemographic-related measurement bias in responses to the CES-D among diverse racial/ethnic groups. Results from Study 2 showed that gender and educational attainment affected item bias in the CES-D. The interaction between gender and educational level and race/ethnicity was also found in Study 2: Mexican American women and lower educated Blacks had a greater predisposition to endorse the 'crying' item. Focusing on Mexican American elders, Study 3 examined how level of acculturation and language influence responses to the CES-D. In Study 3, acculturation and instrument language-biased items were identified in Mexican American elders. Study 3 also suggested that acculturation-bias was entirely explained by whether the CES-D was administered in the English or the Spanish versions. Possible reasons for item bias on the CES-D are discussed in the context of sociocultural differences in each substudy. Findings from this dissertation provide a broader understanding of sociocultural group differences in depressive symptom measures among racially/ethnically diverse older adults and yield research and practice implications for the use of standard screening tools for depression.

No description available.

Notre thèse de doctorat a pour but d’évaluer les contraintes psychosociales au travail et les symptômes dépressifs majeurs chez les femmes enceintes. Plus spécifiquement, il est question d’identifier les facteurs associés aux symptômes dépressifs majeurs, à une tension psychologique au travail ou travail "tendu" ("high-strain" job), à un travail "tendu" avec un faible soutien social au travail ("Iso-strain"), et enfin d’évaluer l’association entre ces contraintes psychosociales au travail et les symptômes dépressifs majeurs chez les femmes enceintes au travail. Les données analysées sont issues de l’Étude Montréalaise sur la Prématurité, une étude de cohorte prospective menée entre mai 1999 et avril 2004, auprès de 5 337 femmes enceintes interviewées à 24-26 semaines de grossesse dans quatre hôpitaux de l’île de Montréal (Québec, Canada). L’échelle CES-D (Center for Epidemiological Studies Depression Scale) a été utilisée pour mesurer les symptômes dépressifs majeurs (score CES-D ≥23). L’échelle abrégée de Karasek a été utilisée pour mesurer les contraintes psychosociales au travail. La présente étude a conduit à la rédaction de quatre articles scientifiques qui seront soumis à des revues avec comité de pairs. Le premier article a permis de comparer la prévalence des symptômes dépressifs majeurs dans différents sous-groupes de femmes enceintes : femmes au foyer, femmes au travail, femmes en arrêt de travail, femmes aux études et de rechercher les facteurs de risque associés aux symptômes dépressifs majeurs pendant la grossesse. À 24-26 semaines de grossesse, la prévalence des symptômes dépressifs majeurs était de 11,9% (11,0-12,8%) pour l’ensemble des femmes enceintes à l’étude (N=5 337). Les femmes enceintes au travail avaient une proportion de symptômes dépressifs moins élevée [7,6% (6,6-8,7%); n=2 514] par rapport aux femmes enceintes au foyer qui avaient les prévalences les plus élevées [19,1% (16,5-21,8%); n=893], suivi des femmes enceintes en arrêt de travail [14,4% (12,7-16,1%); n=1 665] et des femmes enceintes aux études [14,3% (10,3-19,1%); n=265]. Les caractéristiques personnelles (non professionnelles) associées aux symptômes dépressifs majeurs étaient, après ajustement pour toutes les variables, le statut d’emploi, un faible niveau d’éducation, un faible soutien social en dehors du travail, le fait d’avoir vécu des événements stressants aigus, d’avoir manqué d’argent pour les besoins essentiels, les difficultés relationnelles avec son partenaire, les problèmes de santé chronique, le pays de naissance et le tabagisme. Le deuxième article avait pour objectif de décrire l’exposition aux contraintes psychosociales au travail et d’identifier les facteurs qui y sont associés chez les femmes enceintes de la région de Montréal, au Québec (N=3 765). Au total, 24,4% des travailleuses enceintes se trouvaient dans la catégorie travail "tendu" ("high-strain" job) et 69,1% d’entre elles avaient eu un faible soutien social au travail ("Iso-strain"). Les facteurs de risque associés à un travail "tendu" étaient : un faible soutien social au travail, certains secteurs d’activité et niveaux de compétences, le fait de travailler plus de 35 heures par semaine, les horaires irréguliers, la posture de travail, le port de charges lourdes, le jeune âge des mères, une immigration ≥ 5 ans, un bas niveau d’éducation, la monoparentalité et un revenu annuel du ménage <50 000$. Le troisième article a évalué l’association entre les contraintes psychosociales au travail et les symptômes dépressifs majeurs chez les femmes enceintes au travail (N=3 765). Dans les analyses bivariées et multivariées, les femmes enceintes qui avaient un "high-strain job" ou un "Iso-strain" présentaient davantage de symptômes dépressifs majeurs que les autres sous-groupes. Les contraintes psychosociales au travail étaient associées aux symptômes dépressifs majeurs lorsqu’on prenait en compte les autres facteurs organisationnels et les facteurs personnels auxquels elles étaient confrontées à l’extérieur de leur milieu de travail. Notre étude confirme les évidences accumulées en référence aux modèles théoriques "demande-contrôle" et "demande-contrôle-soutien" de Karasek et Theorell. L’impact de ce dernier et le rôle crucial du soutien social au travail ont été mis en évidence chez les femmes enceintes au travail. Cependant, l’effet "buffer" du modèle "demande-contrôle-soutien" n’a pas été mis en évidence. Le quatrième article a permis d’évaluer l’exposition aux contraintes psychosociales au travail chez les femmes enceintes au travail et en arrêt de travail pour retrait préventif et de mesurer l’association entre les contraintes psychosociales au travail et les symptômes dépressifs majeurs en fonction du moment du retrait préventif (N=3 043). À 24-26 semaines de grossesse, les femmes enceintes en retrait préventif du travail (31,4%) avaient été plus exposées à un "high-strain job" (31,0% vs 21,1%) et à un "Iso-strain" (21,0% vs 14,2%) que celles qui continuaient de travailler (p<0,0001); et elles avaient des proportions plus élevées de symptômes dépressifs majeurs. Après ajustement pour les facteurs de risque personnels et professionnels, "l’Iso-strain" restait significativement associé aux symptômes dépressifs majeurs chez les femmes qui continuaient de travailler tout comme chez celles qui ont cessé de travailler, et cela quel que soit leur durée d’activité avant le retrait préventif du travail (4 à 12 semaines/ 13 à 20 semaines/ ≥ 21 semaines). Les contraintes psychosociales au travail représentent un important facteur de risque pour la santé mentale des travailleuses enceintes. Malgré l’application du programme "pour une maternité sans danger" il s’avère nécessaire de mettre en place dans les milieux de travail, des mesures de prévention, de dépistage et d’intervention afin de réduire la prévalence des symptômes dépressifs prénataux et l’exposition aux contraintes psychosociales au travail pour prévenir les complications maternelles et néonatales. D’autant plus que, la dépression prénatale est le principal facteur de risque de dépression postpartum, de même que les enfants nés de mères souffrant de dépression sont plus à risque de prématurité et de petit poids de naissance. / The goal of our thesis was to evaluate psychosocial work demands and major depressive symptoms among pregnant women. More specifically, we evaluated factors associated with major depressive symptoms, "high-strain" or "Iso-strain" jobs, and measure the association between those psychosocial work demands and major depressive symptoms among pregnant workers. Data analyzed are from the Montreal Prematurity Study, a prospective cohort study conducted in Montréal from May 1999 to April 2004. The study looked at prematurity among 5337 pregnant women recruited at 24-26 weeks of pregnancy in four hospitals in Montréal (Québec, Canada). The CES-D scale (Center for Epidemiological Studies Depression Scale) was used to measure major depressive symptoms (CES-D score ≥23). Karasek's abbreviated scale was used to measure psychosocial work demands. Four scientific articles have been written about the current study and will be submitted to peer-reviewed journals. The objectives of the first article were to compare the prevalence of major depressive symptoms between subgroups of pregnant women: working women, women who had stopped working, housewives and students; and to identify risk factors for major depressive symptoms during pregnancy. At 24-26 weeks of pregnancy, prevalence of major depressive symptoms was 11.9% (11.0–12.8%) for all pregnant women (N=5 337). Working women had lower rates of major depressive symptoms [7,6% (6,6-8,7%); n=2 514] than housewives, for whom prevalence was highest [19,1% (16,5-21,8%); n=893], followed by women who had stopped working [14,4% (12,7-16,1%); n=1 665] and students [14,3% (10,3-19,1%); n=265]. Personal characteristics (non-occupational) associated with major depressive symptoms were, after adjusting for all variables, employment status, low level of education, low social support outside of work, having experienced acute stressful events, lack of money for basic needs, experiencing marital strain, chronic health problem, country of birth, and smoking. The objective of the second article was to describe the exposure to psychosocial work demands and to identify factors that are associated among pregnant women in Montréal, Québec (N=3 765). In total, 24.4% of pregnant women were exposed to "high-strain" jobs and the proportion of workers exposed to "Iso-strain" was 69.1%. Risk factors associated with "high-strain" jobs were as follows: low social support at work, some sector of activity and skill level, working over 35 hours a week, irregular schedules, posture at work, lifting loads, young age of mothers, immigration ≥ 5 years, low level of education, single parenthood, and annual household income <$50,000. The third article evaluated the association between psychosocial work demands and major depressive symptoms among working pregnant women (N=3 765). In bivariate and multivariate analyses, pregnant women who had "high-strain" or "Iso-strain" jobs were more likely to have major depressive symptoms. Psychosocial work demands were associated with the mental health of pregnant women, when other organizational and personal factors which they encountered outside the work settings were taken into account. Our study confirms accumulated findings related to Karasek and Theorell's "demand-control" and "demand-control-support" theoretical models. The impact of the "demand-control-support" model and the critical role of social support at work have been demonstrated among working pregnant women. The "buffer" hypothesis of "demand-control-support" model was refuted. The objectives of the fourth article were as follows: assess exposure to psychosocial work demands among working pregnant women and women on preventive withdrawal from work; and measure the association between psychosocial work demands and major depressive symptoms, according to time of withdrawal from work (N=3 043). At 24-26 weeks of pregnancy, women on preventive withdrawal from work (31.4%) had been more exposed to "high-strain" jobs (31.1% vs. 21.1%) and "Iso-strain" (21.0% vs. 14.2%) than those who continued to work (p<0.0001), and had higher proportions of major depressive symptoms. After adjustment for personal and professional risk factors, "Iso-strain" remained significantly associated with major depressive symptoms in working women and women on preventive withdrawal from work, regardless of duration of activity before withdrawal (4 to 12 weeks/ 13 to 20 weeks/ ≥21 weeks). Psychosocial work demands are an important risk factor for the mental health of pregnant workers. Despite the application of preventive measures during pregnancy, screening and intervention measures should be implemented in workplaces to reduce the prevalence of prenatal mental health problems and exposure to psychosocial work demands so as to prevent maternal and neonatal complications. In addition, prenatal depression is the main risk factor for postpartum depression, and infants born of mothers who suffer from depression are at higher risk of prematurity and low birth weight.

Notre thèse de doctorat a pour but d’évaluer les contraintes psychosociales au travail et les symptômes dépressifs majeurs chez les femmes enceintes. Plus spécifiquement, il est question d’identifier les facteurs associés aux symptômes dépressifs majeurs, à une tension psychologique au travail ou travail "tendu" ("high-strain" job), à un travail "tendu" avec un faible soutien social au travail ("Iso-strain"), et enfin d’évaluer l’association entre ces contraintes psychosociales au travail et les symptômes dépressifs majeurs chez les femmes enceintes au travail. Les données analysées sont issues de l’Étude Montréalaise sur la Prématurité, une étude de cohorte prospective menée entre mai 1999 et avril 2004, auprès de 5 337 femmes enceintes interviewées à 24-26 semaines de grossesse dans quatre hôpitaux de l’île de Montréal (Québec, Canada). L’échelle CES-D (Center for Epidemiological Studies Depression Scale) a été utilisée pour mesurer les symptômes dépressifs majeurs (score CES-D ≥23). L’échelle abrégée de Karasek a été utilisée pour mesurer les contraintes psychosociales au travail. La présente étude a conduit à la rédaction de quatre articles scientifiques qui seront soumis à des revues avec comité de pairs. Le premier article a permis de comparer la prévalence des symptômes dépressifs majeurs dans différents sous-groupes de femmes enceintes : femmes au foyer, femmes au travail, femmes en arrêt de travail, femmes aux études et de rechercher les facteurs de risque associés aux symptômes dépressifs majeurs pendant la grossesse. À 24-26 semaines de grossesse, la prévalence des symptômes dépressifs majeurs était de 11,9% (11,0-12,8%) pour l’ensemble des femmes enceintes à l’étude (N=5 337). Les femmes enceintes au travail avaient une proportion de symptômes dépressifs moins élevée [7,6% (6,6-8,7%); n=2 514] par rapport aux femmes enceintes au foyer qui avaient les prévalences les plus élevées [19,1% (16,5-21,8%); n=893], suivi des femmes enceintes en arrêt de travail [14,4% (12,7-16,1%); n=1 665] et des femmes enceintes aux études [14,3% (10,3-19,1%); n=265]. Les caractéristiques personnelles (non professionnelles) associées aux symptômes dépressifs majeurs étaient, après ajustement pour toutes les variables, le statut d’emploi, un faible niveau d’éducation, un faible soutien social en dehors du travail, le fait d’avoir vécu des événements stressants aigus, d’avoir manqué d’argent pour les besoins essentiels, les difficultés relationnelles avec son partenaire, les problèmes de santé chronique, le pays de naissance et le tabagisme. Le deuxième article avait pour objectif de décrire l’exposition aux contraintes psychosociales au travail et d’identifier les facteurs qui y sont associés chez les femmes enceintes de la région de Montréal, au Québec (N=3 765). Au total, 24,4% des travailleuses enceintes se trouvaient dans la catégorie travail "tendu" ("high-strain" job) et 69,1% d’entre elles avaient eu un faible soutien social au travail ("Iso-strain"). Les facteurs de risque associés à un travail "tendu" étaient : un faible soutien social au travail, certains secteurs d’activité et niveaux de compétences, le fait de travailler plus de 35 heures par semaine, les horaires irréguliers, la posture de travail, le port de charges lourdes, le jeune âge des mères, une immigration ≥ 5 ans, un bas niveau d’éducation, la monoparentalité et un revenu annuel du ménage <50 000$. Le troisième article a évalué l’association entre les contraintes psychosociales au travail et les symptômes dépressifs majeurs chez les femmes enceintes au travail (N=3 765). Dans les analyses bivariées et multivariées, les femmes enceintes qui avaient un "high-strain job" ou un "Iso-strain" présentaient davantage de symptômes dépressifs majeurs que les autres sous-groupes. Les contraintes psychosociales au travail étaient associées aux symptômes dépressifs majeurs lorsqu’on prenait en compte les autres facteurs organisationnels et les facteurs personnels auxquels elles étaient confrontées à l’extérieur de leur milieu de travail. Notre étude confirme les évidences accumulées en référence aux modèles théoriques "demande-contrôle" et "demande-contrôle-soutien" de Karasek et Theorell. L’impact de ce dernier et le rôle crucial du soutien social au travail ont été mis en évidence chez les femmes enceintes au travail. Cependant, l’effet "buffer" du modèle "demande-contrôle-soutien" n’a pas été mis en évidence. Le quatrième article a permis d’évaluer l’exposition aux contraintes psychosociales au travail chez les femmes enceintes au travail et en arrêt de travail pour retrait préventif et de mesurer l’association entre les contraintes psychosociales au travail et les symptômes dépressifs majeurs en fonction du moment du retrait préventif (N=3 043). À 24-26 semaines de grossesse, les femmes enceintes en retrait préventif du travail (31,4%) avaient été plus exposées à un "high-strain job" (31,0% vs 21,1%) et à un "Iso-strain" (21,0% vs 14,2%) que celles qui continuaient de travailler (p<0,0001); et elles avaient des proportions plus élevées de symptômes dépressifs majeurs. Après ajustement pour les facteurs de risque personnels et professionnels, "l’Iso-strain" restait significativement associé aux symptômes dépressifs majeurs chez les femmes qui continuaient de travailler tout comme chez celles qui ont cessé de travailler, et cela quel que soit leur durée d’activité avant le retrait préventif du travail (4 à 12 semaines/ 13 à 20 semaines/ ≥ 21 semaines). Les contraintes psychosociales au travail représentent un important facteur de risque pour la santé mentale des travailleuses enceintes. Malgré l’application du programme "pour une maternité sans danger" il s’avère nécessaire de mettre en place dans les milieux de travail, des mesures de prévention, de dépistage et d’intervention afin de réduire la prévalence des symptômes dépressifs prénataux et l’exposition aux contraintes psychosociales au travail pour prévenir les complications maternelles et néonatales. D’autant plus que, la dépression prénatale est le principal facteur de risque de dépression postpartum, de même que les enfants nés de mères souffrant de dépression sont plus à risque de prématurité et de petit poids de naissance. / The goal of our thesis was to evaluate psychosocial work demands and major depressive symptoms among pregnant women. More specifically, we evaluated factors associated with major depressive symptoms, "high-strain" or "Iso-strain" jobs, and measure the association between those psychosocial work demands and major depressive symptoms among pregnant workers. Data analyzed are from the Montreal Prematurity Study, a prospective cohort study conducted in Montréal from May 1999 to April 2004. The study looked at prematurity among 5337 pregnant women recruited at 24-26 weeks of pregnancy in four hospitals in Montréal (Québec, Canada). The CES-D scale (Center for Epidemiological Studies Depression Scale) was used to measure major depressive symptoms (CES-D score ≥23). Karasek's abbreviated scale was used to measure psychosocial work demands. Four scientific articles have been written about the current study and will be submitted to peer-reviewed journals. The objectives of the first article were to compare the prevalence of major depressive symptoms between subgroups of pregnant women: working women, women who had stopped working, housewives and students; and to identify risk factors for major depressive symptoms during pregnancy. At 24-26 weeks of pregnancy, prevalence of major depressive symptoms was 11.9% (11.0–12.8%) for all pregnant women (N=5 337). Working women had lower rates of major depressive symptoms [7,6% (6,6-8,7%); n=2 514] than housewives, for whom prevalence was highest [19,1% (16,5-21,8%); n=893], followed by women who had stopped working [14,4% (12,7-16,1%); n=1 665] and students [14,3% (10,3-19,1%); n=265]. Personal characteristics (non-occupational) associated with major depressive symptoms were, after adjusting for all variables, employment status, low level of education, low social support outside of work, having experienced acute stressful events, lack of money for basic needs, experiencing marital strain, chronic health problem, country of birth, and smoking. The objective of the second article was to describe the exposure to psychosocial work demands and to identify factors that are associated among pregnant women in Montréal, Québec (N=3 765). In total, 24.4% of pregnant women were exposed to "high-strain" jobs and the proportion of workers exposed to "Iso-strain" was 69.1%. Risk factors associated with "high-strain" jobs were as follows: low social support at work, some sector of activity and skill level, working over 35 hours a week, irregular schedules, posture at work, lifting loads, young age of mothers, immigration ≥ 5 years, low level of education, single parenthood, and annual household income <$50,000. The third article evaluated the association between psychosocial work demands and major depressive symptoms among working pregnant women (N=3 765). In bivariate and multivariate analyses, pregnant women who had "high-strain" or "Iso-strain" jobs were more likely to have major depressive symptoms. Psychosocial work demands were associated with the mental health of pregnant women, when other organizational and personal factors which they encountered outside the work settings were taken into account. Our study confirms accumulated findings related to Karasek and Theorell's "demand-control" and "demand-control-support" theoretical models. The impact of the "demand-control-support" model and the critical role of social support at work have been demonstrated among working pregnant women. The "buffer" hypothesis of "demand-control-support" model was refuted. The objectives of the fourth article were as follows: assess exposure to psychosocial work demands among working pregnant women and women on preventive withdrawal from work; and measure the association between psychosocial work demands and major depressive symptoms, according to time of withdrawal from work (N=3 043). At 24-26 weeks of pregnancy, women on preventive withdrawal from work (31.4%) had been more exposed to "high-strain" jobs (31.1% vs. 21.1%) and "Iso-strain" (21.0% vs. 14.2%) than those who continued to work (p<0.0001), and had higher proportions of major depressive symptoms. After adjustment for personal and professional risk factors, "Iso-strain" remained significantly associated with major depressive symptoms in working women and women on preventive withdrawal from work, regardless of duration of activity before withdrawal (4 to 12 weeks/ 13 to 20 weeks/ ≥21 weeks). Psychosocial work demands are an important risk factor for the mental health of pregnant workers. Despite the application of preventive measures during pregnancy, screening and intervention measures should be implemented in workplaces to reduce the prevalence of prenatal mental health problems and exposure to psychosocial work demands so as to prevent maternal and neonatal complications. In addition, prenatal depression is the main risk factor for postpartum depression, and infants born of mothers who suffer from depression are at higher risk of prematurity and low birth weight.

Studies have identified metabolic health factors to be a major concern in Mexican-Americans, including Mexican immigrants to the United States (U.S.). Acculturation stress has been hypothesized to be a factor in the development of many health-related concerns in this population. Specifically, previous studies have shown that acculturation stress contributes to health concerns, including metabolic health concerns (e.g., diabetes, metabolic syndrome). The primary purpose of this study was to examine the relationship between cultural orientation, a measure of acculturation designed to provide more information than traditional acculturation measures, and metabolic health outcomes. Specific acculturation-related stressors (social support, job-related stress, and depression) were hypothesized mediators in this relationship among a convenience sample of 98 foreign-born Mexicans living in Utah County, Utah controlling for age, gender, socio-economic status (SES), and years in the U.S. Data were collected twice with a three year interval to examine change over time. Changes in these constructs were examined through the use of Growth Modeling with Bayesian estimation. The Acculturation Rating Scale for Mexican-Americans (ARSMA-II) was used to measure Anglo Cultural Orientation and Mexican Cultural Orientation. Standard blood analyses were used to measure metabolic health outcomes, which included glycosylated hemoglobin (HbA1c), insulin, and glucose. The Interpersonal Support Evaluation List (ISEL-12) was used to measure social support, the Job Content Questionnaire (JCQ) was used to measure job-related stress, and the Center for Epidemiological Studies-Depression Scale (CES-D) was used to measure depression. No change was identified in Anglo Cultural Orientation or Mexican Cultural Orientation over time in the majority of subjects. A positive relationship between Anglo Cultural Orientation and HbA1c was found, as was a negative relationship between Mexican Cultural Orientation and HbA1c. Mediation analyses showed a mediation effect of depression on the relationship between Anglo Cultural Orientation and glucose. Implications of findings, limitations, and directions for future research are discussed.

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