Masters Thesis

The Role of Acculturative Stress on Maternal Anxiety and Cortisol Levels During Pregnancy

Fifty-two percent of women report experiencing anxiety symptoms while pregnant. Experiencing anxiety during pregnancy is associated with adverse prenatal and birth outcomes for mothers and children. Mexican American women experience unique psychosocial factors, such as lack of culturally competent mental health care, language barriers, and discrimination, which could place them at risk for experiencing higher anxiety levels in the perinatal period compared to other women. Mexican American women also experience acculturative stress that results from the psychological and cultural challenges when interacting between cultures that could impact anxiety levels during pregnancy; however, the association between acculturative stress and anxiety during pregnancy has not yet been established empirically. In addition to the possible impact of cultural stressors on anxiety, stressors can also have physiological effects that may place pregnant Mexican American women at risk for developing mental health symptoms. The measurement of stress-related biomarkers, such as long-term hair cortisol, may contribute to the understanding of the role of cultural stressors in perinatal anxiety. A sample of 151 Mexican American pregnant women completed five assessments across their pregnancy to assess state anxiety, acculturative stress, and hair cortisol levels. The study aimed to explore the role of acculturative stress on the trajectory of cortisol levels and anxiety symptoms in Mexican American pregnant women. The study addressed three hypotheses: 1) participants who reported high levels of acculturative stress would report high levels of state anxiety symptoms across pregnancy; 2) participants who reported high levels of acculturative stress would exhibit increasing levels of cortisol across pregnancy as measured in hair; 3) high levels of maternal cortisol would mediate the relationship between high acculturative stress and elevated maternal anxiety symptoms. A multilevel model analysis showed that acculturative stress was associated with the trajectory of anxiety symptoms (b = -0.047, t (153) = -2.03, p = 0.044); high levels of acculturative stress were associated with an increase early in pregnancy and steady decline of anxiety symptoms across pregnancy. A multilevel model analysis showed no significant relationship between acculturative stress and the trajectory of maternal hair cortisol levels. Maternal hair cortisol level was not a significant mediator for the relationship between acculturative stress and symptoms of anxiety. Findings suggest that Mexican American pregnant women who experience acculturative stress may experience higher symptoms of state anxiety early in pregnancy. Assessing acculturative stress in the perinatal period may help identify women who may be at risk for experiencing symptoms of anxiety and help promote cultural competence for future obstetric interventions.

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