Screening for stressors and strengths at a community health center in the South Bronx

Background: Evidence demonstrates that exposure to unmitigated (“toxic”) stress associated with poverty, inadequate housing, food insecurity, domestic and community violence, and parental depression and anxiety places children at risk for developmental, behavioral, and health problems throughout life. Nurturing caregivers can potentially buffer the effects of stress on children through stable, responsive relationships. This exploratory study was conducted at a federally qualified health center in the South Bronx, one of the poorest communities in the US. Its purpose was to examine stressors and strengths among caregivers of young children, with the aim to develop and implement a screening tool for use in pregnancy and early childhood in a busy primary care setting. Methods: A convenience sample of 200 pregnant women and caregivers of children aged <6 years completed an anonymous survey, consisting of validated instruments to assess depression, anxiety, potential stressors, stress management, and social support. Bivariate and multivariate (binary logistic regression) analyses were used to explore relationships between stressors, strengths and psychological distress. Results: Mean age was 30.8 years (18-68), 82.8% female, 86.5% English speaking, 66.0% Hispanic, and 28.0% Black. Most prevalent stressors included financial problems, unemployment, partner relationships, health, housing, neighborhood safety, and food insecurity. Mean total number of stressors was 3.2 (±2.7); 57.0% reported ≥3. Overall, 46.9% had symptoms suggesting depression or anxiety. In bivariate analyses, the most prevalent stressors as well as domestic violence, legal problems, sibling relationships, traumatic events, and separation or divorce were significantly associated with a positive depression/anxiety screen. Social support and use of stress management (self-care) practices demonstrated a significant inverse relationship to depression/anxiety. Controlling for demographic variables, total number of stressors (OR 1.32: 95% CI 1.09, 1.60) and partner relationship problems (OR 2.77: 95% CI 1.02, 7.51) were significant independent predictors of depression/anxiety, and use of stress management practices remained protective (OR .44: 95% CI .20, .97). The final model will be presented. Conclusion: Based on the latest science of early childhood development, primary care providers are uniquely positioned to systematically assess psychosocial issues in order to help mitigate family stress. Quantification of stressors enabled the development of a screening tool to efficiently and effectively identify these issues. Results also inform the development of targeted interventions, specifically to foster healthy relationships and build capacity to manage stress. Importantly, findings provide an estimate of mental health and other resources needed to address issues uncovered by screening for parental stress in this population.