Browsing by Author "Walker, Rebekah J."
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Item Age and Gender Differences in Trends and Impact of Depression on Quality of Life in the United States, 2008-2016(Women's Health Issues, 2021) Anguzu, Ronald; Nagavally, Sneha; Dawson, Aprill Z.; Walker, Rebekah J.; Egede, Leonard E.We aimed to examine age and gender differences in the relationship between depression and quality of life among United States adults. Medical Expenditure Panel Survey data for 2008 to 2016 on 227,663 adults were analyzed. The dependent variable, quality of life, included physical component summary scores and mental component summary scores from the Short Form Health Survey. The key independent variable, depression, was measured using the two-item Patient Health Questionnaire. General linear regression models examined the relationship between quality of life and depression. Models were adjusted for individual and environmental characteristics, symptom status, functional and biological status, and health perceptions and were stratified by gender and age. In adjusted models, mental component summary scores were significantly lower among those with depression compared with those without depression (β = –0.39; 95% confidence interval [CI], 0.38 to –1.16) and lower among women compared with men (β = –0.10; 95% CI, 0.10 to –1.31). Models stratified by gender and age found women with depression ages 40 to 64 (β = –0.07; 95% CI, 0.07 to –0.20) and 65 or older (β = –0.08; 95% CI, 0.08 to –0.24) had significantly lower physical component summary scores compared with those without depression. Among men with depression, those ages 18 to 39 (β = –0.03; 95% CI, 0.03 to –0.10) and 40 to 64 (β = –0.09, 95% CI, 0.08 to –0.26) had lower physical component summary scores compared with those without depression. Women and men of all ages with depression had significantly lower mental component summary scores compared with those without depression. Public health interventions and clinical approaches to address depression in women and men should target functional status in men and perceptions of health in women.Item Facilitators and barriers to routine intimate partner violence screening in antenatal care settings in Uganda(BMC health services research, 2022) Anguzu, Ronald; Cassidy, Laura D.; Beyer, Kirsten M. M.; Babikako, Harriet M.; Walker, Rebekah J.; Dickson‑Gomez, JuliaUganda clinical guidelines recommend routine screening of pregnant women for intimate partner violence (IPV) during antenatal care (ANC). Healthcare providers play a critical role in identifying IPV during pregnancy in ANC clinics. This study explored facilitators and barriers for IPV screening during pregnancy (perinatal IPV screening) by ANC-based healthcare workers in Uganda. We conducted qualitative in-depth interviews among twenty-eight purposively selected healthcare providers in one rural and an urban-based ANC health center in Eastern and Central Uganda respectively. Barriers and facilitators to IPV screening during ANC were identified iteratively using inductive-deductive thematic analysis. Participants had provided ANC services for a median (IQR) duration of 4.0 (0.1–19) years. Out of 28 healthcare providers, 11 routinely screened women attending ANC clinics for IPV and 10 had received IPV-related training. Barriers to routine IPV screening included limited staffing and space resources, lack of comprehensive gender-based violence (GBV) training and provider unawareness of the extent of IPV during pregnancy. Facilitators were availability of GBV protocols and providers who were aware of IPV (or GBV) tools tended to use them to routinely screen for IPV. Healthcare workers reported the need to establish patient trust and a safe ANC clinic environment for disclosure to occur. ANC clinicians suggested creation of opportunities for triage-level screening and modification of patients’ ANC cards used to document women’s medical history. Some providers expressed concerns of safety or retaliatory abuse if perpetrating partners were to see reported abuse. Our findings can inform efforts to strengthen GBV interventions focused on increasing routine perinatal IPV screening by ANC-based clinicians. Implementation of initiatives to increase routine perinatal IPV screening should focus on task sharing, increasing comprehensive IPV training opportunities, including raising awareness of IPV severity, trauma-informed care and building trusting patient-physician relationships.