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Published in: Maternal and Child Health Journal 7/2018

01-07-2018

Adverse Childhood Experiences and Postpartum Depression in Home Visiting Programs: Prevalence, Association, and Mediating Mechanisms

Authors: Joshua P. Mersky, Colleen E. Janczewski

Published in: Maternal and Child Health Journal | Issue 7/2018

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Abstract

Objectives In this study, we examined the prevalence of postpartum depression (PPD) and its association with select demographic factors and antenatal conditions. We also investigated whether greater exposure to adverse childhood experiences (ACEs) is associated with PPD, and if antenatal conditions mediate the ACE-PPD relationship. Methods Data were collected from 735 low-income women receiving home visiting services. Descriptive and bivariate analyses provided estimates of PPD and its correlates, and nested path analyses were used to test for mediation. Results We found that rates of PPD were high compared to prevalence estimates in the general population. Sample rates of antenatal depression were even higher than the rates of PPD. Omnibus tests revealed that PPD did not vary significantly by maternal age or race/ethnicity, although Hispanic women consistently reported the lowest rates. American Indian women and non-Hispanic white women reported the highest rates. PPD was significantly associated with increased exposure to ACEs. Nested path models revealed that the effects of ACEs were partially mediated by three antenatal conditions: intimate partner violence (IPV), perceived stress, and antenatal depression. Conclusions for Practice Supporting prior research, rates of PPD appear to be high among low-income women. ACEs may increase the risk of antenatal IPV and psychological distress, both of which may contribute to PPD. The findings have implications for screening and assessment as well as the timing and tailoring of interventions through home visiting and other community-based services.
Literature
go back to reference Ammerman, R. T., Putnam, F. W., Altaye, M., Chen, L., Holleb, L. J., Stevens, J., … Van Ginkel, J. B. (2009). Changes in depressive symptoms in first time mothers in home visitation. Child Abuse & Neglect, 33(3), 127–138.CrossRef Ammerman, R. T., Putnam, F. W., Altaye, M., Chen, L., Holleb, L. J., Stevens, J., … Van Ginkel, J. B. (2009). Changes in depressive symptoms in first time mothers in home visitation. Child Abuse & Neglect, 33(3), 127–138.CrossRef
go back to reference Ammerman, R. T., Putnam, F. W., Bosse, N. R., Teeters, A. R., & Van Ginkel, J. B. (2010). Maternal depression in home visitation: A systematic review. Aggression and Violent Behavior, 15(3), 191–200.CrossRefPubMedPubMedCentral Ammerman, R. T., Putnam, F. W., Bosse, N. R., Teeters, A. R., & Van Ginkel, J. B. (2010). Maternal depression in home visitation: A systematic review. Aggression and Violent Behavior, 15(3), 191–200.CrossRefPubMedPubMedCentral
go back to reference Asparouhov, T., & Muthén, B. (2010). Weighted least squares estimation with missing data. Mplus Technical Appendix, 2010, 1–10. Asparouhov, T., & Muthén, B. (2010). Weighted least squares estimation with missing data. Mplus Technical Appendix, 2010, 1–10.
go back to reference Baker, L., Cross, S., Greaver, L., Wei, G., Lewis, R., & CORPS, H. S (2005). Prevalence of postpartum depression in a Native American population. Maternal and Child Health Journal, 9(1), 21–25.CrossRefPubMed Baker, L., Cross, S., Greaver, L., Wei, G., Lewis, R., & CORPS, H. S (2005). Prevalence of postpartum depression in a Native American population. Maternal and Child Health Journal, 9(1), 21–25.CrossRefPubMed
go back to reference Banti, S., Mauri, M., Oppo, A., Borri, C., Rambelli, C., Ramacciotti, D., … Cassano, G. B. (2011). From the third month of pregnancy to 1 year postpartum. Prevalence, incidence, recurrence, and new onset of depression. Results from the Perinatal Depression-Research & Screening Unit study. Comprehensive Psychiatry, 52(4), 343–351.CrossRefPubMed Banti, S., Mauri, M., Oppo, A., Borri, C., Rambelli, C., Ramacciotti, D., … Cassano, G. B. (2011). From the third month of pregnancy to 1 year postpartum. Prevalence, incidence, recurrence, and new onset of depression. Results from the Perinatal Depression-Research & Screening Unit study. Comprehensive Psychiatry, 52(4), 343–351.CrossRefPubMed
go back to reference Beck, C. T. (2001). Predictors of postpartum depression: An update. Nursing Research, 50(5), 275–285.CrossRefPubMed Beck, C. T. (2001). Predictors of postpartum depression: An update. Nursing Research, 50(5), 275–285.CrossRefPubMed
go back to reference Bennett, H. A., Einarson, A., Taddio, A., Koren, G., & Einarson, T. R. (2004). Prevalence of depression during pregnancy: Systematic review. Obstetrics & Gynecology, 103(4), 698–709.CrossRef Bennett, H. A., Einarson, A., Taddio, A., Koren, G., & Einarson, T. R. (2004). Prevalence of depression during pregnancy: Systematic review. Obstetrics & Gynecology, 103(4), 698–709.CrossRef
go back to reference Bergink, V., Kooistra, L., Lambregtse-van den Berg, M. P., Wijnen, H., Bunevicius, R., van Baar, A., & Pop, V. (2011). Validation of the Edinburgh Depression Scale during pregnancy. Journal of Psychosomatic Research, 70(4), 385–389.CrossRefPubMed Bergink, V., Kooistra, L., Lambregtse-van den Berg, M. P., Wijnen, H., Bunevicius, R., van Baar, A., & Pop, V. (2011). Validation of the Edinburgh Depression Scale during pregnancy. Journal of Psychosomatic Research, 70(4), 385–389.CrossRefPubMed
go back to reference Beydoun, H. A., Beydoun, M. A., Kaufman, J. S., Lo, B., & Zonderman, A. B. (2012). Intimate partner violence against adult women and its association with major depressive disorder, depressive symptoms and postpartum depression: A systematic review and meta-analysis. Social Science & Medicine, 75(6), 959–975.CrossRef Beydoun, H. A., Beydoun, M. A., Kaufman, J. S., Lo, B., & Zonderman, A. B. (2012). Intimate partner violence against adult women and its association with major depressive disorder, depressive symptoms and postpartum depression: A systematic review and meta-analysis. Social Science & Medicine, 75(6), 959–975.CrossRef
go back to reference Burke, N. J., Hellman, J. L., Scott, B. G., Weems, C. F., & Carrion, V. G. (2011). The impact of adverse childhood experiences on an urban pediatric population. Child Abuse & Neglect, 35(6), 408–413.CrossRef Burke, N. J., Hellman, J. L., Scott, B. G., Weems, C. F., & Carrion, V. G. (2011). The impact of adverse childhood experiences on an urban pediatric population. Child Abuse & Neglect, 35(6), 408–413.CrossRef
go back to reference Chapman, D. P., Whitfield, C. L., Felitti, V. J., Dube, S. R., Edwards, V. J., & Anda, R. F. (2004). Adverse childhood experiences and the risk of depressive disorders in adulthood. Journal of Affective Disorders, 82(2), 217–225.CrossRefPubMed Chapman, D. P., Whitfield, C. L., Felitti, V. J., Dube, S. R., Edwards, V. J., & Anda, R. F. (2004). Adverse childhood experiences and the risk of depressive disorders in adulthood. Journal of Affective Disorders, 82(2), 217–225.CrossRefPubMed
go back to reference Chung, E. K., Mathew, L., Elo, I. T., Coyne, J. C., & Culhane, J. F. (2008). Depressive symptoms in disadvantaged women receiving prenatal care: The influence of adverse and positive childhood experiences. Ambulatory Pediatrics, 8(2), 109–116.CrossRefPubMed Chung, E. K., Mathew, L., Elo, I. T., Coyne, J. C., & Culhane, J. F. (2008). Depressive symptoms in disadvantaged women receiving prenatal care: The influence of adverse and positive childhood experiences. Ambulatory Pediatrics, 8(2), 109–116.CrossRefPubMed
go back to reference Cohen, S., Kamarck, T., & Mermelstein, R. (1983). A global measure of perceived stress. Journal of Health and Social Behavior, 24(4), 385–396.CrossRefPubMed Cohen, S., Kamarck, T., & Mermelstein, R. (1983). A global measure of perceived stress. Journal of Health and Social Behavior, 24(4), 385–396.CrossRefPubMed
go back to reference Cox, J. L., Holden, J. M., & Sagovsky, R. (1987). Detection of postnatal depression. Development of the 10-item Edinburgh Postnatal Depression Scale. The British Journal of Psychiatry, 150(6), 782–786.CrossRefPubMed Cox, J. L., Holden, J. M., & Sagovsky, R. (1987). Detection of postnatal depression. Development of the 10-item Edinburgh Postnatal Depression Scale. The British Journal of Psychiatry, 150(6), 782–786.CrossRefPubMed
go back to reference Deal, L. W., & Holt, V. L. (1998). Young maternal age and depressive symptoms: Results from the 1988 National Maternal and Infant Health Survey. American Journal of Public Health, 88(2), 266–270.CrossRefPubMedPubMedCentral Deal, L. W., & Holt, V. L. (1998). Young maternal age and depressive symptoms: Results from the 1988 National Maternal and Infant Health Survey. American Journal of Public Health, 88(2), 266–270.CrossRefPubMedPubMedCentral
go back to reference Felitti, V. J., Anda, R. F., Nordenberg, D., Williamson, D. F., Spitz, A. M., Edwards, V., … Marks, J. S. (1998). Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults: The Adverse Childhood Experiences (ACE) Study. American Journal of Preventive Medicine, 14(4), 245–258.CrossRefPubMed Felitti, V. J., Anda, R. F., Nordenberg, D., Williamson, D. F., Spitz, A. M., Edwards, V., … Marks, J. S. (1998). Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults: The Adverse Childhood Experiences (ACE) Study. American Journal of Preventive Medicine, 14(4), 245–258.CrossRefPubMed
go back to reference Field, T. (2010). Postpartum depression effects on early interactions, parenting, and safety practices: A review. Infant Behavior and Development, 33(1), 1–6.CrossRefPubMed Field, T. (2010). Postpartum depression effects on early interactions, parenting, and safety practices: A review. Infant Behavior and Development, 33(1), 1–6.CrossRefPubMed
go back to reference Gavin, N. I., Gaynes, B. N., Lohr, K. N., Meltzer-Brody, S., Gartlehner, G., & Swinson, T. (2005). Perinatal depression: A systematic review of prevalence and incidence. Obstetrics and Gynecology, 106(5 Pt 1), 1071–1083.CrossRefPubMed Gavin, N. I., Gaynes, B. N., Lohr, K. N., Meltzer-Brody, S., Gartlehner, G., & Swinson, T. (2005). Perinatal depression: A systematic review of prevalence and incidence. Obstetrics and Gynecology, 106(5 Pt 1), 1071–1083.CrossRefPubMed
go back to reference Gjerdingen, D. K., & Yawn, B. P. (2007). Postpartum depression screening: Importance, methods, barriers, and recommendations for practice. The Journal of the American Board of Family Medicine, 20(3), 280–288.CrossRefPubMed Gjerdingen, D. K., & Yawn, B. P. (2007). Postpartum depression screening: Importance, methods, barriers, and recommendations for practice. The Journal of the American Board of Family Medicine, 20(3), 280–288.CrossRefPubMed
go back to reference Gone, J. P., & Trimble, J. E. (2012). American Indian and Alaska Native mental health: Diverse perspectives on enduring disparities. Annual Review of Clinical Psychology, 8, 131–160.CrossRefPubMed Gone, J. P., & Trimble, J. E. (2012). American Indian and Alaska Native mental health: Diverse perspectives on enduring disparities. Annual Review of Clinical Psychology, 8, 131–160.CrossRefPubMed
go back to reference Goodson, B. D., Mackrain, M., Perry, D. F., O’Brien, K., & Gwaltney, M. K. (2013). Enhancing home visiting with mental health consultation. Pediatrics, 132(Supplement 2), S180–S190.CrossRefPubMed Goodson, B. D., Mackrain, M., Perry, D. F., O’Brien, K., & Gwaltney, M. K. (2013). Enhancing home visiting with mental health consultation. Pediatrics, 132(Supplement 2), S180–S190.CrossRefPubMed
go back to reference Grace, S. L., Evindar, A., & Stewart, D. E. (2003). The effect of postpartum depression on child cognitive development and behavior: A review and critical analysis of the literature. Archives of Women’s Mental Health, 6(4), 263–274.CrossRefPubMed Grace, S. L., Evindar, A., & Stewart, D. E. (2003). The effect of postpartum depression on child cognitive development and behavior: A review and critical analysis of the literature. Archives of Women’s Mental Health, 6(4), 263–274.CrossRefPubMed
go back to reference Green, J. G., McLaughlin, K. A., Berglund, P. A., Gruber, M. J., Sampson, N. A., Zaslavsky, A. M., & Kessler, R. C. (2010). Childhood adversities and adult psychiatric disorders in the national comorbidity survey replication I: Associations with first onset of DSM-IV disorders. Archives of General Psychiatry, 67(2), 113–123.CrossRefPubMedPubMedCentral Green, J. G., McLaughlin, K. A., Berglund, P. A., Gruber, M. J., Sampson, N. A., Zaslavsky, A. M., & Kessler, R. C. (2010). Childhood adversities and adult psychiatric disorders in the national comorbidity survey replication I: Associations with first onset of DSM-IV disorders. Archives of General Psychiatry, 67(2), 113–123.CrossRefPubMedPubMedCentral
go back to reference Hasin, D. S., Goodwin, R. D., Stinson, F. S., & Grant, B. F. (2005). Epidemiology of major depressive disorder: Results from the National Epidemiologic Survey on Alcoholism and Related Conditions. Archives of General Psychiatry, 62(10), 1097–1106.CrossRefPubMed Hasin, D. S., Goodwin, R. D., Stinson, F. S., & Grant, B. F. (2005). Epidemiology of major depressive disorder: Results from the National Epidemiologic Survey on Alcoholism and Related Conditions. Archives of General Psychiatry, 62(10), 1097–1106.CrossRefPubMed
go back to reference Hobfoll, S. E., Ritter, C., Lavin, J., Hulsizer, M. R., & Cameron, R. P. (1995). Depression prevalence and incidence among inner-city pregnant and postpartum women. Journal of Consulting and Clinical Psychology, 63(3), 445–453.CrossRefPubMed Hobfoll, S. E., Ritter, C., Lavin, J., Hulsizer, M. R., & Cameron, R. P. (1995). Depression prevalence and incidence among inner-city pregnant and postpartum women. Journal of Consulting and Clinical Psychology, 63(3), 445–453.CrossRefPubMed
go back to reference Howell, E. A., Mora, P. A., Horowitz, C. R., & Leventhal, H. (2005). Racial and ethnic differences in factors associated with early postpartum depressive symptoms. Obstetrics and Gynecology, 105(6), 1442–1450.CrossRefPubMedPubMedCentral Howell, E. A., Mora, P. A., Horowitz, C. R., & Leventhal, H. (2005). Racial and ethnic differences in factors associated with early postpartum depressive symptoms. Obstetrics and Gynecology, 105(6), 1442–1450.CrossRefPubMedPubMedCentral
go back to reference Lancaster, C. A., Gold, K. J., Flynn, H. A., Yoo, H., Marcus, S. M., & Davis, M. M. (2010). Risk factors for depressive symptoms during pregnancy: A systematic review. American Journal of Obstetrics and Gynecology, 202(1), 5–14.CrossRefPubMedPubMedCentral Lancaster, C. A., Gold, K. J., Flynn, H. A., Yoo, H., Marcus, S. M., & Davis, M. M. (2010). Risk factors for depressive symptoms during pregnancy: A systematic review. American Journal of Obstetrics and Gynecology, 202(1), 5–14.CrossRefPubMedPubMedCentral
go back to reference LaNoue, M., Graeber, D., de Hernandez, B. U., Warner, T. D., & Helitzer, D. L. (2012). Direct and indirect effects of childhood adversity on adult depression. Community Mental Health Journal, 48(2), 187–192.CrossRefPubMed LaNoue, M., Graeber, D., de Hernandez, B. U., Warner, T. D., & Helitzer, D. L. (2012). Direct and indirect effects of childhood adversity on adult depression. Community Mental Health Journal, 48(2), 187–192.CrossRefPubMed
go back to reference Lee, E. H. (2012). Review of the psychometric evidence of the perceived stress scale. Asian Nursing Research, 6(4), 121–127.CrossRefPubMed Lee, E. H. (2012). Review of the psychometric evidence of the perceived stress scale. Asian Nursing Research, 6(4), 121–127.CrossRefPubMed
go back to reference Lee, E. J., & Park, J. S. (2015). Development of a prediction model for postpartum depression: Based on the mediation effect of antepartum depression. Journal of Korean Academy of Nursing, 45(2), 211–220.CrossRefPubMed Lee, E. J., & Park, J. S. (2015). Development of a prediction model for postpartum depression: Based on the mediation effect of antepartum depression. Journal of Korean Academy of Nursing, 45(2), 211–220.CrossRefPubMed
go back to reference Luke, S., Salihu, H. M., Alio, A. P., Mbah, A. K., Jeffers, D., Berry, E. L., & Mishkit, V. R. (2009). Risk factors for major antenatal depression among low-income African American women. Journal of Women’s Health, 18(11), 1841–1846.CrossRefPubMed Luke, S., Salihu, H. M., Alio, A. P., Mbah, A. K., Jeffers, D., Berry, E. L., & Mishkit, V. R. (2009). Risk factors for major antenatal depression among low-income African American women. Journal of Women’s Health, 18(11), 1841–1846.CrossRefPubMed
go back to reference McEwen, B. S. (1999). Stress and hippocampal plasticity. Annual Review of Neuroscience, 22(1), 105–122.CrossRefPubMed McEwen, B. S. (1999). Stress and hippocampal plasticity. Annual Review of Neuroscience, 22(1), 105–122.CrossRefPubMed
go back to reference Mersky, J. P., Topitzes, J., & Reynolds, A. J. (2013). Impacts of adverse childhood experiences on health, mental health, and substance use in early adulthood: A cohort study of an urban, minority sample in the US. Child Abuse & Neglect, 37(11), 917–925.CrossRef Mersky, J. P., Topitzes, J., & Reynolds, A. J. (2013). Impacts of adverse childhood experiences on health, mental health, and substance use in early adulthood: A cohort study of an urban, minority sample in the US. Child Abuse & Neglect, 37(11), 917–925.CrossRef
go back to reference Murray, D., & Cox, J. (1990). Screening for depression during pregnancy with the Edinburgh Postnatal Depression Scale (EPDS). Journal of Reproductive and Infant Psychology, 8(2), 99–107.CrossRef Murray, D., & Cox, J. (1990). Screening for depression during pregnancy with the Edinburgh Postnatal Depression Scale (EPDS). Journal of Reproductive and Infant Psychology, 8(2), 99–107.CrossRef
go back to reference Muthén, L. K., & Muthén, B. O. (1998–2012). Mplus user’s guide (7th ed.). Los Angeles, CA: Muthén & Muthén. Muthén, L. K., & Muthén, B. O. (1998–2012). Mplus user’s guide (7th ed.). Los Angeles, CA: Muthén & Muthén.
go back to reference O’Hara, M. W., & Swain, A. M. (1996). Rates and risk of postpartum depression—A meta-analysis. International Review of Psychiatry, 8(1), 37–54.CrossRef O’Hara, M. W., & Swain, A. M. (1996). Rates and risk of postpartum depression—A meta-analysis. International Review of Psychiatry, 8(1), 37–54.CrossRef
go back to reference Rabin, R. F., Jennings, J. M., Campbell, J. C., & Bair-Merritt, M. H. (2009). Intimate partner violence screening tools: A systematic review. American Journal of Preventive Medicine, 36(5), 439–445.CrossRefPubMedPubMedCentral Rabin, R. F., Jennings, J. M., Campbell, J. C., & Bair-Merritt, M. H. (2009). Intimate partner violence screening tools: A systematic review. American Journal of Preventive Medicine, 36(5), 439–445.CrossRefPubMedPubMedCentral
go back to reference Riolo, S. A., Nguyen, T. A., Greden, J. F., & King, C. A. (2005). Prevalence of depression by race/ethnicity: Findings from the National Health and Nutrition Examination Survey III. American Journal of Public Health, 95(6), 998–1000.CrossRefPubMedPubMedCentral Riolo, S. A., Nguyen, T. A., Greden, J. F., & King, C. A. (2005). Prevalence of depression by race/ethnicity: Findings from the National Health and Nutrition Examination Survey III. American Journal of Public Health, 95(6), 998–1000.CrossRefPubMedPubMedCentral
go back to reference Robertson, E., Grace, S., Wallington, T., & Stewart, D. E. (2004). Antenatal risk factors for postpartum depression: A synthesis of recent literature. General Hospital Psychiatry, 26(4), 289–295.CrossRefPubMed Robertson, E., Grace, S., Wallington, T., & Stewart, D. E. (2004). Antenatal risk factors for postpartum depression: A synthesis of recent literature. General Hospital Psychiatry, 26(4), 289–295.CrossRefPubMed
go back to reference Rudolph, K. D., Flynn, M., Abaied, J. L., Groot, A., & Thompson, R. (2009). Why is past depression the best predictor of future depression? Stress generation as a mechanism of depression continuity in girls. Journal of Clinical Child & Adolescent Psychology, 38(4), 473–485.CrossRef Rudolph, K. D., Flynn, M., Abaied, J. L., Groot, A., & Thompson, R. (2009). Why is past depression the best predictor of future depression? Stress generation as a mechanism of depression continuity in girls. Journal of Clinical Child & Adolescent Psychology, 38(4), 473–485.CrossRef
go back to reference Rudolph, K. D., Hammen, C., Burge, D., Lindberg, N., Herzberg, D., & Daley, S. E. (2000). Toward an interpersonal life-stress model of depression: The developmental context of stress generation. Development and Psychopathology, 12(02), 215–234.CrossRefPubMed Rudolph, K. D., Hammen, C., Burge, D., Lindberg, N., Herzberg, D., & Daley, S. E. (2000). Toward an interpersonal life-stress model of depression: The developmental context of stress generation. Development and Psychopathology, 12(02), 215–234.CrossRefPubMed
go back to reference Segre, L. S., O’Hara, M. W., Arndt, S., & Stuart, S. (2007). The prevalence of postpartum depression. Social Psychiatry and Psychiatric Epidemiology, 42(4), 316–321.CrossRefPubMed Segre, L. S., O’Hara, M. W., Arndt, S., & Stuart, S. (2007). The prevalence of postpartum depression. Social Psychiatry and Psychiatric Epidemiology, 42(4), 316–321.CrossRefPubMed
go back to reference Soeken, K. L., McFarlane, J., Parker, B., & Lominack, M. C. (1998). The abuse assessment screen: A clinical instrument to measure frequency, severity, and perpetrator of abuse against women. Sage Series on Violence Against Women, 10, 195–203. Soeken, K. L., McFarlane, J., Parker, B., & Lominack, M. C. (1998). The abuse assessment screen: A clinical instrument to measure frequency, severity, and perpetrator of abuse against women. Sage Series on Violence Against Women, 10, 195–203.
go back to reference Thombs, B. D., Arthurs, E., Coronado-Montoya, S., Roseman, M., Delisle, V. C., Leavens, A., … Zelkowitz, P. (2014). Depression screening and patient outcomes in pregnancy or postpartum: A systematic review. Journal of Psychosomatic Research, 76(6), 433–446.CrossRefPubMed Thombs, B. D., Arthurs, E., Coronado-Montoya, S., Roseman, M., Delisle, V. C., Leavens, A., … Zelkowitz, P. (2014). Depression screening and patient outcomes in pregnancy or postpartum: A systematic review. Journal of Psychosomatic Research, 76(6), 433–446.CrossRefPubMed
go back to reference Wisner, K. L., Chambers, C., & Sit, D. K. (2006). Postpartum depression: A major public health problem. JAMA, 296(21), 2616–2618.CrossRefPubMed Wisner, K. L., Chambers, C., & Sit, D. K. (2006). Postpartum depression: A major public health problem. JAMA, 296(21), 2616–2618.CrossRefPubMed
Metadata
Title
Adverse Childhood Experiences and Postpartum Depression in Home Visiting Programs: Prevalence, Association, and Mediating Mechanisms
Authors
Joshua P. Mersky
Colleen E. Janczewski
Publication date
01-07-2018
Publisher
Springer US
Published in
Maternal and Child Health Journal / Issue 7/2018
Print ISSN: 1092-7875
Electronic ISSN: 1573-6628
DOI
https://doi.org/10.1007/s10995-018-2488-z

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