A Model for Maternal Depression (original) (raw)
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Supporting Low Income Women Experiencing Perinatal Depression: A Qualitative Study
2017
In addition to pregnancy and parenting-related stress, such as low maternal self-esteem and childcare stress, women experiencing poverty are exceptionally vulnerable to depression (Beck, 2001; Belle & Doucet, 2003). Psychosocial factors including low socioeconomic status, inadequate social support, chronic stress, and negative life events are associated with increased rates of perinatal depression (Beck, 2001). In fact, one study found that depression rates in both homeless and housed low-income mothers are about twice as high as in the general population of women (Bassuk, Buckner, Perloff, & Bassuk, 1998). Untreated depression poses a health risk to mothers, their infants, and society overall. In the US, suicides from perinatal depression exceed the number of deaths from other obstetric medical conditions, including hemorrhage and hypertensive disorders (Gynecologists, 2015; T. Pearlstein, Howard, Salisbury, & Zlotnick, 2009). Maternal depression may also diminish a mother's attachment and bonding with her infant, resulting in increased risk for behavioral, cognitive, and social impairments among children (Gress-Smith et al., 2012). Perinatal depression is associated with missed pediatric outpatient appointments and increased pediatric emergency service utilization (Flynn, Davis, Marcus, Cunningham, & Blow, 2004). Despite the effectiveness of a variety of both pharmacological and non-pharmacological treatment options, only 1 in 4 women diagnosed with maternal depression actually attends their first mental health appointment (Byatt, Levin, Ziedonis, Moore Simas, & Allison, 2015). Given the prevalence and associated adverse outcomes, perinatal depression among low-income women is a significant and under-recognized public health issue. Effective prevention, screening, and treatment for perinatal depression are crucial in improving maternal and child health (Siu et al., 2016). Because of the stigma associated with seeking mental health services as well as the limitations of standard approaches to treating maternal depression, innovative interventions with community partners are needed. A San Francisco Bay Area community-based organization (CBO) partnered with a safety-net hospital and academic center to address the prevalence and consequences of perinatal depression among low-income women utilizing their services. We employed qualitative methods during the needs assessment phase of our partnership to 1) identify sources of distress for pregnant and postpartum women, 2) identify barriers in recovering from perinatal depression, and 3) identify examples of successful support for perinatal depression. We engaged directly with our community partners (both providers and clients) to gather their perspectives on how to better address the intersection of basic needs and psychological distress that often accompany perinatal depression, especially among socially and financially disadvantaged women. 2 Methods We conducted focus groups with pregnant and postpartum women, as well as their providers in our partner CBO. We chose focus groups as the most appropriate methodology to explore their varying and shared explanatory model of the risks for perinatal depression and experiences securing access to care. Because perinatal depression can be stigmatizing topic, we felt that a focus group setting would allow participants to share more than they would in one-onone interviews. The group discussion would also allow collective brainstorming of solutions and possible interventions (Kitzinger, 1995). Study Setting The CBO in this study is a social services organization that serves low-income and homeless families in a dense, urban setting. Their mission is to end childhood poverty with supportive, nonjudgmental case management to empower families, especially mothers, to support their children's success and healthy development. This CBO is unique in being one of the first agencies in the San Francisco Bay Area to hire previous clients to become case managers and community health workers. About half of the pregnant and postpartum clients identify as Hispanic or Latino, and a quarter identify as Black. About one third of the client base speaks Spanish as their primary language. Case managers and community health workers provide information and resources for stable housing and economic self-sufficiency. Additional case managers are available for support regarding interpersonal violence and Child Protective Services (CPS) cases. Wellness services, like prenatal classes, mother-baby bonding activities, support groups, and parenting classes, are provided to empower families to support the healthy development of their children. Some on-site psychological therapy is available as well. Data Collection We conducted a total of eight focus groups, four with CBO providers and four with CBO clients. This study was approved by the Institutional Review Board at the University of California, San Francisco. Providers were invited to participate in audio-recorded focus groups during team meetings. We recruited community health workers, case managers, and therapists from our partner CBO. Providers verbally provided consent and demographic information about age and race/ethnicity. Each provider focus group was conducted in English for one hour and was cofacilitated by two research team members. CBO clients were primarily recruited to focus groups through wellness services. Flyers were also posted on organization billboards and handed to clients in case management meetings. Women were informed that the focus group topics were 1) "stressful experiences for pregnant women and new moms," and 2) "how to improve services for pregnant women and new moms." We used generic terms like stress and anxiety rather than depression to reduce the stigma of participating in focus groups and to recruit women across the spectrum of psychological distress. Prior research with at-risk, low-income women has shown that women prefer to use abstract terminology to describe their own distress rather than depression (Bilszta, Ericksen, Buist, & Milgrom, 2010; Guy, Sterling, Walker, & Harrison, 2014). Lunch, childcare, and a $50 Visa gift card were incentives for participation. Eligible participants for our study were pregnant or the mother of a child 0-3 years of age, at least 18 years old, and able to read and write in English or Spanish to complete self-administered surveys.
Depression Research and Treatment, 2011
Postpartum depression is a serious and common psychiatric illness. Mothers living in poverty are more likely to be depressed and have greater barriers to accessing treatment than the general population. Mental health utilization is particularly limited for women with postpartum depression and low-income, minority women. As part of an academic-community partnership, focus groups were utilized to examine staff practices, barriers, and facilitators in mental health referrals for women with depression within a community nonprofit agency serving low-income pregnant and postpartum women. The focus groups were analyzed through content analyses and NVIVO-8. Three focus groups with 16 community health workers were conducted. Six themes were identified: (1) screening and referral, (2) facilitators to referral, (3) barriers to referral, (4) culture and language, (5) life events, and (6) support. The study identified several barriers and facilitators for referring postpartum women with depression to mental health services.
Primary Health Care Research & Development
IntroductionPerinatal mood and anxiety disorders (PMADs) are the most common complication of pregnancy and have been found to have long-term implications for both mother and child. In vulnerable patient populations such as those served at Denver Health, a federally qualified health center the prevalence of PMADs is nearly double the nationally reported rate of 15–20%. Nearly 17% of women will be diagnosed with major depression at some point in their lives and those numbers are twice as high in women who live in poverty. Women also appear to be at higher risk for depression in the child-bearing years. In order to better address these issues, an Integrated Perinatal Mental Health program was created to screen, assess, and treat PMADs in alignment with national recommendations to improve maternal–child health and wellness. This program was built upon a national model of Integrated Behavioral Health already in place at Denver Health.MethodsA multidisciplinary team of physicians, behavio...
Scientific Reports
In South Africa, symptoms of common mental disorders (CMDs) such as depression and anxiety are highly prevalent during the perinatal period and linked to experiences of domestic violence. However, limited routine detection and treatment is available to pregnant women with these problems, even though evidence suggests that screening and treating CMDs during pregnancy improves the health and economic outcomes of mothers and their children, and has been suggested as a key approach to improving the health of perinatal women and children. We investigated facilitators and barriers of service-providers and service-users in detecting and treating pregnant women with symptoms of CMDs and experiences of domestic violence. This study was conducted in four midwife obstetric units (MOUs) in Cape Town, South Africa, and in the non-profit organisations providing community-based support in the communities surrounding the MOUs. Service-provider perspectives were informed by qualitative interviews wi...
Addressing perinatal depression in a group of underserved urban women: a focus group study
BMC Pregnancy and Childbirth, 2014
Background: Perinatal mental health problems are common complications of pregnancy that can go undetected and untreated. Research indicated that mental health complications are more prevalent in women from disadvantaged communities, yet women from these communities often experience barriers to accessing treatments and interventions. Untreated depression during pregnancy can lead to poor self-care, increased substance abuse, poor obstetrical outcomes, developmental delay in children, and increased risk of postpartum depression. In this study we investigated the perceived perinatal mental health needs of our participants and they wanted to address their perceived needs. Methods: In this qualitative study, we invited women who resided in an underserved, urban community who were pregnant or who delivered within the past year to participate in focus groups. Results: Thirty-seven women participated in seven focus groups. Thirteen themes emerged which were described in relation to mental health needs, help currently accessed and the type of support wanted. The themes included the various mental health needs including dealing with changing moods, depression, feelings of isolation, worrying and a sense of being burdened. Women described using a limited range of supports and help. Participants expressed a preference for mental health support that was empowerment focused in its orientation, including peer support. Women also described the compounding effect that social and economic stresses had on their mental health. Conclusions: Participants wanted access to a greater range of supports for mental health than were currently available to them, including peer support, and wanted assistance in addressing social and economic needs. These findings offer a challenge to further broaden the types of services offered to women, and demonstrate that those services need to be responsive to the challenging contexts of women's lives. Integrating women's views and experiences into the development of services may help to overcome barriers to care.
Patient, provider, and system-level barriers and facilitators to addressing perinatal depression
… of Reproductive and …, 2012
Objective: To explore perinatal health care professionals' perspectives on barriers and facilitators to addressing perinatal depression. Background: Perinatal depression is common and associated with deleterious effects on mother, foetus, child and family. Although the regular contact between mothers and perinatal health care professionals may make the obstetric setting ideal for addressing depression, barriers persist, and depression remains under-diagnosed and undertreated. Methods: Four 90-minute focus groups were conducted with perinatal health care professionals, including obstetric resident and attending physicians, licensed independent practitioners, nurses, patient care assistants, social workers and administrative support staff. Focus groups were transcribed, and resulting data were analysed using a grounded theory approach. Results: Participants identified patient-, provider-and system-level barriers and facilitators to addressing perinatal depression. Provider-level barriers included lack of resources, skills and confidence needed to diagnose, refer and treat perinatal depression. Limited access to mental health care and resources were identified as system-level barriers. Facilitators identified included targeted training for perinatal health care professionals', structured screening and referral processes, and enhanced support and guidance from mental health providers. Conclusion: A complex set of interactions between women and perinatal health care professionals contributes to perinatal depression being untreated. Service gaps could be closed by addressing identified barriers through integrated obstetric and depression care and enhanced collaborations. Future intervention testing could include targeted training, improved access, and mental health provider support to empower perinatal health care professionals' to address perinatal depression, and thereby improve delivery of depression treatment in obstetric settings.
Archives of Women's Mental Health, 2008
Postpartum depression (PPD) is a major health problem for many women, including rural low-income African-American women. Researchers have documented the long lasting consequences of PPD. The purpose of this pilot study was to examine the initial acceptability, feasibility, and effectiveness of the ROSE Program, a brief, interpersonally-based intervention in a group of lowincome, rural African-American pregnant women at risk for PPD. Participants were 36 African-American pregnant women at risk for PPD who attended a rural hospitalaffiliated prenatal clinic. Participants were randomly assigned to the ROSE Program or to treatment as usual (TAU). Outcomes included measures of depressive symptoms, postpartum adjustment, and parental stress at 3 months postpartum. At 3 months postpartum, the study found no significant differences between the two conditions in degree of depressive symptoms or level of parental stress. The women in the intervention condition reported significantly better postpartum adjustment at 3 months postpartum than women in the TAU group. Those in the ROSE Program reported improvement in depressive symptoms over time, whereas women in the TAU group did not evidence such changes. These results provide initial effectiveness for the ROSE Program in improving postpartum functioning in a group of low-income, rural African-American pregnant women.
General hospital psychiatry, 2015
Best practices for addressing women's mental health and screening for depression in public health clinics are not available. Clinic staff are often responsible for screening for depression; however, few studies examine staff perceptions on feasibility and acceptability of using perinatal screening for mood disorders in ethnically diverse public health clinics. During December 2012, we conducted four focus groups using a semistructured interview guide with public health clinic staff of varying disciplines (n=25) in a Special Supplemental Nutrition Program for Women, Infants, and Children. All interviews were audio recorded and analyzed using thematic analysis. We found five descriptive themes related to acceptability and feasibility of screening for perinatal depression in a public health clinic. The main themes include (1) literacy barriers, (2) need for referrals and follow-up with outside services, (3) training and capacity needs, (4) stigma of depression, and (5) location and...
Journal of Psychosomatic Obstetrics & Gynecology, 2017
Objectives: Universal screening for depression during pregnancy and postpartum is recommended, yet mental health treatment and follow up rates among screen positive women in rural settings are low. We studied the feasibility, acceptability and effectiveness of perinatal depression treatment integrated into a rural obstetric setting. Methods: We conducted an open treatment study of a screening and intervention program modified from the Depression Attention for Women Now (DAWN) Collaborative Care model in a rural obstetric clinic. Depression screen positive pregnant and postpartum women received Problem Solving Therapy (PST) with or without antidepressants. A care manager coordinated communication between patient, obstetrician and psychiatric consultant. We measured change in the Patient Health Questionnaire 9 (PHQ −9) score. We used surveys and focus groups to measure patient and provider satisfaction and analyzed focus groups using qualitative analysis. Results: The intervention was well accepted by providers and patients, based on survey and focus group data. Feasibility was also evidenced by recruitment (87.1%) and retention (92.6%) rates and depression outcomes (64% with >50% improvement in PHQ 9) which were comparable to clinical trials in similar urban populations. Conclusions for practice: DAWN Collaborative Care modified for treatment of perinatal depression in a rural obstetric setting is feasible and acceptable. Behavioral health services integrated into rural obstetric settings could improve care for perinatal depression.