Bridging Disciplinary Boundaries (January 11 - 14, 2007)

Purpose. Poor mental health during pregnancy places women at risk for a number of perinatal complications, making it a typical target of intervention for intensive home visiting programs that seek to ensure healthy births and prevent child maltreatment. Ecological theories such as Krieger's ecosocial model suggest that an interplay of factors at multiple levels contribute to mental health status. This study examined the contribution of demographics, relational factors, and neighborhood characteristics to the mental health status of pregnant adult women that participated in the 2003 California Health Interview Survey (CHIS 2003).

Method. The CHIS 2003 Adult Survey is a population-based, random-digit dial telephone survey of California households. Of the 42,044 respondents, 436 women reported to be pregnant at the time of the interview. Demographic indicators, health behaviors, measures of social support, and neighborhood characteristics were examined in relation to the mental health status of these women using descriptive procedures, ANOVA, and stepwise regression techniques.

Results. On average, women reported that for 4.4 days during the past thirty, their mental health was not good when taking stress, depression, and problems with emotions into consideration. African American women had a significantly higher mean number of poor mental health days (8.8) when compared to Asian and Pacific Islanders (p=.001) who had the lowest mean (1.4 days). Number of poor mental health days was positively correlated with smoking and alcohol consumption, behaviors known to be harmful during pregnancy. In regression modeling, being married, having someone available to understand problems, and having someone to “love you and make you feel wanted” significantly reduced the number of days of poor mental health, whereas living at 199% or less of the poverty level and being treated badly because of race or ethnicity significantly increased the number of days. When neighborhood characteristics were entered into the model, including living in a neighborhood with a crime prevention or neighborhood watch program and living in a neighborhood where people “shared values” and “got along,” poverty level lost its significance, to suggest that neighborhood level factors may in some way offset the more deleterious effects of individual poverty. The experience of racism, however, retained its significance, accounting for an additional 3.7 days of poor mental health in the final model (p=.000).

Implications. Scholars have argued that improvements in perinatal health and the prevention of child maltreatment have stagnated because existing interventions focus primarily on individual risks while factors such as neighborhood and culture are typically overlooked. The results of this analysis suggest that mental health status during pregnancy is mediated by an interplay of factors at multiple levels, including the exchanges that take place in immediate relationships as well as those that occur within the neighborhood and the larger community. Additional research is needed to identify how this interplay varies among different ethnic groups with consideration given to interventions that expand on the successes of intensive home visiting by cutting across multiple sectors, such as neighborhood development and interventions to combat racism.