The Role of Perinatal Loss History In Low Income Women's Help-Seeking for Depression

Background and Purpose: Untreated depression has potentially deleterious consequences for mothers and children across the lifespan (Field et al., 2010; Segre et al., 2010). Low income and ethnic minority women in particular may experience additional stressors which elevate their risk for depression, including compromised social support, inequitable access to mental health treatment and services, and stigmatization of both their symptoms and their help seeking (Beeghly et al., 2003; Howell et al., 2005; Song et al., 2004). Compounding this risk are pronounced disparities in fetal and infant mortality in the United States, which disproportionately impact low-income and ethnic minority women. The aim of this study is to establish a social work research agenda linking research on perinatal depression with research on fetal and infant mortality disparities in order to address these co-existing life stressors in disenfranchised communities. Methods: Two related studies from the author's ongoing research will be discussed during this presentation. The first, a quantitative study (N=1,086) examines correlates of depression screening and help-seeking patterns for women in a low-income rural community. The second, a qualitative study (N=24) utilized focus groups and in-depth interviews to examine a group of urban low income women's experiences of loss and depression. The analyses from these studies utilized SPSS 18 and NVivo, respectively. Results: In the first study of help-seeking for perinatal depression in a rural community, 20% of all participants reported a prior fetal or infant death, which is consistent with national prevalence estimates (Price, 2006). This prior history of perinatal loss emerges as a statistically significant predictor of sub-diagnostic but elevated depressive symptoms (÷2 = 5.77, p = .016) as well as of help-seeking in the informal/self-help service sector (OR = 7.95, CI = 1.24, 50.82). In the second qualitative study of community experiences of depression, women reported the experience of reproductive and perinatal loss as central to their lived experiences individually, and also describe fetal and infant mortality in their communities as an “undiscussed and non-disclosed fact of life.” Women also revealed that they were hesitant to discuss perinatal loss with others as an emotional experience, although would report it factually to their physician providers; this was linked to perceived social stigma around vocalized emotional response to perinatal loss. Conclusions and Implications Results from these two studies begin to illustrate the salient linkages between the experience of fetal and infant mortality and perinatal mental health among groups of low-income women. While the health sector and mental health sector have examined these experiences separately, concerted efforts to link and examine bi-directional relationships between perinatal loss and perinatal depression are an important future direction for social work's role in promoting transdisciplinary research in this area. Future research efforts may embrace a service delivery format that combines fetal and infant mortality risk reduction with mental health promotion while minimizing access barriers to mental health services for low income women where help-seeking is more complex. Maternal and child health home visiting programs offer one possible opportunity for this future integration.