Depressive Symptoms and Behavioral Health Risks in Pregnant and Postpartum Women: Prevalence and Risk Co-Occurrence in Low-Resource Communities

Background:  Depression screening has been widely promoted during pregnancy and post-partum; however, women in low-resource communities face added help-seeking challenges (author et al, 2009).   Low resource communities are defined as economically challenged (rural or urban) with significant provider shortages and identified disparities in maternal and child health.  Studying patterns of risk without adequate community resources presents ethical concerns.  Therefore, this study is housed within a larger project providing brief intervention, systemic service enhancement, and behavioral health consultation to all participants. 

Objectives:  The aim of this study is to understand the prevalence and severity of depressive symptoms and concomitant behavioral health risks of substance use, interpersonal violence, and smoking in women residing in low-resource communities.  This knowledge is intended to inform the development and implementation of targeted behavioral health supports and responsive social policies which address this documented disparity between maternal mental health needs and service availability.

Methods:  In this maternal, infant, and early childhood home visiting (MIECHV) funded study, a community based, statewide sample of home visiting eligible pregnant and postpartum women (N=1,515) were engaged in a tiered screening, brief intervention, and referral to treatment protocol managed via RedCap.  The Institute for Health and Recovery’s Behavioral Health Risk Screen (BHRS) served as the initial risk triage, with the substitution of the Edinburgh 3 item subscale to reflect emotional health (Kabir, Sheeder & Kelly 2008).  The positive endorsement of any item(s) on the BHRS autopopulated a full screening instrument (Edinburg Postnatal Depression Scale/EPDS; Relationship Assessment Tool; Perinatal Substance “4 P’s” and smoking quantity and frequency).  Data were analyzed using SPSS 23 to examine patterns of prevalence and risk co-occurrence along with referral outcomes.

Results:  In this community-based sample, 22% of participants (N=330) triggered emotional health risk using the Edinburgh 3.  Of these, the range of EPDS scores was 1 – 28 (mean = 11.4, SD 5.7) with 113 (34.2%) scoring at or above the generally accepted total cut-off score ≥ 13.  Severity of depressive symptoms was associated with concurrent smoking (F=15.16, p <.0005) and substance use (F=8.96, p=.003), although current or past risk of interpersonal violence did not contribute significantly to the model.  Severity of depressive symptoms was associated with mental health services referral (F=10.68, p=.001) but was not related to home visiting referral, since utilization of this supportive intervention was universally high (over 85%) in the sub-sample.

Conclusion:  In this low-resource community sample, risk for depression exceeds that of the general population of pregnant and postpartum women.  Elevated depressive symptoms were significantly associated with use of substances and smoking which, while detrimental to pregnancy outcomes, may suggest deployment of short-term coping mechanisms.  The high uptake of home visiting and supportive mental health services offered through this project suggests that these services are desirable and utilized when made available.  While further research is warranted to extend these findings beyond the target communities, findings from this study demonstrate the necessity and benefit of expanding interventions and promoting social policies which address gaps in mental health service delivery.