Reducing Disparities in Postpartum Mental Health: Results from a Home Visiting Intervention Among Low-Income Latinas

Background and Purpose: Postpartum depression is the leading cause of maternal morbidity in the U.S ^{1, 2}. It is estimated that U.S. Latinas have a higher risk of developing postpartum depression (PPD) than the general population ^3-6. Although Latinas may be at higher risk for PPD, they have lower levels of treatment engagement than Whites⁷. Cost, transportation and cultural beliefs that do not endorse mental illness as treatable have been cited as common barriers among Latina⁸. The Problem-solving Tools for Postpartum Depression (PST4PPD) is a home-based intervention that combines the principles of problem-solving therapy (PST) and motivational interviewing (MI). The intervention consists of one intake session utilizing MI techniques, and four problem solving treatment sessions. PST4PPD is an affordable and accessible treatment for low-income mothers^{9, 10}. This study examined the feasibility and effectiveness of the PST4PPD conducted by bilingual community lay healthcare workers (LHW) among low-income Latina mothers.

Methods: Using a one-group pre/post-test design we assessed the feasibility of delivering the PST4PPD by LHWs and its effectiveness for reducing depressive symptoms and increasing self-efficacy. Implementation of the intervention occurred at five different community faith-based organizations (CFBOs) in four states. The Edinburgh Postnatal Depression Scale (EPDS) and the Patient Health Questionnaire (PHQ-9) were used to assess depressive symptoms; the New General Self-Efficacy Scale (NGSE) and the Maternal Efficacy Questionnaire (MEQ) measured general self-efficacy and parenting self-efficacy, respectively.

Paired sample’s t-tests were conducted to determine if there were any significant changes in depression and self-efficacy scores from pre-test to post-test. A linear growth model was used to further investigate the changes in PHQ-9 scores after each treatment session.

Results: In total, 97 Latina mothers were enrolled in the intervention. Among the enrolled mothers, most of them were not born in the U.S. (n=65, 67.7%) and spoke Spanish at home (n=78, 81.3%). Finally, 74 (76%) participants finished the intervention and were included in the analysis.

Paired-t tests of EPDS and PHQ-9 both demonstrated that depressive symptoms reduced significantly: pre-post difference in EPDS=7.92, SD=5.00, n=74, t(df=73) =13.622, p=.001; pre-post difference in PHQ-9 =5.86, SD=5.31, n=74, t(df=73) =9.49, p<.001. Participants’ self-efficacy—both general self-efficacy and parenting self-efficacy—increased significantly post intervention (pre-post difference in NGSE=-3.08, SD=7.77, n=74, t(df=73) =-3.41, p=.001; pre-post difference in MEQ =-2.86, SD=4.98, n=74, t(df=73) =-4.94, p<.001).PHQ-9 scores decreased steadily along with each treatment session.  The linear growth model estimated that on average, participants’ PHQ-9 scores decreased by 1.4 points after each treatment session.

Conclusions and Implications: In this community-based intervention, lay health workers were trained to recruit, enroll and deliver a home visiting intervention to reduce PPD. With a 76% completion rate, demonstrable improvements were seen in the mother’s self-efficacy and her depression. Implications for practice and policy that promote culturally relevant interventions and reduces disparities in mental healthcare are described. Lessons learned about how to train and engage lay health workers for best results are discussed.