Toward Equity in Mental Health in Pregnancy and Postpartum for Black and Latina Women: One Healthy Start Site’s Story

Background and Purpose:

Perinatal mood and anxiety disorders (PMADs) occur at roughly 12-15% and describe a spectrum of mental health conditions that occur during pregnancy and up to one year after childbirth. Unmet social and mental health needs are correlated with poor maternal mental health functioning. Postpartum depression (PPD) rates double among mothers living in poverty. Fewer than 20% of women nationwide are screened for postpartum depression. Among mothers who score positive for depression during the perinatal period, only 22% receive mental health treatment. Rates of screening and treatment are even lower for women who live in poverty and for women of color.

Mental health conditions are an underlying cause of maternal mortality and 53% of maternal deaths occur after the woman leaves the hospital. Community-level approaches to preventing PMADs and ensuring healthy pregnancy are needed. This study explored the physical and mental health characteristics of participants and gathered experiences of Healthy Start (HS) participants.

Methods: The research questions guiding this study were as follows: 1) What were the mental health needs among HS mothers when screened prenatally? 2) How did those screened at risk of PPD receive referral services from HS? 3) How do participants evaluate the HS program's influence on their mental wellbeing? To address these queries, we employed a Concurrent Mixed Methods approach. Data was collected at the individual level quantitatively during home visits and qualitatively in focus groups.

Results: Results reveal that mothers (N=164) were living below the federal poverty line, had high school or less education and were 80% Black and 18% Latina. Program outcomes revealed lower rates of preterm birth and lower rates of low birth weight among Black participants compared to national rates of these birth outcomes among Black women. Screening for postpartum depression was 1t 975 with a 78% referral rate. Screening for interpersonal violence (IPV), a known correlate of PMADs, was 98% with a 100% referral rate for the 4 women who screen positive for IPV. Focus groups (N=23) revealed close knit relationships with case managers and doulas that encouraged disclosure of symptoms, honest discussions and increased desire to ask for help when needed. Themes included: “I’m here for you”. Persistence and authenticity were critical to gain client trust; 2) : “That’s my girl” A culture of sisterhood positively affected women’s’ mental health 3; : “Ready to help me find resources”. Case Managers Were Proactive with Emotional Support and Resource Referral.

Conclusions and Implications: The HS program had a near perfect postpartum depression screening rate and assessed for SDOH, engaging in a crucial aspect of maternal healthcare. Approximately 11% of the sample scored high in depressive symptomatology and 79% of women with elevated depression scores accepted referral to mental health services. Our qualitative findings support a need for investment in case management and other maternal health focused staff in home visiting programs. The Healthy Start model of care may provide a buffer to stressful effects of the various SDOH clients face by increasing the support the mother receives in pregnancy.