Abstract
Background
The presence of postpartum depression can lead to poor maternal-child attachment, failure to thrive, and even infant death. Postpartum depression affects 13–19 % of parturients. However, among racial and ethnic minority parturients, postpartum depression rates have been shown to reach up to 35–67 % (as reported by O’Hara and McCabe, Annu Rev Clin Psychol 9:379–407, 2013; Boury et al., Women Health. 39(3):19–34, 2004; Ramos-Marcuse et al.. J Affect Disord. 122(1–2):68–75, 2010; Lucero et al., J Am Acad Nurse Pract. 24(12):726–34, 2012). This is more concerning when considering the fact that these mothers are also hardest to reach because they are usually marginalized and displaced within mainstream US society. The current study assesses potential risk factors that contribute to postpartum depression among African-American and Latina mothers.
Methods
We analyze data from 3317 Healthy Start participants living in small cities, towns, and rural areas in Pennsylvania using a logistic regression analysis controlling for known contributing risk factors, including maternal health, family life, social support, socioeconomic and demographic characteristics, and community of residence. We use a multiple imputation multivariate analysis to account for the potential effects of missing data.
Results
The results show that the odds of a risk of postpartum depression is nearly 80 and 40 % greater for African-American (OR = 1.80, p < .001) and Latina mothers (OR = 1.41, p < .01), respectively, as compared to white mothers. While the higher risks of postpartum depression for Latinas is explained in part by socioeconomic status, community of residence, and immigrant status, the significantly higher risk among African-American mothers cannot be completely ameliorated by the controlled variables. Our study highlights the need for further research into the impact of social and environmental stressors on postpartum depression among racial and ethnic minority populations living in small cities, towns, and rural areas.
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References
O’Hara MW, McCabe JE. Postpartum depression: current status and future directions. Annu Rev Clin Psychol. 2013;9:379–407.
Andrews-Fike C. A review of postpartum depression. Primary Care Companion to The Journal of Clinical Psychiatry. 1999;1(1):9–14.
Patel M, Bailey RK, Jabeen S, Ali S, Barker NC, Osiezagha K. Postpartum depression: a review. J Health Care Poor Underserved. 2012;23(2):534–42.
Sidebottom AC, Hellerstedt WL, Harrison PA, Hennrikus D. An examination of prenatal and postpartum depressive symptoms among women served by urban community health centers. Arch Womens Ment Health. 2014;17(1):27–40.
Kingston D, Tough S, Whitfield H. Prenatal and postpartum maternal psychological distress and infant development: a systematic review. Child Psychiatry Hum Dev. 2012;43(5):683–714.
Moore GA, Cohn JF, Campbell SB. Infant affective responses to mother’s still face at 6 months differentially predict externalizing and internalizing behaviors at 18 months. Dev Psychol. 2001;37(5):706–14.
Gefland DM, Teti DM. The effects of maternal depression on children. Clin Psychol Rev. 1990;10:329–53.
Gjerdingen D, McGovern P, Attanasio L, Johnson PJ, Kozhimannil KB. Maternal depressive symptoms, employment, and social support. J Am Board Fam Med. 2014;27(1):87–96.
Norhayati MN, Hazlina NH, Asrenee AR, Emilin WM. Magnitude and risk factors for postpartum symptoms: a literature review. J Affect Disord. 2015;175:34–52.
Ramos-Marcuse F, Oberlander SE, Papas MA, McNary SW, Hurley KM, Black MM. Stability of maternal depressive symptoms among urban, low-income, African American adolescent mothers. J Affect Disord. 2010;122(1–2):68–75.
Lucero NB, Beckstrand RL, Callister LC, Sanchez Birkhead AC. Prevalence of postpartum depression among Hispanic immigrant women. J Am Acad Nurse Pract. 2012;24(12):726–34.
Brett K. Prevalence of self-reported postpartum depressive symptoms—17 states, 2004–2005. In: Centers for Disease Control and Prevention, editor. Washington, DC: U.S. Government Printing Office; 2008. p. 361–6.
Centers for Disease Control and Prevention. PRAMStat Data Portal: Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion; 2015 [Available from: http://www.cdc.gov/prams/work-directly-pramstat.html.
Kozhimannil KB, Trinacty CM, Busch AB, Huskamp HA, Adams AS. Racial and ethnic disparities in postpartum depression care among low-income women. Psychiatr Serv. 2011;62(6):619–25.
Wang L, Wu T, Anderson JL, Florence JE. Prevalence and risk factors of maternal depression during the first three years of child rearing. J Women’s Health (Larchmt). 2011;20(5):711–8.
Yonkers KA, Ramin SM, Rush AJ, Navarrete CA, Carmody T, March D, et al. Onset and persistence of postpartum depression in an inner-city maternal health clinic system. Am J Psychiatry. 2001;158(11):1856–63.
Hobfoll SE, Ritter C, Lavin J, Hulsizer MR, Cameron RP. Depression prevalence and incidence among inner-city pregnant and postpartum women. J Consult Clin Psychol. 1995;63(3):445–53.
Dolbier CL, Rush TE, Sahadeo LS, Shaffer ML, Thorp J. Community child health network I. Relationships of race and socioeconomic status to postpartum depressive symptoms in rural African American and non-Hispanic white women. Matern Child Health J. 2013;17(7):1277–87.
Liu CH, Tronick E. Rates and predictors of postpartum depression by race and ethnicity: results from the 2004 to 2007 New York City PRAMS survey (Pregnancy Risk Assessment Monitoring System). Matern Child Health J. 2013;17(9):1599–610.
Surkan PJ, Peterson KE, Hughes MD, Gottlieb BR. The role of social networks and support in postpartum women’s depression: a multiethnic urban sample. Matern Child Health J. 2006;10(4):375–83.
Segre LS, O’Hara MW, Losch ME. Race/ethnicity and perinatal depressed mood. Journal of Reproductive and Infant Psychology. 2006;24(2):99–106.
Howell EA, Mora PA, Horowitz CR, Leventhal H. Racial and ethnic differences in factors associated with early postpartum depressive symptoms. Obstet Gynecol. 2005;105(6):1442–50.
Rich-Edwards JW, Kleinman K, Abrams A, Harlow BL, McLaughlin TJ, Joffe H, et al. Sociodemographic predictors of antenatal and postpartum depressive symptoms among women in a medical group practice. J Epidemiol Community Health. 2006;60(3):221–7.
Boury JM, Larkin KT, Krummel DA. Factors related to postpartum depressive symptoms in low-income women. Women Health. 2004;39(3):19–34.
Le HN, Perry DF, Ortiz G. The postpartum depression screening scale—Spanish version: examining the psychometric properties and prevalence of risk for postpartum depression. J Immigr Minor Health. 2010;12(2):249–58.
Gress-Smith JL, Luecken LJ, Lemery-Chalfant K, Howe R. Postpartum depression prevalence and impact on infant health, weight, and sleep in low-income and ethnic minority women and infants. Matern Child Health J. 2012;16(4):887–93.
Kuo WH, Wilson TE, Holman S, Fuentes-Afflick E, O’Sullivan MJ, Minkoff H. Depressive symptoms in the immediate postpartum period among Hispanic women in three U.S. cities. J Immigr Health. 2004;6(4):145–53.
Martinez-Schallmoser L, Telleen S, MacMullen NJ. The effect of social support and acculturation on postpartum depression in Mexican American women. J Transcult Nurs. 2003;14(4):329–38.
O’Hara MW, Swain AM. Rates and risk of postpartum depression—a meta-analysis. International Review of Psychiatry. 1996;8(1):37.
Seplowitz R, Miller H, Ostermeyer B, Sangi-Haghpeykar H, Silver E, Kunik ME. Utilization of psychiatric services by postpartum women in a predominantly minority, low-socioeconomic-status, urban population. Community Ment Health J. 2015;51(3):275–80.
Alvidrez J. Ethnic variations in mental health attitudes and service use among low-income African American, Latina, and European American young women. Community Ment Health J. 1999;35(6):515–30.
Abrams LS, Dornig K, Curran L. Barriers to service use for postpartum depression symptoms among low-income ethnic minority mothers in the United States. Qual Health Res. 2009;19(4):535–51.
Cardoso JB, Padilla YC, Sampson M. Racial and ethnic variation in the predictors of maternal parenting stress. J Soc Serv Res. 2010;36(5):429–44.
Gaynes BN, Gavin N, Meltzer-Brody S, Lohr KN, Swinson T, Gartlehner G, et al. Perinatal depression: prevalence, screening accuracy, and screening outcomes. Evid Rep Technol Assess (Summ). 2005(119):1–8.
Horowitz JA, Murphy CA, Gregory KE, Wojcik J. A community-based screening initiative to identify mothers at risk for postpartum depression. J Obstet Gynecol Neonatal Nurs. 2011;40(1):52–61.
Rogers CE, Kidokoro H, Wallendorf M, Inder TE. Identifying mothers of very preterm infants at-risk for postpartum depression and anxiety before discharge. J Perinatol. 2013;33(3):171–6.
Shellman L, Beckstrand RL, Callister LC, Luthy KE, Freeborn D. Postpartum depression in immigrant Hispanic women: a comparative community sample. J Am Assoc Nurse Pract. 2014;26(9):488–97.
Berube A, Singer A, Wilson J, Frey W. Finding exurbia: America’s fast-growing communities at the metropolitan fringe. Washington, DC: Brookings Institute; 2006.
Health Resources and Services Administration. Healthy Start: U.S. Department of Health and Human Services; 2016 [Available from: http://mchb.hrsa.gov/programs/healthystart/.
Zubaran C, Schumacher M, Roxo MR, Foresti K. Screening tools for postpartum depression: validity and cultural dimensions. Afr J Psychiatry (Johannesbg). 2010;13(5):357–65.
Hewitt CE, Gilbody SM, Mann R, Brealey S. Instruments to identify post-natal depression: which methods have been the most extensively validated, in what setting and in which language? Int J Psychiatry Clin Pract. 2010;14(1):72–6.
Cox JL, Holden JM, Sagovsky R. Detection of postnatal depression. Development of the 10-item Edinburgh postnatal depression scale. Br J Psychiatry. 1987;150:782–6.
Evins GG, Theofrastous JP. Postpartum depression: a review of postpartum screening. Primary Care Update Ob/Gyns. 1997;4(6):242–5.
Downie J, Wynaden D, McGowan S, Juliff D, Axten C, Fitzpatrick L, et al. Using the Edinburgh Postnatal Depression Scale to achieve best practice standards. Nurs Health Sci. 2003;5(4):283–7.
Beck CT. Predictors of postpartum depression: an update. Nurs Res. 2001;50(5):275–85.
Kurz B. Depression and mental-health service utilization among women in WIC. Journal of Ethnic And Cultural Diversity in Social Work. 2005;14(3–4):81–102.
Van Buuren S, Boshuizen HC. D.L. K. Multiple imputation of missing blood pressure covariates in survival analysis. Stat Med. 1999;18(6):681–94.
Raghunathan TE, Lepkowski JM, Van Hoewyk J, Solenberger P. A multivariate technique for multiply imputing missing values using a sequence of regression models. Survey Methodology. 2001;27(1):85–96.
U. S. Census Bureau. Population Estimates Program (PEP). In: Commerce USDo, editor. Washington, DC: U.S. Department of Commerce; 2010.
U. S. Census Bureau. American Community Survey (ACS), five-year estimates. In: Commerce USDo, editor. Washington, DC: U.S. Department of Commerce; 2014.
Mayberry LJ, Horowitz JA, Declercq E. Depression symptom prevalence and demographic risk factors among U.S. women during the first 2 years postpartum. J Obstet Gynecol Neonatal Nurs. 2007;36(6):542–9.
Righetti-Veltema M, Conne-Perréard E, Bousquet A, Manzano J. Risk factors and predictive signs of postpartum depression. J Affect Disord. 1998;49(3):167–262.
Wallace G. African-American mothers’ community social capital and parenting quality. Sociol Perspect. 2013;56(2):261–85.
Callister LC, Beckstrand RL, Corbett C. Postpartum depression and help-seeking behaviors in immigrant Hispanic women. J Obstet Gynecol Neonatal Nurs. 2011;40(4):440–9.
Dailey DE, Humphreys JC. Social stressors associated with antepartum depressive symptoms in low-income African American women. Public Health Nurs. 2011;28(3):203–12.
Hutto HF, Kim-Godwin Y, Pollard D, Kemppainen J. Postpartum depression among white, African American, and Hispanic low-income mothers in rural southeastern North Carolina. J Community Health Nurs. 2011;28(1):41–53.
Willie TC, Powell A, Kershaw T. Stress in the city: influence of urban social stress and violence on pregnancy and postpartum quality of life among adolescent and young mothers. J Urban Health. 2016;93(1):19–35.
Siefert K, Bowman PJ, Heflin CM, Danziger S, Williams DR. Social and environmental predictors of maternal depression in current and recent welfare recipients. Am J Orthopsychiatry. 2000;70(4):510–22.
Franzini L, Ribble JC, Keddie, AM. Understanding the hispanic paradox. Ethn Dis. 2001;11(3):496–18.
de la Rosa, IA. Prenatal outcomes among Mexican Americans: a review of an epidemiological paradox. Ethn Dis. 2002;12(14):480–487.
Ceballos M, Palloni A. Maternal and infant health of Mexican immigrants in the USA: the effects of acculturation, duration, and selective return migration. Ethn. Health. 2010;15(4):377–96.
Ceballos M. Simulating the effects of acculturation and return migration on the maternal and infant health of Mexican immigrants in the United States: a research note. Demography. 2011;48(2):425–36.
Acknowledgments
This research was supported by a Pennsylvania’s State System of Higher Education Faculty Professional Development Grant. Authors also express thanks to the Chester County Maternal and Child Health Consortium, Michelle Legaspe Sánchez, and Milena Lanz for support of this project.
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The authors declare that they have no conflict of interest.
Research Involving Human Participants
This study was approved by the West Chester University of Pennsylvania Institutional Review Board.
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Ceballos, M., Wallace, G. & Goodwin, G. Postpartum Depression among African-American and Latina Mothers Living in Small Cities, Towns, and Rural Communities. J. Racial and Ethnic Health Disparities 4, 916–927 (2017). https://doi.org/10.1007/s40615-016-0295-z
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DOI: https://doi.org/10.1007/s40615-016-0295-z