Introduction
Methods
Acknowledgements
Rates of postpartum depression (PPD) are disproportionately high among marginalized populations, such as low-income, minority, and immigrant women. The Holistic Opportunity for Everyone (H.O.P.E.) Initiative seeks to integrate behavioral and public health services to meet the holistic needs of WIC and Family Planning clinic clients in Mecklenburg County, North Carolina, which serve a high percentage of clients from marginalized populations.
Race/Ethnicity of Patients Served
The H.O.P.E. Initiative is informed by community psychology values, therefore centering the voices of marginalized individuals is critical to improving implementation efforts. Behavioral Health Providers (BHPs) and the H.O.P.E. Initiative can better support patients by understanding diverse patient's perspectives on PPD and by capturing their views on receiving mental health screenings.
Twenty peer-reviewed sources published in databases (e.g. Sage Journals and PsychINFO) between 2007-2022 were analyzed in a literature review.
Keywords
Black Women
Compared to white women, one source found that African American women more confidently and frequently sought help from religious leaders for treatment deliveries. (O'Mahen & Flynn, 2008). Other researchers found that Black postpartum mothers were less likely to accept prescription medication and mental health counseling (Bodnar-Deren et al., 2017).
Low Income Women
In a study, authors found that low-income women must choose between staying home with their child and losing money or working to pay for childcare, on top of the fear of losing their child due to poverty. The stress of money and paying bills to afford the costs associated with having a child can make PPD more severe (Maxwell et al., 2018).
I would like to thank my faculty advisor, Dr. Victoria Scott for allowing me the opportunity to work with the H.O.P.E. Initiative this academic year. I would also like to thank Annalise Tolley, a Doctoral Student in the Health Psychology PhD program for her assistance and supervision while working with the H.O.P.E. Initiative. Lastly, I would like to thank Porscha Street Elton and Dr. Diane Zablotsky for reviewing my abstract prior to submission.
Key Takeaways
A lot still needs to be done to reduce the stigma associated with mental illness. Marginalized populations not only have higher rates of PPD (Maxwell et al., 2018), but also higher stigma associated with mental illness and treatment (O'Mahen & Flynn, 2008). It is important for BHPs to understand the stigmas and beliefs about mental health through a cultural perspective to better understand their patients. Patients from low-income backgrounds also have certain stressors contributing to their PPD or mental illness.
Next Steps
Background
Mental Health Care Concerns Among Marginalized Populations
Kayla Walker, UNC Charlotte
Dr. Victoria Scott, PhD, MBA, Department of Psychological Science
References
Research Questions
Bodnar-Deren, S., Benn, E. K. T., Balbierz, A., & Howell, E. A. (2017, January 19). Stigma and Postpartum Depression Treatment Acceptability Among Black and White Women in the First Six-Months Postpartum. Maternal and Child Health Journal, 21(7), 1457-1468. https://doi.org/10.1007/s10995-017-2263-6
Callister, L. C., Beckstrand, R. L., & Corbett, C. (2011, June 03). Postpartum Depression and Help-Seeking Behaviors in Immigrant Hispanic Women. Journal of Obstetric, Gynecologic, & Neonatal Nursing, 40(4), 440-449. https://doi.org/10.1111/j.1552-6909.2011.01254.x
Coffman, M. J., Scott, V. C., Schuch, C., Mele, C., Mayfield, C., Balasubramanian,, V., Stevens, A., & Dulin, M. (2020, January 6). Postpartum Depression Screening and Referrals in Special Supplemental Nutrition Program for Women, Infants, and Children Clinics. Journal of Obstetric, Gynecologic & Neonatal Nursing, 49(1), 27-40. https://doi.org/10.1016/j.jogn.2019.10.007
Maxwell, D., Robinson, S., & Rogers, K. (2018, September 04). “I keep it to myself”: A qualitative meta-interpretive synthesis of experiences of postpartum depression among marginalised women. Health & Social Care in the Community, 27(3), 23-36. https://doi.org/10.1111/hsc.12645
O'Mahen, H. A., & Flynn, H. A. (2008, October 01). Preferences and Perceived Barriers to Treatment for Depression during the Perinatal Period. Journal of Women's Health, 17(8), 1301-1309. https://doi.org/10.1089/jwh.2007.0631
Sampson, M., Torres, M. I. M., Duron, J., & Davidson, M. (2017, November 28). Latina Immigrants’ Cultural Beliefs About Postpartum Depression. SAGE Journals, 33(2), 208-220. https://doi.org/10.1177/0886109917738745
Do women from marginalized communities have unique views, stigmas, and preferred treatments for postpartum depression? What survey questions and methods have been used to understand reactions to depression screenings in marginalized populations?
Results
Hispanic/Latina Women
One study identified beliefs and stigmas about mental health and illness, hesitancy to seek treatment for symptoms of PPD, and cultural beliefs about motherhood as personal barriers to seeking treatment (Callister et al., 2011). Social barriers noted include immigration status, the lack of English proficiency, and social support. Systemic barriers included finances, time constraints, lack of child care, and transportation. Another study suggested that to promote health seeking, family should be seen as a supportive resource (Sampson et al., 2017).
Figure 1. Pie chart depicting racial/ethnic diversity of patients served in clinics (Coffman et al., 2020)
Conclusions
Recommendation for BHPs
Population | Major Theme | Recommendation for BHPs |
Hispanic Women | Stigma: American issue, | Use family as supportive resources |
Language barriers | Have bilingual BHPs, offer in-person interpreting services, | |
Fear of accessing services due to immigration status | Ensure protection of patients under HIPAA, provide resources, offer alternate forms of service | |
Black Women | More acceptance to spiritual forms of therapy | Refer patient to spiritual forms of therapy if value is expressed |
Less acceptance of medication to treat PPD | Offer other forms of treatment such as psychotherapy, community support, etc. | |
Mistrust in medical system | Have diverse staff with similar backgrounds | |
Low- Income Women | Time is money | Be cognisant of wait times |
Fear of losing children due to poverty | Leverage patient-physician relationship, destigmatize PPD |
Figure 2. Table showing major determinants to treatment for different marginalized communities with recommendations for BHPs