Is There a Connection Between Postpartum Depression and Socioeconomic Status? (by Rebecca Lacy)

Introduction:

My Community Volunteer Project over the term has been with Baby Blues Connection. I began working with Baby Blues Connection more than three years ago when I felt I was ready to give back to the organization after accessing services.

Baby Blues Connection provides peer support services to families struggling with adjustment to parenthood. Parents can call BBC for phone support, attend groups in person or online through social media. In the time I’ve been volunteering with BBC, I have aided in drafting a proposal and policy around a social media based support group, launched said group, and provided peer support through phone and in person while facilitating groups. I’ve also been on the Outreach and Education Committee for a year and a half, trying to find ways to make our services more accessible to families in poverty. The rate of PPD/A among parents rises disproportionately when socioeconomic status declines.

Research Question: Is there a connection between Postpartum Depression and Socioeconomic Status?

The Research Findings:

1.     Deepika Goyal, PhD, RN, FNP,* Caryl Gay, PhD, and Kathryn A. Lee, RN, PhD, FAAN How much does low socioeconomic status increase the risk of prenatal and postpartum depressive symptoms in first-time mothers?” March April 2010, Web. November 26, 2014

I chose this piece of research found through PubMed.gov because it was the most current piece of research I could find on this subject. I appreciated that the authors found a connection between SES and PPD/A while I struggled with their method and the small sample of women who participated in the study suggesting to me that more needs to be done. Additionally, I wished I had access to any supporting documentation through this piece linking the SES and PPD/A to their lack of college education, being unmarried, and unemployed. These factors were not broken down to indicate what percentage if any were more heavily impacted or what percentage of participants experienced one or more of these outcomes.

  1. Lisa Belkin, “Postpartum Depression and Poverty: Breaking the Cycle” Huffington Post. Web. September 5, 2012

This article outlines exactly why the mental health care system needs a makeover. The article clearly identifies the obstacles that have to be overcome by a parent in poverty without access to the services they need. Namely, geographical location of help, therapy, as well as accessibility, affordability, transportation and childcare challenges.

  1. Linda H Chaudron, MD, MS “Accuracy of Depression Screening Tools for Identifying Postpartum Depression among Urban Mothers” American Academy of Pediatrics. Web. October 20, 2009 Copyright c. 2010 by the American Academy of Pediatrics

This piece was valuable in showcasing the prominent rise in the instance of PPD/A with the occurrence of poverty.

Part II Public Writing:

My public writing piece is a letter to Governor John Kitzhaber addressing the connection between Postpartum Depression & Anxiety with SES and the impact on these families not having access to adequate mental health services through the Oregon Health Plan. The letter will outline where the Oregon Health Plan is failing lower SES families in access to mental health services and recommendations for how to change the system to benefit family outcomes and reduce costs through earlier resolution to mental health issues, reduced wait time for appointments and shorter duration of symptoms through earlier diagnosis and treatment.

It may seem odd to write this letter directly to the Governor of Oregon, however, it may be best placed as an open letter to the Governor as he’s a champion for OHP which was his own initiative from its inception.

The Honorable Governor John Kitzhaber

900 Court Street, NE

Salem, Oregon 97301

Dear Governor Kitzhaber:

I am writing this letter to request that you take under consideration the current state of the mental health segment of health care underwritten by The Oregon Health Plan and it’s impact on low income Mothers in the birth year and beyond. It occurs to me that there are a number of mothers I meet every year who lack access to qualified mental health professionals skilled in treating postpartum depression and anxiety due to the fact that they are on a form of OHP. The system allows them to seek help through county based mental health at clinics contracted with OHP. As the Affordable Healthcare Act has launched, and changes to OHP have been made to accommodate the rise in enrollment, we have also seen strained services in mental health become even more strained. With strain on these vital services to the poor and working poor, we find ourselves at a point in Oregon where we need to work on providing better services to new parents to aid in healthier outcomes for children. Children with healthy parents have better outcomes, themselves. Research shows that the instance of depression rises among women in lower SES groups.

“Low SES was associated with increased depressive symptoms in late pregnancy and at 2 and 3 months, but not at 1 month postpartum. Women with four SES risk factors (low monthly income, less than a college education, unmarried, unemployed) were 11 times more likely than women with no SES risk factors to have clinically elevated depression scores at 3 months postpartum, even after controlling for the level of prenatal depressive symptoms.” (Goyle, Gay & Lee)

When a woman experiencing postpartum depression and or anxiety, or a perinatal mood disorder of any kind during or after pregnancy, she isn’t afforded the opportunity to be treated by anyone who specializes in the field of maternal mental health. When a woman on OHP reaches out to her physician and is referred to a practice that cannot take OHP, this only exacerbates an already complicated and frightening situation. Too often, parents in poverty are finding they are not entitled to the same care as a middle class income earner. They must complete an intake with an agency that employs social workers for family therapy when, in fact the parent may need more specialized care. For example, a Psychiatric Mental Health Nurse Practitioner, Psychiatrist or Psychologist experienced or specialized in treating perinatal mood disorders or depression and anxiety would be the best fit for a mother experiencing difficulties related to parental adjustment and the higher the score on the Edinburgh Postnatal Depression Scale, the higher the need for early intervention with specialized care.

Lacking access to resources results in a continued cycle of response systematically and by the individual. These stories of families repeat all over the country and the best outcome for these families involves adequate mental health coverage.

“the biggest predictive factor for postpartum depression is a history of depression in general,” explained Dr. Samantha Meltzer-Brody, director of the perinatal psychiatry program at the University of North Carolina at Chapel Hill. And the likelihood of all depression increases as income decreases, triggered by the greater instability of an impoverished life. The result is cyclical. “If Mom is not attached and tuned in, but depressed and checked out instead, that that can lead to neurodevelopmental delays in the baby,” Meltzer-Brody said. (Belkin)

There is essentially so much supporting documentation necessitating improvement in mental health services within larger managed care programs like OHP, that we need to act to improve these services for the poor so that we can impact the outcomes of children being raised in poverty. Without equal access to adequate mental health services for parents in poverty, we aren’t providing children in poverty the equal opportunity at a healthy beginning as their middle class peers. Parents with adequate coping skills will teach these skills to their children. As stated by Meltzer-Brody, it’s a cycle. Additional research has

Suggestions for improvement would include the following.

  1. A mother scores above 12 on the Edenburgh Scale and she has the option of seeing a specialist in perinatal mood disorders.
  2. Low income mothers are provided transportation and childcare vouchers for their sessions.
  3. Fund a day unit outpatient program for mothers who need extra support and can attend therapy while childcare is available through a state facility like OHSU at a central location.
  4. Part of the criteria for providers taking OHP would include their accessibility to public transportation. That programs already contracted with OHP recruit for mental health workers who specialize in the field of perinatal mood disorders.
  5. Funding for peer support groups through non-profits to expand and offer services in areas, particularly rural areas and underserved communities state-wide.

Ultimately, we need more maternal mental health resources for women on Medicaid, and we need reform soon. We are eleven times more likely to experience maternal mental health issues if we are simultaneously experiencing economic stressors. Improving access to mental health services for mothers experiencing depression and anxiety improves the outcome for the children in their care.

 Works Cited

·      Deepika Goyal, PhD, RN, FNP,* Caryl Gay, PhD, and Kathryn A. Lee, RN, PhD, FAAN How much does low socioeconomic status increase the risk of prenatal and postpartum depressive symptoms in first-time mothers?” March April 2010, Web. November 26, 2014

  • Lisa Belkin, “Postpartum Depression and Poverty: Breaking the Cycle” Huffington Post. Web. September 5, 2012
  • Linda H Chaudron, MD, MS “Accuracy of Depression Screening Tools for Identifying Postpartum Depression among Urban Mothers” American Academy of Pediatrics. Web. October 20, 2009 Copyright c. 2010 by the American Academy of Pediatrics
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One comment

  1. Brittany Plymell

    Rebecca, I really like that you letter is addressing an issue that is community related, and that you have suggested some solutions. It’s unfortunate and sad that people living in poverty level often don’t have access to simple health benefits. It doesn’t make sense that the US is one of the only industrialized nations that doesn’t provide its’ citizens with health care. You did a great job tackling this project.
    Brittany

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