One quarter of mothers of young children experience high levels of depressive symptoms, and only half are identified by themselves or their providers. Little is known about what factors influence maternal and provider recognition of depression. We use data from the San Mateo County, California, Prenatal to Three project to explore self-recognition, provider response, and referral among low-income Hispanic mothers of infants and toddlers. The goals are (1) to describe the patterns of self-recognition of maternal depression, maternal reporting of health professional response, and referrals for mental health services as related to depression severity and (2) to identify determinants of self-recognition, provider response, and mental health referrals.
Our sample consists of 218 nonpregnant Hispanic mothers in San Mateo County. Self-recognition was defined as an affirmative answer to the question, "Have you thought that you needed help with sadness or depression since your child was born?" High depressive symptoms were defined as a score of > or =10 on the Edinburgh Postnatal Depression Scale (EPDS). We performed chi-square and logistic regression analyses.
Twenty-eight percent responded that they needed help with depression since the birth of their baby. Less than half discussed depressive feelings with their provider. Depression recognition factors differed between mothers and health professionals.
Maternal depression is prevalent among Hispanic women on Medicaid but is not readily detected by women or providers. Women and providers use different cues to identify depression, possibly leading to communication discrepancies. Further research on the factors that influence self-recognition and provider recognition of maternal depression is needed.
"In addition, healthcare providers are less likely to identify PPD symptoms in Hispanic women (Chaudron et al., 2005; Howell et al., 2005). If healthcare providers do not routinely screen for PPD, Hispanic American women are not likely to reveal their PPD symptoms (Chaudron et al., 2005). Even when PPD screening occurs, less acculturated Hispanic patients may not understand the questions that could lead to misdiagnosis. "
[Show abstract][Hide abstract] ABSTRACT: To determine whether a high rate of postpartum depression (PPD), previously found in immigrant Hispanic women at a community clinic, would also be found in a community sample.
Sixty women from local community settings were given the PPDS-S instrument and the General Acculturation Index to screen for PPD symptoms. Data were then compared with previously published community clinic data.
Sixty percent of the immigrant Hispanic women showed significant PPD. The only statistically significant positive predictive factor for increased PPD symptoms was having a previous history of depression. In addition, 54% had an elevated symptom content profile score for suicidal thinking.
Health practitioners should be aware of a potentially high rate of PPD in this population, especially in light of previously studied increased rates of suicide attempts in Latinas. If a prior history of depression is predictive of PPD, it is possible that many of the mothers in our sample suffered from depression prior to the postpartum period, but were not appropriately diagnosed or treated. Recommendations for outreach and further research are discussed. In particular, further research regarding the prenatal prevalence of depression in immigrant Hispanic women is recommended in order to further understand the high incidence of PPD.
Journal of the American Association of Nurse Practitioners 09/2014; 26(9). DOI:10.1002/2327-6924.12088
"). Instrumental barriers are most commonly related to limited or no mental health insurance coverage, few financial resources, and lack of transportation and child care (Ahmed et al., 2008; Alvidrez & Azocar, 1999; Anderson et al., 2006; Guarnaccia & Marinez, 2002; Kouyoumdjian, Zamboanga, & Hansen, 2003). Social barriers include (among others) stigma of mental illness, a preference for family and other informal support networks over formal care, lack of awareness and recognition of mental health problems, the perceived failure of previous treatment, concerns about efficacy and safety (regarding pharmaceutical treatment), self-reliant attitudes , and lack of trust (Ahmed et al.; Alvidrez & Azocar; Chaudron et al., 2005; Guarnaccia & Marinez; Kouyoumdjian et al., 2003; Lewis-Fernández et al., 2005). Some fears are unique to pregnant women and new mothers. "
[Show abstract][Hide abstract] ABSTRACT: The study described here was designed to determine treatment preferences among Latinas to identify treatment options that meet their needs and increase their engagement. Focus group interviews were conducted with 22 prenatal and postpartum Latinas at risk for depression. The group interviews were conducted in Spanish and English using a standardized interview protocol. Focus group transcripts were analyzed to identify themes regarding perinatal depression coping strategies, preferred approaches to treating perinatal depression, and recommendations for engaging perinatal Latinas in treatment. The results suggest that Latinas' treatment preferences consist of a pathway (i.e., hierarchical) approach that begins with the use of one's own resources, followed by the use of formal support systems (e.g., home-visiting nurse), and supplemented with the use of behavioral therapy. Antidepressant use was judged to be acceptable only in severe cases or after delivery. The data indicate that to increase health-seeking behaviors among perinatal Latinas, practitioners should first build trust.
Qualitative Health Research 01/2014; 24(2). DOI:10.1177/1049732313519866 · 2.19 Impact Factor
"Several factors highlight the need for a dedicated study of paternal PPD among Mexican American men. Studies have observed rates of PPD in Hispanic women to be considerably higher than women in the majority culture, with estimates ranging from 28% to 64% (Chaudron et al., 2005; Kuo et al., 2004; Le et al., 2010; Martinez-Schallmoser et al., 2003) as compared to prevalence rates of 7–19% among Caucasian women (Gavin et al., 2005). "
[Show abstract][Hide abstract] ABSTRACT: Although maternal postpartum depression (PPD) is a well-documented phenomenon that has been the focus of a large body of literature, much less is known about the prevalence and predictors of depressive symptoms among fathers following the birth of a child. Particularly scarce is research with Mexican American men, an understudied population at high risk given limited socioeconomic resources and elevated rates of maternal PPD.
The current study used descriptive and path analyses to examine the prevalence and predictors of PPD in 92 Mexican American fathers (M age=31.3 years).
At both 15 and 21 postpartum week assessments, 9% of fathers met criteria for PPD. Path analyses suggested that unemployment status, fewer biological children, poor marital relationship quality, and lower orientation to Anglo culture predicted higher 15 week paternal PPD symptoms, which was associated with greater paternal depressive symptoms at 21 weeks. Predictive paths from symptoms of maternal to paternal PPD were not significant.
Lack of generalizability to other ethnic groups, sampling of primarily resident fathers, and the absence of historical assessments of depression are limitations of the current study.
Findings support the importance of PPD screenings among Mexican American fathers and suggest certain demographic, familial, and cultural factors may render men particularly vulnerable for maladjustment during the early infancy period.
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