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Rodas NV, Liu SR, Chavira DA, Godino JG. Depression among Latina women in the United States from pregnancy to early postpartum: longitudinal examination of risk factors. BMC Pregnancy Childbirth 2025; 25:501. [PMID: 40281502 PMCID: PMC12023503 DOI: 10.1186/s12884-025-07548-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2025] [Accepted: 03/28/2025] [Indexed: 04/29/2025] Open
Abstract
BACKGROUND The present study examined the prevalence of symptoms of depression throughout pregnancy and the early postpartum period (first trimester through six weeks postpartum) in low-income Latina women. Further, this study examined whether established risk factors in non-Latina women also predict perinatal depressive symptom trajectories in low-income Latinas. METHODS The sample included 240 Latina women from a federally qualified health center (FQHC). RESULTS Latent growth curve modeling found that, on average, symptoms of depression decreased from the first trimester of pregnancy through six weeks postpartum. Change in symptoms of depression from the first trimester through six weeks postpartum were predicted by limited English proficiency and age. CONCLUSIONS Findings of the current study add to existing evidence that can guide clinical care for Latina maternal mental health throughout the perinatal period.
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Affiliation(s)
- Naomi V Rodas
- Laura Rodriguez Research Institute, Family Health Centers of San Diego, 1750 5th Ave, San Diego, CA, 92101, USA.
| | - Sabrina R Liu
- Department of Human Development, California State University, San Marcos, CA, USA
| | - Denise A Chavira
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA, USA
| | - Job G Godino
- Laura Rodriguez Research Institute, Family Health Centers of San Diego, 1750 5th Ave, San Diego, CA, 92101, USA
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, San Diego, CA, USA
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Warren JR, Natarajan S, Roess AA. Superwoman Schema Endorsement and its Association to Perceived Stress During Pregnancy and Birth Outcomes among Non-Hispanic Black American Women. J Racial Ethn Health Disparities 2025:10.1007/s40615-025-02324-w. [PMID: 40126803 DOI: 10.1007/s40615-025-02324-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2024] [Revised: 11/12/2024] [Accepted: 02/18/2025] [Indexed: 03/26/2025]
Abstract
The superwoman schema (SWS), rooted in historical racist stereotypes, acts as a sociocultural construct that many Black American women in the U.S. currently adopt, known as the strong Black woman (SBW) stereotype. This SWS, reinforced by racial discrimination, has been identified as a stressor contributing to psychological strain and mental health disorders. Research indicates that the SWS may negatively affect maternal mental health and perinatal outcomes. However, there is a paucity of research focusing on the SWS's impact on pregnant Black American women regarding their psychological health and birth outcomes. Addressing this gap, this study involved 305 African American women aged 21-45 who reported on their SWS endorsement, perceived stress levels during pregnancy, mental health diagnoses, and birth outcomes. Findings revealed a significant correlation between SWS endorsement and increased stress and a diagnosis of anxiety or depression. A higher SWS endorsement and perceived stress were correlated with caring for others and resisting vulnerability, although no direct link was found between SWS endorsement, perceived stress, and delivering a preterm or low birth-weight infant. Further research is necessary on the SWS's adaptive attributes and its archetypic reification in obstetric care. However, these findings underscore the importance of mental health interventions and support systems for pregnant Black American women, especially among unmarried mothers and those with limited education. This study contributes to understanding the SWS as a racial stressor and a contributory mechanism to racial disparities in maternal and perinatal health.
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Affiliation(s)
- Jennifer R Warren
- Institute of Health Equity Education & Research LLP, 36 Lighthouse Court, Atlantic City, NJ, USA.
| | - Sahana Natarajan
- Western University of Health Sciences, College of Osteopathic Medicine of the Pacific-Northwest, 200 Mullins Dr, Lebanon, OR, 97355, USA
| | - Amira A Roess
- Department of Global and Community Health, College of Public Health, George Mason University, 4400 University Drive, Fairfax, VA, 22030, USA
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Huang Y, Alvernaz S, Kim SJ, Maki P, Dai Y, Peñalver Bernabé B. Predicting Prenatal Depression and Assessing Model Bias Using Machine Learning Models. BIOLOGICAL PSYCHIATRY GLOBAL OPEN SCIENCE 2024; 4:100376. [PMID: 39399154 PMCID: PMC11470166 DOI: 10.1016/j.bpsgos.2024.100376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Revised: 07/16/2024] [Accepted: 07/21/2024] [Indexed: 10/15/2024] Open
Abstract
Background Perinatal depression is one of the most common medical complications during pregnancy and postpartum period, affecting 10% to 20% of pregnant individuals, with higher rates among Black and Latina women who are also less likely to be diagnosed and treated. Machine learning (ML) models based on electronic medical records (EMRs) have effectively predicted postpartum depression in middle-class White women but have rarely included sufficient proportions of racial/ethnic minorities, which has contributed to biases in ML models. Our goal is to determine whether ML models could predict depression in early pregnancy in racial/ethnic minority women by leveraging EMR data. Methods We extracted EMRs from a large U.S. urban hospital serving mostly low-income Black and Hispanic women (n = 5875). Depressive symptom severity was assessed using the Patient Health Questionnaire-9 self-report questionnaire. We investigated multiple ML classifiers using Shapley additive explanations for model interpretation and determined prediction bias with 4 metrics: disparate impact, equal opportunity difference, and equalized odds (standard deviations of true positives and false positives). Results Although the best-performing ML model's (elastic net) performance was low (area under the receiver operating characteristic curve = 0.61), we identified known perinatal depression risk factors such as unplanned pregnancy and being single and underexplored factors such as self-reported pain, lower prenatal vitamin intake, asthma, carrying a male fetus, and lower platelet levels. Despite the sample comprising mostly low-income minority women (54% Black, 27% Latina), the model performed worse for these communities (area under the receiver operating characteristic curve: 57% Black, 59% Latina women vs. 64% White women). Conclusions EMR-based ML models could moderately predict early pregnancy depression but exhibited biased performance against low-income minority women.
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Affiliation(s)
- Yongchao Huang
- Department of Biomedical Engineering, Colleges of Engineering and Medicine, University of Illinois, Chicago, Illinois
| | - Suzanne Alvernaz
- Department of Biomedical Engineering, Colleges of Engineering and Medicine, University of Illinois, Chicago, Illinois
| | - Sage J. Kim
- Division of Health Policy and Administration, School of Public Health, University of Illinois, Chicago, Illinois
| | - Pauline Maki
- Department of Psychiatry, College of Medicine, University of Illinois, Chicago, Illinois
- Department of Psychology, College of Medicine, University of Illinois, Chicago, Illinois
- Department of Obstetrics and Gynecology, College of Medicine, University of Illinois, Chicago, Illinois
| | - Yang Dai
- Department of Biomedical Engineering, Colleges of Engineering and Medicine, University of Illinois, Chicago, Illinois
- Center of Bioinformatics and Quantitative Biology, University of Illinois, Chicago, Illinois
| | - Beatriz Peñalver Bernabé
- Department of Biomedical Engineering, Colleges of Engineering and Medicine, University of Illinois, Chicago, Illinois
- Center of Bioinformatics and Quantitative Biology, University of Illinois, Chicago, Illinois
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Hofheimer JA, McGowan EC, Smith LM, Meltzer-Brody S, Carter BS, Dansereau LM, Pastyrnak S, Helderman JB, Neal CR, DellaGrotta SA, O'Shea TMD, Lester BM. Risk Factors for Postpartum Depression and Severe Distress among Mothers of Very Preterm Infants at NICU Discharge. Am J Perinatol 2024; 41:1396-1408. [PMID: 37072014 PMCID: PMC11223892 DOI: 10.1055/s-0043-1768132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 02/03/2023] [Indexed: 04/20/2023]
Abstract
OBJECTIVE To identify psychological, medical, and socioenvironmental risk factors for maternal postpartum depression (PPD) and severe psychological distress (SPD) at intensive care nursery discharge among mothers of very preterm infants. STUDY DESIGN We studied 562 self-identified mothers of 641 infants born <30 weeks who were enrolled in the Neonatal Neurobehavior and Outcomes in Very Preterm Infants Study (NOVI) conducted in nine university-affiliated intensive care nurseries. Enrollment interviews collected socioenvironmental data, depression, and anxiety diagnoses prior to and during the study pregnancy. Standardized medical record reviews ascertained prenatal substance use, maternal and neonatal medical complications. The Edinburgh Postnatal Depression Scale and Brief Symptom Inventory were administered at nursery discharge to screen for PPD and SPD symptoms, respectively. RESULTS Unadjusted analyses indicated mothers with positive screens for depression (n = 76, 13.5%) or severe distress (n = 102, 18.1%) had more prevalent prepregnancy/prenatal depression/anxiety, and their infants were born at younger gestational ages, with more prevalent bronchopulmonary dysplasia, and discharge after 40 weeks postmenstrual age. In multivariable analyses, prior depression or anxiety was associated with positive screens for PPD (risk ratio [RR]: 1.6, 95% confidence interval [CI]: 1.1-2.2) and severe distress (RR: 1.6, 95% CI: 1.1-2.2). Mothers of male infants had more prevalent depression risk (RR: 1.7, 95% CI: 1.1-2.4), and prenatal marijuana use was associated with severe distress risk (RR: 1.9, 95% CI: 1.1-2.9). Socioenvironmental and obstetric adversities were not significant after accounting for prior depression/anxiety, marijuana use, and infant medical complications. CONCLUSION Among mothers of very preterm newborns, these multicenter findings extend others' previous work by identifying additional indicators of risk for PPD and SPD associated with a history of depression, anxiety, prenatal marijuana use, and severe neonatal illness. Findings could inform designs for continuous screening and targeted interventions for PPD and distress risk indicators from the preconception period onward. KEY POINTS · Preconceptional and prenatal screening for postpartum depression and severe distress may inform care.. · Prior depression, anxiety, and neonatal complications predicted severe distress and depression symptoms at NICU discharge.. · Readily identifiable risk factors warrant continuous NICU screening and targeted interventions to improve outcomes..
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Affiliation(s)
- Julie A. Hofheimer
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Elisabeth C. McGowan
- Department of Pediatrics, Women and Infant's Hospital/Brown University, Providence, Rhode Island
| | - Lynne M. Smith
- Department of Pediatrics, Harbor-UCLA Medical Center, Los Angeles, California
| | - Samantha Meltzer-Brody
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Brian S. Carter
- Department of Pediatrics, Department of Medical Humanities and Bioethics, University of Missouri-Kansas City, School of Medicine, Kansas City, Missouri
| | - Lynne M. Dansereau
- Brown Center for the Study of Children at Risk, Brown Alpert Medical School and Women and Infants Hospital, Providence, Rhode Island
| | - Steven Pastyrnak
- Department of Pediatrics, Spectrum Health Helen DeVos Children's Hospital/Michigan State University, Grand Rapids, Michigan
| | - Jennifer B. Helderman
- Department of Pediatrics, Wake Forest University School of Medicine, Winston Salem, North Carolina
| | - Charles R. Neal
- Division of Neonatology, Department of Pediatrics, Kapi'olani Medical Center for Women and Children and Hawaii Pacific Medical Group, University of Hawaii John A Burns School of Medicine, Honolulu, Hawaii
| | - Sheri A. DellaGrotta
- Brown Center for the Study of Children at Risk, Brown Alpert Medical School and Women and Infants Hospital, Providence, Rhode Island
| | - Thomas Michael D. O'Shea
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Barry M. Lester
- Departments of Pediatrics, Brown Center for the Study of Children at Risk, Brown Alpert Medical School and Women and Infants Hospital, Providence, Rhode Island
- Department of Psychiatry and Human Behavior, Brown Center for the Study of Children at Risk, Brown Alpert Medical School and Women and Infants Hospital, Providence, Rhode Island
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Gennaro S, Melnyk BM, Szalacha LA, Hoying J, Cooper A, Aviles MM, O'Connor C, Gibeau A. Depression, anxiety, and stress in pregnant Black people: A case for screening and evidence-based intervention. Nurse Pract 2023; 48:37-46. [PMID: 37991519 DOI: 10.1097/01.npr.0000000000000117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2023]
Abstract
BACKGROUND Guidelines call for pregnant people to be screened for depression and anxiety. Screening may be particularly important for pregnant Black individuals who are reported to be more likely than non-Hispanic White pregnant people to experience prenatal stress, anxiety, and depressive symptoms. The purpose of this study was to determine if depression, anxiety, and stress co-occur in pregnant Black people and to identify which demographic factors are related to these mental health concerns. METHODS A subset analysis of an ongoing randomized controlled trial examined the risk of coexisting mental health conditions in pregnant Black people who screened eligible to participate (that is, they had high levels of depression, anxiety, and/or stress) in two urban clinics using a descriptive correlational design. RESULTS Of the 452 pregnant Black people who were screened for eligibility, 194 (42.9%) had elevated scores on depression, anxiety, and/or stress measures and were enrolled in the larger study. The average scores of the 194 enrolled participants were anxiety, mean (M) = 9.16 (standard deviation [SD] = 4.30); depression, M = 12.80 (SD = 4.27); and stress, M = 21.79 (SD = 4.76). More than one-third (n = 70, 36.1%) experienced two symptoms and 64 (33.0%) reported all three symptoms. CONCLUSION Pregnant Black individuals experience high levels of comorbid mental health distress including depression, anxiety, and stress. The findings indicate that treatment for mental health concerns needs to be broad-based and effective for all three conditions. Prenatal interventions should aim to address mental health distress through screening and treatment of depression, anxiety, and stress, especially for pregnant Black individuals. This study furthers understanding of the prevalence of prenatal mental health conditions in pregnant Black people.
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Huang Y, Alvernaz S, Kim SJ, Maki P, Dai Y, Bernabé BP. Predicting prenatal depression and assessing model bias using machine learning models. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.07.17.23292587. [PMID: 37503225 PMCID: PMC10371186 DOI: 10.1101/2023.07.17.23292587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/29/2023]
Abstract
Perinatal depression (PND) is one of the most common medical complications during pregnancy and postpartum period, affecting 10-20% of pregnant individuals. Black and Latina women have higher rates of PND, yet they are less likely to be diagnosed and receive treatment. Machine learning (ML) models based on Electronic Medical Records (EMRs) have been effective in predicting postpartum depression in middle-class White women but have rarely included sufficient proportions of racial and ethnic minorities, which contributed to biases in ML models for minority women. Our goal is to determine whether ML models could serve to predict depression in early pregnancy in racial/ethnic minority women by leveraging EMR data. We extracted EMRs from a hospital in a large urban city that mostly served low-income Black and Hispanic women (N=5,875) in the U.S. Depressive symptom severity was assessed from a self-reported questionnaire, PHQ-9. We investigated multiple ML classifiers, used Shapley Additive Explanations (SHAP) for model interpretation, and determined model prediction bias with two metrics, Disparate Impact, and Equal Opportunity Difference. While ML model (Elastic Net) performance was low (ROCAUC=0.67), we identified well-known factors associated with PND, such as unplanned pregnancy and being single, as well as underexplored factors, such as self-report pain levels, lower levels of prenatal vitamin supplement intake, asthma, carrying a male fetus, and lower platelet levels blood. Our findings showed that despite being based on a sample mostly composed of 75% low-income minority women (54% Black and 27% Latina), the model performance was lower for these communities. In conclusion, ML models based on EMRs could moderately predict depression in early pregnancy, but their performance is biased against low-income minority women.
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Affiliation(s)
- Yongchao Huang
- Department of Biomedical Engineering, Colleges of Engineering and Medicine, University of Illinois, Chicago, IL, USA
| | - Suzanne Alvernaz
- Department of Biomedical Engineering, Colleges of Engineering and Medicine, University of Illinois, Chicago, IL, USA
| | - Sage J Kim
- Division of Health Policy and Administration, School of Public Health, University of Illinois, Chicago, IL, USA
| | - Pauline Maki
- Department of Psychiatry, College of Medicine, University of Illinois, Chicago, IL, USA
- Department of Psychology, College of Medicine, University of Illinois, Chicago, IL, USA
- Department of Obstetrics and Gynecology, College of Medicine, University of Illinois, Chicago, IL, USA
| | - Yang Dai
- Department of Biomedical Engineering, Colleges of Engineering and Medicine, University of Illinois, Chicago, IL, USA
- Center of Bioinformatics and Quantitative Biology, University of Illinois, Chicago, IL, USA
| | - Beatriz Penñalver Bernabé
- Department of Biomedical Engineering, Colleges of Engineering and Medicine, University of Illinois, Chicago, IL, USA
- Center of Bioinformatics and Quantitative Biology, University of Illinois, Chicago, IL, USA
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Sroka AW, Mbayiwa K, Ilyumzhinova R, Meyer W, Fowle J, Gipson CJ, Norcott C, Hipwell AE, Keenan K. Depression screening may not capture significant sources of prenatal stress for Black women. Arch Womens Ment Health 2023; 26:211-217. [PMID: 36797547 DOI: 10.1007/s00737-023-01297-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 01/30/2023] [Indexed: 02/18/2023]
Abstract
Exposure to stress during pregnancy, including depression, has a significant impact on maternal health. Black women experience varied stressors that impact pregnancy outcomes. Although the move to engage in universal screening of women for depression is a positive step toward improving women's health, it has been deployed without a comprehensive examination of its utility for capturing exposure to other stressors with known associations with perinatal and neonatal health problems for Black women such as discrimination stress. In the present study, we examine the overlap between several sources of stress and a positive screen on the Edinburgh Postnatal Depression Scale (EPDS) in Black pregnant women. Data were gathered from a study examining the effects of stress on prenatal health (N = 168). Discrimination stress, structural and systemic racism stress, perceived stress, and partner abuse were measured using standardized questionnaires during pregnancy. Using a score of ≥ 13 to indicate probable depression the sensitivity of the EPDS to identify women who experienced high levels of discrimination stress (41.7%), structural and systemic racism (39.5%), perceived stress (63.4%), and partner abuse (45.2%) was suboptimal. Lowering the threshold for a positive screen on the EPDS to a score of 10 improved sensitivity but did not solve the problem of under-identification of women whose health is at risk. The focus on depression screening for pregnant women should be re-considered. A screening toolkit that more rigorously and broadly assesses risk and need for support and intervention is needed to improve perinatal health outcomes for Black women.
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Affiliation(s)
- Anna W Sroka
- Department of Psychiatry and Behavioral Neuroscience, The University of Chicago, IL, Chicago, USA
| | - Kimberley Mbayiwa
- Department of Psychiatry and Behavioral Neuroscience, The University of Chicago, IL, Chicago, USA
| | - Rimma Ilyumzhinova
- Department of Psychiatry and Behavioral Neuroscience, The University of Chicago, IL, Chicago, USA
| | - Willa Meyer
- Department of Psychiatry and Behavioral Neuroscience, The University of Chicago, IL, Chicago, USA
| | - Jill Fowle
- Department of Psychiatry and Behavioral Neuroscience, The University of Chicago, IL, Chicago, USA
| | - Cherrelle J Gipson
- Department of Psychiatry and Behavioral Neuroscience, The University of Chicago, IL, Chicago, USA
| | - Candice Norcott
- Department of Psychiatry and Behavioral Neuroscience, The University of Chicago, IL, Chicago, USA
| | - Alison E Hipwell
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
| | - Kate Keenan
- Department of Psychiatry and Behavioral Neuroscience, The University of Chicago, IL, Chicago, USA.
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Stevenson K, Fellmeth G, Edwards S, Calvert C, Bennett P, Campbell OMR, Fuhr DC. The global burden of perinatal common mental health disorders and substance use among migrant women: a systematic review and meta-analysis. Lancet Public Health 2023; 8:e203-e216. [PMID: 36841561 DOI: 10.1016/s2468-2667(22)00342-5] [Citation(s) in RCA: 35] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 12/16/2022] [Accepted: 12/20/2022] [Indexed: 02/25/2023]
Abstract
BACKGROUND There are one billion migrants globally, of whom 82 million are forced migrants. Pregnant migrants face pre-migration stressors such as conflict, transit stressors including poverty, and post-migration stressors including navigating the immigration system; these stressors can make them vulnerable to mental illness. We aimed to assess the global prevalence of and risk factors for perinatal mental health disorders or substance use among women who are migrants. METHODS In this systematic review and meta-analysis, we searched OVID MEDLINE, Embase, PsycINFO, CENTRAL, Global Health, Scopus, and Web of Science for studies published from database inception until July 8, 2022. Cohort, cross-sectional, and interventional studies with prevalence data for any mental illness in pregnancy or the postnatal period (ie, up to a year after delivery) or substance use in pregnancy were included. The primary outcome was the prevalence of perinatal common mental health disorders among women who are migrants, globally. Data for study quality and risk factors were also extracted. A random-effects meta-analysis was used to calculate pooled prevalence estimates, when appropriate. Sensitivity analyses were conducted according to study quality, sample representativeness, and method of outcome assessment. Risk factor data were synthesised narratively. This study is registered with PROSPERO, CRD42021226291. FINDINGS 18 650 studies were retrieved, of which 135 studies comprising data from 621 995 participants met the inclusion criteria. 123 (91%) of 135 studies were conducted in high-income host countries. Five (4%) of 135 studies were interventional, 40 (30%) were cohort, and 90 (66%) were cross-sectional. The most common regions of origin of participants were South America, the Middle East, and north Africa. Only 26 studies presented disaggregated data for forced migrants or economic migrants. The pooled prevalence of perinatal depressive disorders was 24·2% (range 0·5-95·5%; I2 98·8%; τ2 0·01) among all women who are migrants, 32·5% (1·5-81·6; 98·7%; 0·01) among forced migrants, and 13·7% (4·7-35·1; 91·5%; 0·01) among economic migrants (p<0·001). The pooled prevalence of perinatal anxiety disorders was 19·6% (range 1·2-53·1; I2 96·8%; τ2 0·01) among all migrants. The pooled prevalence of perinatal post-traumatic stress disorder (PTSD) among all migrant women was 8·9% (range 3·2-33·3; I2 97·4%; τ2 0·18). The pooled prevalence of perinatal PTSD among forced migrants was 17·1% (range 6·5-44·3; I2 96·6%; τ2 0·32). Key risk factors for perinatal depression were being a recently arrived immigrant (ie, approximately within the past year), having poor social support, and having a poor relationship with one's partner. INTERPRETATION One in four women who are migrants and who are pregnant or post partum experience perinatal depression, one in five perinatal anxiety, and one in 11 perinatal PTSD. The burden of perinatal mental illness appears higher among women who are forced migrants compared with women who are economic migrants. To our knowledge, we have provided the first pooled estimate of perinatal depression and PTSD among women who are forced migrants. Interpreting the prevalence estimate should be observed with caution due to the very wide range found within the included studies. Additionally, 66% of studies were cross-sectional representing low quality evidence. These findings highlight the need for community-based routine perinatal mental health screening for migrant communities, and access to interventions that are culturally sensitive, particularly for forced migrants who might experience a higher burden of disease than economic migrants. FUNDING UK National Institute for Health Research (NIHR); March of Dimes European Preterm Birth Research Centre, Imperial College; Imperial College NIHR Biomedical Research Centre; and Nuffield Department of Population Health, University of Oxford.
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Affiliation(s)
- Kerrie Stevenson
- Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK; Institute of Reproductive and Developmental Biology, Imperial College London, London, UK; Institute of Health Informatics, University College London, London, UK.
| | - Gracia Fellmeth
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Samuel Edwards
- School of Health Sciences, University of Liverpool, Liverpool, UK
| | - Clara Calvert
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK; Centre for Global Health, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Phillip Bennett
- Institute of Reproductive and Developmental Biology, Imperial College London, London, UK
| | - Oona M R Campbell
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Daniela C Fuhr
- Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK; Leibniz Institute of Prevention Research and Epidemiology, Bremen, Germany; Health Sciences, University of Bremen, Bremen, Germany
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9
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Patel I, Dev A. What is prenatal stress? A scoping review of how prenatal stress is defined and measured within the context of food insecurity, housing instability, and immigration in the United States. WOMEN'S HEALTH (LONDON, ENGLAND) 2023; 19:17455057231191091. [PMID: 37596926 PMCID: PMC10440065 DOI: 10.1177/17455057231191091] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 06/20/2023] [Accepted: 07/13/2023] [Indexed: 08/21/2023]
Abstract
BACKGROUND Stress during pregnancy can lead to significant adverse outcomes for maternal mental health. Early evaluation of prenatal stress can help identify treatment needs and appropriate interventions. Disparities in the social determinants of health can contribute to stress, but what constitutes stress during pregnancy within the social determinants of health framework is poorly understood. OBJECTIVE To scope how prenatal stress is defined and measured among pregnant people exposed to three prominent social stressors in the United States: insecurity pertaining to food, housing, and immigration. ELIGIBILITY CRITERIA We included all studies that focused on stress during pregnancy in the context of food insecurity, housing instability, and immigration, given their recent policy focus due to the COVID-19 pandemic and ongoing political discourse, in addition to their importance in American College of Obstetricians and Gynecologists (ACOG's) social determinants of health screening tool. SOURCES OF EVIDENCE We searched PubMed, Scopus, and Web of Science for articles published between January 2012 and January 2022. CHARTING METHODS Using a piloted charting tool, we extracted relevant study information from the selected articles and analyzed the content pertaining to stress. RESULTS An initial search identified 1,023 articles, of which 24 met our inclusion criteria. None of the studies defined prenatal stress, and only one used the Prenatal Distress Questionnaire, a prenatal stress-specific tool to measure it. The Perceived Stress Scale was the most common instrument used in seven studies. Fifteen studies measured over 25 alternative exposures that researchers theorized were associated with stress, and 4 of the 15 studies did not explain the association between the measure and stress. CONCLUSIONS Our findings demonstrate a fundamental inconsistency in how prenatal stress is defined and measured in the context of social determinants of health, limiting the comparison of results across studies and the potential development of effective interventions to promote better maternal mental health.
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Affiliation(s)
- Ishani Patel
- Chicago College of Osteopathic Medicine, Midwestern University, Downers Grove, IL, USA
| | - Alka Dev
- The Dartmouth Institute for Health Policy & Clinical Practice, Dartmouth College, Hanover, IL, USA
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Corona K, Chavez T, Stewart K, Toledo-Corral CM, Farzan SF, Habre R, Grubbs B, Al-Marayati L, Lurvey N, Lerner D, Eckel SP, Lagomasino I, Breton CV, Bastain TM. Adverse childhood experiences and prenatal depression in the maternal and development risks from environmental and social stressors pregnancy cohort. J OBSTET GYNAECOL 2022; 42:3014-3020. [PMID: 36178435 PMCID: PMC9851371 DOI: 10.1080/01443615.2022.2125298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
The aim of this study was to examine the association between adverse childhood experiences (ACEs) and risk for depression among 480 predominantly low-income Hispanic/Latina women in the Maternal and Development Risks from Environmental and Social Stressors pregnancy cohort. Models were fitted to evaluate associations between ACEs and prenatal probable depression measured by the Center for Epidemiologic Studies-Depression Scale adjusting for recruitment site, age, income, race/ethnicity, marital status and parity. The ACEs Questionnaire parameterised experiences as counts (0-10), categories (0, 1-3 and 4+ ACEs) and domains. Participants had a significantly higher likelihood of prenatal probable depression per unit increase in ACEs count or if they reported 4+ ACEs relative to 0 ACEs. Higher likelihood of probable depression was also associated with higher counts of each ACEs domains: abuse, neglect and household dysfunction. Findings suggest systematic screening for depressive symptoms in those with a history of childhood adversities may be important in prenatal care practice.Impact StatementWhat is already known on this subject? Experiencing depression during pregnancy has been associated with later adverse maternal mental and physical health outcomes. Emerging studies indicate that adverse childhood experiences (ACEs) may maintain or increase the predisposition to prenatal depression.What do the results of this study add? Although prenatal depressive symptoms are prevalent among racial/ethnic minority samples including Hispanic/Latinas, research determining whether the association between ACEs and prenatal depression varies by nativity is scarce. Overall, ACEs were common among Maternal and Developmental Risks from Environmental and Social Stressors (MADRES) participants and were associated with a higher likelihood of probable depression during pregnancy. These patterns did not significantly differ among the foreign-born versus U.S.-born Hispanic/Latina women, although the associations were stronger among U.S.-born Hispanic/Latina women.What are the implications of these findings for clinical practice and/or further research? Research should continue to focus on the effects of ACEs in communities that have been historically excluded in perinatal mental health services such as pregnant women from racial and ethnic minority groups. It may be important for clinicians to routinely screen for mental health during pregnancy as an adverse, psychological environment may impact both women and children. These findings suggest a need for improvement in systematic screening for depressive symptoms in those with a history of childhood adversities.
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Affiliation(s)
- Karina Corona
- Department of Population and Public Health Sciences, University of Southern California
| | - Thomas Chavez
- Department of Population and Public Health Sciences, University of Southern California
| | - Kennedy Stewart
- Department of Health Sciences, California State University, Northridge
| | - Claudia M. Toledo-Corral
- Department of Population and Public Health Sciences, University of Southern California
- Department of Health Sciences, California State University, Northridge
| | - Shohreh F. Farzan
- Department of Population and Public Health Sciences, University of Southern California
| | - Rima Habre
- Department of Population and Public Health Sciences, University of Southern California
| | - Brendan Grubbs
- Department of Obstetrics and Gynecology, University of Southern California
| | - Laila Al-Marayati
- Department of Obstetrics and Gynecology, University of Southern California
| | | | | | - Sandrah P. Eckel
- Department of Population and Public Health Sciences, University of Southern California
| | - Isabel Lagomasino
- Department of Psychiatry and Behavioral Sciences, University of Southern California
| | - Carrie V. Breton
- Department of Population and Public Health Sciences, University of Southern California
| | - Theresa M. Bastain
- Department of Population and Public Health Sciences, University of Southern California
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