Perinatal Behavioral Health, the COVID-19 Pandemic, and a Social Determinants of Health Framework

Trends in demographics and needs for nurse-family partnership clients enrolled between 1997 and 2022

BACKGROUND

Demographics and needs of nulliparous, Medicaid-eligible pregnant individuals, the target profile for Nurse-Family Partnership (NFP), have shifted over recent decades as teen pregnancy rates have dropped and Medicaid eligibility has expanded.

OBJECTIVE

We examined trends in the proportion of NFP clients with demographic characteristics and needs impacting client and child outcomes.

PARTICIPANTS AND SETTING

Participants were nulliparous, pregnant individuals (N = 349,935; 33 % Hispanic, 30 % non-Hispanic Black, 30 % non-Hispanic White) enrolled between 1997 and 2022 in NFP, a national public health intervention aimed at improving client and child outcomes through in-home nurse visitation.

METHODS

Generalized linear models and time-varying models examined change over time.

RESULTS

Later enrollment year predicted enrollment of: more racially/ethnically diverse clients with older age (β = 0.24 ± 0.002, P < .0001) more educated clients (college degree vs. high school diploma/GED OR 1.195, 95 % CI 1.194-1.195), more married/cohabiting clients (OR 1.131, 95 % CI 1.129-1.132), clients with higher mastery scores (β = 0.007 ± 0.0001, P < .0001), and increased client needs (pre-pregnancy mental/physical health diagnoses, substance use/addiction, IPV exposure, and homelessness; ORs 1.082 to 1.300, all P < .0001). The average summed needs of clients increased from 1.17 in 1997 to 1.36 in 2022. Non-Hispanic White clients had greater summed needs compared to Hispanic and non-Hispanic Black clients, driven by higher rates of health diagnoses and substance use.

CONCLUSION

The demographics and needs of NFP clients have shifted over time. Compared to the original trials and earlier program replication, recent clients are older and more educated but have greater needs in a variety of domains increasing risk of poor client and child outcomes.

"Will I survive this?": A qualitative exploration of the wider impacts of the COVID-19 pandemic on the health and well-being of pregnant and parenting youth and their children in Canada

BACKGROUND

Pregnant and parenting youth in Canada face multiple challenges in fulfilling their parenting responsibilities while meeting their own unique needs. The COVID-19 pandemic and its associated public health restrictions exacerbated their challenges by reducing access to support networks, limiting opportunities to promote growth and well-being, and destabilizing their financial and economic standing. The impacts of the pandemic on the mental, physical, and emotional health of individuals are well-documented in the literature. However, there is limited research on how the pandemic influenced the lives, health, and well-being of pregnant and parenting youth and their children in Canada. Therefore, we aimed to examine the wider impacts (social and structural determinants that directly or indirectly impact health and well-being) of the pandemic and its implications for this population.

METHODS

We used a constructivist grounded theory approach to explore the experiences of pregnant and parenting youth during the pandemic and how certain social determinants of health intersected to shape health outcomes and influence their ability to access services. We conducted qualitative interviews using a semi-structured interview guide over Zoom. Using grounded theory principles, we inductively analyzed the data and categorized our findings into themes.

RESULTS

We recruited a total of 50 participants from different regions in Canada. The findings from the interviews were categorized into the following themes: (1) "They bear the burden alone": Struggles of pregnant and parenting youth, (2) "How will I live the next day?": Concerns and consequences arising from the pandemic, and (3) "Try to keep your mask on": Navigating healthcare services while maintaining public health guidelines. Our findings highlight the various challenges encountered by the youth during the pandemic, particularly those associated with financial and economic constraints, lack of accessible health and social services, and increased stress from parenting responsibilities.

CONCLUSION

Pregnant and parenting youth in Canada encountered various barriers while accessing health and social services, maintaining their well-being, and connecting with reliable sources of support during the pandemic. Our study findings emphasize the urgent need for adaptable and comprehensive support systems explicitly catering to the needs of pregnant and parenting youth during crises, such as the pandemic.

Healthcare Provider Narratives of the Impacts of the COVID-19 Pandemic on Pregnant and Parenting Youth in Canada: A Qualitative Study

The COVID-19 pandemic led to significant challenges for healthcare providers working with pregnant and parenting youth. However, the impacts of the pandemic on this population and healthcare services from the perspective of healthcare providers are not well documented in Canada. We examined the narratives and experiences of healthcare providers regarding these impacts and explored the challenges to service provision. Using a qualitative interpretative description (ID) approach, we recruited 25 health and service providers from Alberta, Ontario, and British Columbia for individual qualitative interviews. Our analysis resulted in three themes: complexities of health service provision during COVID-19, healthcare providers' accounts of impacts on pregnant and parenting youth, and leveraging challenges into opportunities for service provision. Participants described the influence of pandemic policies and distancing measures on accessibility of health services, availability of healthcare resources and personnel, and well-being of their clients. They also reported increased mental health issues, isolation, and exacerbation of inequities within this population. Providers highlighted the role of telemedicine in ensuring some degree of continuity of care. Additionally, they commented on service adaptations to address the evolving needs of their clients. Our findings underline the need for a resilient and adaptable healthcare system that can better support the needs of vulnerable populations during crises.

Integrating Mental Health Care in Ambulatory Obstetrical Practices: Strategies and Models

Perinatal mental health is recognized as a priority component of obstetrical care. Perinatal patients often turn to their obstetrician for help with mental health concerns as they view them as their primary health care provider. Unfortunately, obstetricians face challenges in providing adequate support due to time constraints and limited expertise. Integrated behavioral health care offers a collaborative and cost-effective solution to enhance patient care and clinician satisfaction. Integrated behavioral health clinicians possess fundamental skills to care for patients throughout the reproductive lifespan and assist obstetricians in identifying and managing common mood concerns.

Social determinants of perinatal mental health during the COVID-19 pandemic

OBJECTIVE

We sought to clarify relevant social-structural determinants of perinatal mental health-material and social resources, as well as pandemic employment-related stressors, in White and BIPOC child-bearers-toward building comprehensive risk screening and prevention/intervention models that can alleviate health disparities. Each of these determinants was hypothesized to contribute to perinatal symptoms in ways that disproportionately benefit White child-bearers.

METHOD

A community sample of Illinois child-bearers (n = 409 pregnant, 122 new parents) completed online questionnaires from May 2020-June 2021. Relations between composite measures of child-bearers' material resources, social resources, and pandemic employment-related stressors and mental health symptoms were tested in multiple regression models. Main effects of social determinant composites and moderated effects by race/ethnic identification were tested.

RESULTS

All social determinants displayed significant unique associations with mental health in the sample, with social resources carrying the greatest weight. Although no moderated effects of composite resource measures were found, the relation between pandemic employment-related reduced resources and symptoms proved stronger in BIPOC compared to White child-bearers.

CONCLUSIONS

Both stable social-structural determinants and acute crisis-related shifts contribute to perinatal mental health, with higher levels and/or impacts of resources helping to explain racial/ethnic disparities. These findings can inform more comprehensive screening and prevention protocols and policy recommendations that improve perinatal health outcomes.

Context Matters: Assessing the Association Between Area Deprivation and the Severity of Injury and Types of Domestic Violence Victimization Among Women

OBJECTIVES

To analyze the association between social determinants of health (SDOH), as measured by the Area Deprivation Index (ADI), and the severity of injury and types of domestic violence (DV) victimization among women (≥18 years of age) in Milwaukee, Wisconsin.

METHODS

Neighborhood ADI data from the American Community Survey (2014-2018) were merged with Milwaukee Police Department DV data (2013-2017). ADI included multiple SDOH domains (education, employment, income/poverty, and housing quality). Types of DV were classified using an adaptation of the FBI-Uniform Crime Reporting-Hierarchy Rule, including Crimes Against Persons (homicide/negligent manslaughter, sexual assault/rape, and aggravated battery/assault). Chi-square, Anova tests, and logistic regression analyses were performed using Stata v.14.2; p-values ≤ .05 were considered statistically significant.

FINDINGS

Except for aggravated battery/assault (OR: 1.003, 95% CI: 1.001-1.010), there was no statistically significant relationship between neighborhood disadvantage and DV victimization in 21,095 DV incidents between 2013 and 2017. Adjusted model results indicate that with each increase in neighborhood disadvantage (by ADI), there was a 1.003 increase in the likelihood for aggravated battery/assault (OR: 1.003, 95% CI: 1.001-1.005). Severity of DV injury was not significantly associated with ADI (OR: 1.002, 95% CI: 0.999-1.004). However, non-Hispanic Black women were 1.3 times more likely than non-Hispanic Whites to be victims of aggravated battery/assault (OR: 1.321, 95% CI: 1.189-1.469). Hispanic women were more likely than non-Hispanic Whites to sustain a more severe injury (OR: 0.841, 95% CI: 0.732-0.970]).

CONCLUSION

The likelihood of DV-aggravated battery/assault increased with neighborhood deprivation, and significant associations (and highly lopsided prevalence) were found in types of DV victimization by race/ethnicity, with non-Hispanic Black women experiencing higher prevalence than others. This study adds to the body of knowledge by looking at how macro-level neighborhood-SDOH characteristics influence women's exposure to various forms of DV victimization and demonstrated the feasibility of linking law enforcement DV data to SDOH metrics, providing context for law enforcement DV victimizations.