INTRODUCTION: Perinatal depression affects one in seven women, and is associated with significant morbidity. Limited data suggest depression rates to be twice as high among low-income, minority women. This study aimed to identify associations between race/ethnicity and perinatal depression in a medically and psychosocially at-risk population. METHODS: Study data were collected from interviews conducted from December 2013 through August 2016 by Community Health Workers as part of the initial obstetric assessment. Depression was scored on the Center for Epidemiologic Studies Depression (CES-D) Scale, with depression defined as a score of greater than 16 for clinical symptoms. Race and ethnicity were self-reported. Chi-square analyses were performed. RESULTS: A total of 3,214 women were included in the study. Analyses revealed that a larger proportion of African American women (26.2%) met criteria for depression than their White (20.1%), Asian (5.2%) and Mixed Race counterparts (2.6%; chi-square less than .01, P greater than .001). Analyses involving ethnicity revealed that women who identified as Hispanic/Latina (27.1%) were less likely than non-Hispanic women (38.5%) to meet CES-D depression criteria (chi-square=44, P less than .001). CONCLUSION: Race and ethnicity were significantly associated with perinatal depression. A higher proportion was seen among African American women, while a lower proportion seen among Hispanic/Latinas. Implications for practice include increasing mental health support and a referral network to access during pregnancy and postpartum. Future research might include examination of protective factors for depressive symptoms in pregnant women of different ethnic/racial backgrounds. Screening tools for other mental health conditions may account for other ethnic/racial differences.
INTRODUCTION: Medical-legal partnership (MLP) aims to address the numerous social determinants of health. In July 2018 we added an MLP service for pregnant and postpartum women in an underserved safety net hospital in Los Angeles County. Here, we examine the prevalence of legal needs ascertained by self-administered legal needs assessments and the conversion rate of referrals to legal cases. METHODS: The MLP service was implemented as part of the continuum of clinical care. Referrals are tracked as part of case management. Review of self-administered screenings provided our referral screen-positive rates. Of those clients referred, a case conversion rate was calculated when legal cases were generated. RESULTS: Legal needs were identified in the following areas: family law (27%), employment (25%), housing (11%), and immigration (11%). A 72% screen positive rate (79 of 110) was found when clinic staff (provider, nursing, or social worker) directly referred to the MLP. Legal advice was often provided to those who screened positive (64%). Conversion rates were also high with 58% of those referred for formal legal action resulting in open cases (46 of 79 referred). CONCLUSION: Legal needs, such as assistance with employment law for pregnancy related disability accommodations, may have direct impacts on perinatal outcomes. Incorporating the MLP in resource-limited clinical settings can be achieved by including stakeholders in its development. The high conversion rate of referrals to cases illustrates the ability of the medical staff and patients to effectively identify legal needs and then partner with legal aid groups to address these concerns.
INTRODUCTION: Nearly 40% of women do not attend their postpartum visits. Attendance rates are even lower in underserved populations. Increasing patient participation, especially in communities of low resources, involves a multi-faceted approach in care coordination. We highlight a bundle of systems changes implemented by three Los Angeles County Department of Health Services (LAC DHS) hospitals to improve the rates of postpartum visits. METHODS: We collected baseline data on postpartum visits for women who delivered in the LAC DHS from July 2016 to June 2017. A bundle of interventions were implemented throughout the health system including: 3rd trimester scheduling of postpartum visits, appointment confirmation on day of discharge after delivery for both 3-week and 6-week visits, congratulations calls with appointment reminders at 1 week post-delivery, reminder calls the day before appointments, and coordinating pediatric visits at discharge with existing maternal appointments. During the bundle implementation year, data collection continued and performance improvement was assessed at 6 months and 1 year after baseline assessment. Services were identified by CPT, ICD-9-CM and ICD-10-CM codes. RESULTS: Six months following baseline, 47% (n=753) of patients attended postpartum visits. One year following baseline, 58% (n=954) of patients attended. There was a statistically significant difference chi-square (1, N=3,251)=36.11, P<.001, with a 60% improvement in follow-up rates. CONCLUSION: Increased postpartum return rates in resource-limited setting can be achieved through coordinated efforts. Performance improvement teams can utilize a bundle of structured activities and track change through rapid cycle improvement initiatives.
INTRODUCTION: Single parent households are common and their impact is greatest in underserved communities where racial and ethnic minorities primarily reside. Paternal parental involvement has been shown to improve a child's behavioral, social and mental health, while their absence fuels school dropout, incarceration, violence and drug involvement. This study describes a father's intention for involvement in the pregnancy and the baby's life across different couple types. METHODS: Data was collected from interviews with pregnant women enrolling in MAMAs, a prenatal care program at a Los Angeles County Health facility, from December 2013 to August 2016. During the intake visit, demographic information was collected, including maternal and paternal race/ethnicity, relationship status, as well as the expressed or assumed paternal intentions for involvement during pregnancy and in the baby's life. A Chi-Square test examined father's intentions to persist through the pregnancy and the child's life among couples of the same (concordant) and different (discordant) racial and ethnic backgrounds. RESULTS: Of the 3259 women interviewed, 87.2% (n=2841) stated the father of the baby intended to be involved during and after the pregnancy. In pregnancies with discordant parents (16.4%), the fathers were less likely to want to be involved than in pregnancies with concordant parents (Chi-Square =10.15, P=0.001). CONCLUSION: Intentions for paternal involvement during and after pregnancy differ significantly based on parental race and ethnic concordance. Children with discordant parents are at higher risk for absent fathers. Pregnant women with discordant partners may benefit from increased social support during prenatal care and throughout the child's life.
INTRODUCTION: Preterm birth (PTB) is a leading cause of infant morbidity and mortality; the strongest risk factor for PTB is a mother's history of preterm delivery. Certain modifiable risk factors for PTB could be addressed between pregnancies to decrease recurrence rates. This study describes associations between previous PTB and select associated interconception health behaviors. METHODS: Between December 2013 and August 2016, community health workers conducted intake interviews with pregnant women enrolling into the MAMA'S Los Angeles County prenatal care program. Select interconception health behaviors associated with PTB were assessed in women's current pregnancies, including: trimester of prenatal care initiation, pregnancy intent, and tobacco use at conception. Participants self-reported all outcomes and PTB history. Chi-square tests were performed. RESULTS: Analyses included data from 3,259 women, 322 (9.9%) of whom reported a prior PTB. There was no significant association between prior PTB and early (first trimester) initiation of prenatal care in the current pregnancy (chi-square=.40, P=.53). Women reporting a prior PTB were not significantly more likely to report that their current pregnancy was intended (chi-square=.01, P=.92). The proportion of women reporting tobacco use at conception did not differ between women who did (9.7%) and did not (9.9%) report a prior PTB (chi-square=.02, P=.90). CONCLUSION: Women reporting a prior PTB did not differ significantly from women without a PTB history with respect to select self-reported interconception health behaviors. Findings suggest that women with a prior PTB could benefit from interventions that could reduce the risk of recurrence by addressing relevant interconception health behaviors.
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