Background: Maternal mortality decreased globally by about 38% between 2000 and 2017, yet, it continues to climb in the United States. Gaping disparities exist in U.S. maternal mortality between white (referent group) and minority women. Despite important and appropriate attention to disparities for black women, almost no attention has been given to American Indian/Alaska Native (AI/AN) women. The purpose of this scoping review is to synthesize available literature concerning AI/AN maternal mortality. Methods: Databases were searched using the terms maternal mortality and pregnancy-related death, each paired with American Indian, Native American, Alaska Native, Inuit, and Indigenous. Criteria (e.g., hemorrhage) were paired with initial search terms. Next, pregnancy-associated death was paired with American Indian, Native American, Alaska Native, Inuit, and Indigenous. Criteria in this category were homicide, suicide, and substance use. Results: The three leading causes of AI/AN pregnancy-related maternal mortality are hemorrhage, cardiomyopathies, and hypertensive disorders of pregnancy. AI/AN maternal mortality data for homicide and suicide consistently include small samples and often categorize AI/AN maternal deaths in an ''Other'' race/ethnicity, which precludes targeted AI/AN data analysis. No studies that reported AI/AN maternal mortality as a result of substance use were found. Health care characteristics such as quality, access, and location also may influence maternal outcomes and maternal mortality. Conclusions: Despite AI/AN maternal mortality being disproportionately high compared to other racial/ethnic groups, relatively little is known about root causes.
This review examined validation studies of the Edinburgh Postnatal Depression Scale (EPDS) and the Patient Health Questionnaire-9 (PHQ-9) to identify an appropriate postpartum depression (PPD) screening tool for American Indian and Alaska Native (AI/AN) women in the U.S. Databases were searched using: EPDS paired with psychometric properties or validation and PHQ-9 paired with PPD and psychometric properties or validation, yielding a final sample of 58 articles. Both tools have good internal consistency, but discriminative validity for detecting PPD in women from non-Western cultures is low. Positive predictive values in these women are low and diverse (EPDS [n = 21] median 67%, range 21.1-90%; PHQ-9 [n = 1] median 26%). The low predictive accuracy of both tools suggests the tools may be culturally biased.
Background: Postpartum depression (PPD) is the most common complication of childbirth and affects one in nine new mothers in the United States. Objective: The purpose of this review was to synthesize PPD research in American Indian/Alaska Native (AI/AN) women. Specific aims were to 1) explore the extent to which PPD literature includes AI/AN women measured by the proportion of study samples that were AI/AN women and 2) identify and analyze gaps in the PPD literature for AI/AN women. Design: Databases were searched using: “postpartum depression” and “American Indian,” “Native American,” “Alaska Native,” “Inuit,” and “Indigenous.” “Postpartum depressive symptoms” and “puerperal mood disorder” were each paired with race/ethnicity search terms, yielding a final sample of nine articles. Results: The proportion of study samples that were AI/AN women ranged from 0.8% to 100%. Compared with all women in the United States (11%), AI/AN women have higher PPD prevalence (14%-29.7%), suggesting a disparity among the different groups of women. Screening instruments were inconsistent among studies, and not all studies used a screening instrument specific to PPD. No cultural influences, risk, or protective factors were reported for AI/AN women. In the only intervention study, no significant differences in PPD symptoms between groups were found after the intervention. Conclusions: This review uncovered significant gaps in the literature and suggested ways to advance the PPD science for AI/AN women. Clinical implications were described.
Postpartum depression (PPD) is a common mental illness adversely affecting maternal and child health outcomes (Earls et al., 2019). Risk factors include low socioeconomic status (SES), lack of social support, history of depression, prenatal depression or anxiety, and others (Beck, 2001). Prevalence is about 13% for all U.S. women (Centers for Disease Control and Prevention, 2020) but ranges from 14% to 29.7% for First American women (Heck, 2021), suggesting a racial/ethnic disparity. Many descriptive terms are used to describe First American people: Indigenous, Native American, American Indian, and others. We use "First American" because that is the term preferred by the Chickasaw Nation. Similar to Canadian PPD research with Indigenous women (Leason, 2021), we know little of First American perspectives of PPD. It is reasonable that First American women may have experiences and meanings for those experiences that differ from the dominant culture. The purpose was to describe First American women's lived PPD experiences by examining their perinatal and cultural infl uences. Specifi c aims were to describe: 1) First American women's PPD experiences and the meanings they ascribe to them and 2) the cultural knowledge, i nfl uences, and practices during the perinatal period of First American women experiencing PPD now or in the past. This study is unique as we were unable to identify any other published studies reporting qualitative PPD research with First American women despite an extensive search of the literature.
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