A Prospective Study of Social Needs Associated with Mental Health among Postpartum Patients Living in Underserved Communities

Abstract

Objective: Given the rising rates of maternal morbidity and mortality in the United States and the contribution of mental illness, especially among individuals living in under-resourced communities, the objective was to evaluate the prevalence of unmet health-related social needs and their impact on perinatal mental health outcomes. Study Design: This was a prospective observational study of postpartum patients residing within regions with increased rates of poor perinatal outcomes and sociodemographic disparities. Patients were enrolled in a multidisciplinary public health initiative “Extending Maternal Care After Pregnancy (eMCAP)” between October 1, 2020, and October 31, 2021. Unmet health-related social needs were assessed at delivery. Symptoms of postpartum depression and anxiety were evaluated at one month postpartum utilizing the Edinburg Postnatal Depression Scale (EPDS) and Generalized Anxiety Disorder-7 (GAD-7) screening tools respectively. Mean EPDS and GAD7 scores and odds of screening positive (scoring ≥10) were compared among individuals with and without unmet health-related social needs with p< 0.05 considered significant. Results: Of participants enrolled in eMCAP, 603 completed at least one EPDS or GAD7 at one month. Most had at least one social need, most commonly dependence on social programs for food (n=413/603 (68%)). Individuals lacking transportation to medical (OR 4.0, 95% CI: 1.2 – 13.32) and non-medical appointments (OR 4.17 95% CI: 1.08 – 16.03) had significantly higher odds of screening positive on EPDS while participants lacking transportation to medical appointments (OR 2.73 95% CI: 0.97 – 7.70) had significantly higher odds of screening positive on GAD7. Conclusion: Among postpartum individuals in underserved communities, social needs correlate with higher depression and anxiety screening scores. This highlights the need to address social needs to improve maternal mental health.