Is Screening for Depression in the Perinatal Period Enough? The Co-Occurrence of Depression, Substance Abuse, and Intimate Partner Violence in Culturally Diverse Pregnant Women

Abstract

Background: The perinatal period provides unique opportunities to identify and intervene with the co-occurrence of perinatal depression, intimate partner violence (IPV), and substance use problems. Psychosocial screening recommended for women seen in maternal child health settings tends to target single rather than multiple risk factors; there is limited research examining the co-occurrence of these issues especially in racially and ethnically diverse women across the perinatal period. These analyses explore the relationships of sociodemographic, psychosocial, and behavioral characteristics in a large, diverse sample of women. Method: Women receiving perinatal services at routinely scheduled visits, including the 6-week postpartum visit, were recruited from 10 community obstetric/gynecologic clinics. Data were collected on perinatal depression, IPV, maternal substance use, and sociodemographic characteristics by bilingual, bicultural research assistants. Results: A total of 1868 women were screened, 1526 (82%) Latina, 1099 (58.8%) interviewed in Spanish; 20.4% (n = 382) screened positive for depressive symptoms based on an Edinburgh Postnatal Depression Scale score of 10 or above, 20.9% reported harmful drinking, 4.3% reported drug use, 23% reported substance use problems, and 3.5% reported current or recent IPV. Women who were Black, Asian, Pacific Islander, or other race/ethnicity had greater odds for depressive symptoms relative to women who were Hispanic or Latino (odds ratio [OR] = 1.81, p = 0.005). Women reporting substance use problems (OR = 2.37, p < 0.0001) and IPV (OR = 3.98, p < 0.0001) had higher odds for depressive symptoms. Conclusion: In a predominately Latina sample, 1 in 5 mothers (20.4%) screened positive for depressive symptoms and over one third (36.7%) reported one or more psychosocial issues during the perinatal period. Screening for multiple risk factors rather than just one can help clinicians tailor interventions for the successful management of psychosocial issues.

Intimate Partner Violence During Pregnancy: Maternal and Neonatal Outcomes

“…Finally, nearly 80% of those studies examining the association between IPV and sexually transmitted infections or urinary tract infections found an association. 32 Maternal mental health IPV during pregnancy is associated with depression, both during pregnancy 19,33,34 and in the postpartum period. [35][36][37] Indeed, women experiencing abuse during pregnancy are 2.5 times more likely to report depressive symptomatology than their nonabused counterparts.…”

A review of research and nursing management of mental health problems in pregnancy and motherhood

“…Currently, opioid use in pregnancy is a growing health problem. 43,44 Women who use heroin intravenously face additional complications that include overdosing, contracting sexually transmitted and other infectious diseases, and living in potentially lethal, explosive, and 4 Not only are these pregnant women at risk physically but also they are at risk mentally due to stress and anxiety. An additional risk for pregnant women who use opioids is the concomitant use of other drugs (polysubstance use), such as alcohol, benzodiazepines, amphetamines, and cocaine, which are potentially teratogenic.…”

“…44 The researchers identified a range of comorbid problems including depressive symptoms, IPV, and substance use. 44 In a largely Latina sample, they discovered that ∼20% screened positive for depressive symptoms and more than 30% reported psychosocial issues during the pregnancy period. Similar to the clinic established by Nguyen et al, 2 the range of support and targeted treatment provided an unexpected outcome-social support.…”

“…Similar to the clinic established by Nguyen et al, 2 the range of support and targeted treatment provided an unexpected outcome-social support. 44 The available literature reveals that women at risk of SMI, pre-and post pregnancy, are not well served by the current system. Further research is indicated to determine the efficacy of different assessment tools and to allow for the recommendation of a standard approach for all or for a tailored approach to meet the needs of this specific population.…”

Safety for Aboriginal Women in Couples Counseling Where There is a History of Intimate Partner Violence

“…In particular, substance abuse by the male partner elevates risk considerably (Klostermann, Kelley, Mignone, Pusateri, & Fals-Stewart, 2010). Additionally, safety concerns are raised if she (Connelly, Hazen, Baker-Ericzén, Landsverk, & Horwitz, 2013) or both (Smith, 2013) are abusing substances. The effects are noted in the increased likelihood (Curadi, 2009) and severity (Kraanen et al, 2013a) of abuse under those circumstances.…”