Predictors of Postpartum Depression Among Women with Low Incomes in the United States

Abstract

Purpose: To evaluate the predictors of postpartum depression and to examine the effects of maternal racial identity on postpartum depression among women with low incomes in the United States. Study Design and Methods: We conducted a secondary data analysis using baseline data from the Baby's First Years study, including postpartum women living below the federal poverty line who were recruited from four diverse communities in the United States. Postpartum depression symptoms were assessed using the Center for Epidemiologic Studies Depression Scale (CES-D). Logistic regressions were performed to identify associations between pre-identified postpartum depression risk factors and postpartum depression among participants, followed by predictive margins analyses to elaborate on probability of postpartum depression across different racial identity groups in the sample. Results: The sample included 1,051 postpartum women. Almost one-half of participants identified as Black (45.9%), followed by White (20.7%), American Indian (1.8%), and Asian (1.3%). Prevalence of postpartum depression in the sample was 24%. Financial insecurity and alcohol use were positively associated with postpartum depression, whereas level of education and reported physical health were negatively associated with postpartum depression. Mothers who identified as Black had an 8.3% higher probability of postpartum depression than that of White mothers in the sample. Clinical Implications: Nurses working with populations with low income should assess social determinants of health to provide holistic mental health care. Women with low incomes should be referred to resources which account for their financial burden. Racial disparities exist in perinatal care, and birth and postpartum mental health outcomes. It is crucial to address the systemic racism faced by Black mothers experiencing postpartum depression.

Access to Mental Healthcare Services for Black Women during Perinatal Period – A Scoping Review

“…mental health and access to mental healthcare (Alegría et al, 2018). Living in poverty can expose mothers to the risk of developing mental health disorders and make existing symptoms, such as postpartum depression (PPD), worse (Lau & Adams, 2023). Chalmers and Omer-Hashi (2002) postulate that Black women in Canada face cultural insensitivity, such as a lack of a role in decision-making, which could prevent access to mental health services and contribute to poor mental health.…”