Skip to main content

Advertisement

SpringerLink
Log in

Reducing the Risk of Postpartum Depression in a Low-Income Community Through a Community Health Worker Intervention

  • Published:
Maternal and Child Health Journal Aims and scope Submit manuscript

Abstract

Objectives To clarify the effectiveness of perinatal social support interventions in reducing postpartum depression among minority, low-income women. Methods The Transdisciplinary Research Consortium for Gulf Resilience on Women’s Health supported a community-based participatory research project to improve perinatal health among low-income, first-time pregnant women living in a vulnerable Gulf Coast region. Community health workers (CHWs) were partnered with recruited women, and used a mix of mobile technology and home visits to develop a supportive relationship during the perinatal period. Results Women enrolled in the CHW-led intervention had lower (F: 2.38, p = 0.04) average postpartum depression scores (EPDS) 6 months postpartum than a comparison population. The difference, however, was not seen among women in the intervention group who reported relatively poor relationships with their CHWs. Conclusions for Practice Results reinforce the evidence that perinatal social support can affect postpartum depression outcomes. CHWs are increasingly utilized by public programs to reach at-risk populations. We discuss the potential efficacy of CHW programs, but also, the need to pair outreach with effective monitoring and evaluation of the relationship development between CHW and clients.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  • Abdollahi, F., Sazlina, S. G., Zain, A. M., Zarghami, M., Asghari Jafarabadi, A. M., & Lye, M. S. (2014). Postpartum depression and psycho-socio-demographic predictors. Asia-Pacific Psychiatry, 6(4), 425–434.

    PubMed  Google Scholar 

  • Ballard, C., Davis, R., Cullen, P., Mohan, R., & Dean, C. (1994). Prevalence of postnatal psychiatric morbidity in mothers and fathers. The British Journal of Psychiatry, 164(6), 782–788.

    Article  CAS  PubMed  Google Scholar 

  • Banker, J. E., & LaCoursiere, D. Y. (2014). Postpartum depression: Risks, protective factors, and the couple’s relationship. Issues in Mental Health Nursing, 35(7), 503–508.

    Article  PubMed  Google Scholar 

  • Beck, C. T. (1995). The effects of postpartum depression on maternal-infant interaction: A meta-analysis. Nursing Research, 44(5), 298–305.

    Article  CAS  PubMed  Google Scholar 

  • Beck, C. T. (1996). A meta-analysis of predictors of postpartum depression. Nursing Research, 45(5), 297–303.

    Article  CAS  PubMed  Google Scholar 

  • Beck, C. T. (2001). Predictors of postpartum depression: An update. Nursing Research, 50(5), 275–285.

    Article  CAS  PubMed  Google Scholar 

  • Brugha, T. S., Wheatley, S., Taub, N. A., Culverwell, A., Friedman, T., Kirwan, P.,.. . Shapiro, D. (2000). Pragmatic randomized trial of antenatal intervention to prevent post-natal depression by reducing psychosocial risk factors. Psychological Medicine, 30(06), 1273–1281.

    Article  CAS  PubMed  Google Scholar 

  • Catty, J., Cowan, N., Poole, Z., Ellis, G., Geyer, C., Lissouba, P.,.. . Burns, T. (2012). Attachment to the clinical team and its association with therapeutic relationships, social networks, and clinical well-being. Psychology and Psychotherapy: Theory, Research and Practice, 85(1), 17–35.

    Article  Google Scholar 

  • Clatworthy, J. (2012). The effectiveness of antenatal interventions to prevent postnatal depression in high-risk women. Journal of Affective Disorders, 137(1), 25–34.

    Article  PubMed  Google Scholar 

  • Cox, J., & Holden, J. (2003). Perinatal mental health: A guide to the Edinburgh Postnatal Depression Scale (EPDS). London: Royal College of Psychiatrists.

    Google Scholar 

  • Da Costa, D., Larouche, J., Dritsa, M., & Brender, W. (2000). Psychosocial correlates of prepartum and postpartum depressed mood. Journal of Affective Disorders, 59(1), 31–40.

    Article  PubMed  Google Scholar 

  • Eberhard-Gran, M., Tambs, K., Opjordsmoen, S., Skrondal, A., & Eskild, A. (2004). Depression during pregnancy and after delivery: A repeated measurement study. Journal of Psychosomatic Obstetrics & Gynecology, 25(1), 15–21.

    Article  CAS  Google Scholar 

  • Gavin, N. I., Gaynes, B. N., Lohr, K. N., Meltzer-Brody, S., Gartlehner, G., & Swinson, T. (2005). Perinatal depression: A systematic review of prevalence and incidence. Obstetrics & Gynecology, 106(5, part 1), 1071–1083.

    Article  Google Scholar 

  • Goldstein, B. D., Osofsky, H. J., & Lichtveld, M. Y. (2011). The Gulf oil spill. New England Journal of Medicine, 364(14), 1334–1348.

    Article  CAS  PubMed  Google Scholar 

  • Gress-Smith, J. L., Luecken, L. J., Lemery-Chalfant, K., & Howe, R. (2012). Postpartum depression prevalence and impact on infant health, weight, and sleep in low-income and ethnic minority women and infants. Maternal and child health journal, 16(4), 887–893.

    Article  PubMed  Google Scholar 

  • Harville, E. W., Jacobs, M., & Boynton-Jarrett, R. (2015). When is exposure to a natural disaster traumatic? comparison of a trauma questionnaire and disaster exposure inventory. PLoS ONE, 10(4), e0123632. https://doi.org/10.1371/journal.pone.0123632.

    Article  PubMed  PubMed Central  Google Scholar 

  • Hawkins, R. L., & Maurer, K. (2012). Waiting for the white man to fix things: Rebuilding black poverty in New Orleans. Journal of Sociology & Social Welfare, 39, 111.

    Google Scholar 

  • Horowitz, J. A., & Goodman, J. H. (2005). Identifying and treating postpartum depression. Journal of Obstetric, Gynecologic, and Neonatal Nursing, 34(2), 264–273.

    Article  PubMed  Google Scholar 

  • Kessler, R. C., Barker, P. R., Colpe, L. J., Epstein, J. F., Gfroerer, J. C., Hiripi, E.,.. . Walters, E. E. (2003). Screening for serious mental illness in the general population. Archives of General Psychiatry, 60(2), 184–189.

    Article  PubMed  Google Scholar 

  • le Roux, I. M., Tomlinson, M., Harwood, J. M., O’Connor, M. J., Worthman, C. M., Mbewu, N.,.. . Comulada, W. S. (2013). Outcomes of home visits for pregnant mothers and their infants: A cluster randomized controlled trial. AIDS, 27(9), 1461–1471.

    Article  PubMed  Google Scholar 

  • Lefkovics, E., Baji, I., & Rigó, J. (2014). Impact of maternal depression on pregnancies and on early attachment. Infant Mental Health Journal, 35(4), 354–365.

    Article  PubMed  Google Scholar 

  • Leigh, B., & Milgrom, J. (2008). Risk factors for antenatal depression, postnatal depression and parenting stress. BMC Psychiatry, 8(1), 1.

    Article  Google Scholar 

  • Lichtveld, M. Y., Shankar, A., Mundorf, C., Hassan, A., & Drury, S. (2016). Measuring the developing therapeutic relationship between pregnant women and community health workers over the course of the pregnancy in a study intervention. [journal article]. Journal of Community Health, 41(6), 1167–1176. https://doi.org/10.1007/s10900-016-0198-2.

    Article  PubMed  PubMed Central  Google Scholar 

  • Mcguire-Snieckus, R., McCABE, R., Catty, J., Hansson, L., & Priebe, S. (2007). A new scale to assess the therapeutic relationship in community mental health care: STAR. Psychological Medicine, 37(01), 85–95.

    Article  PubMed  Google Scholar 

  • McNair, D., Lorr, M., & Droppleman, L. (1971). POMS profile—profile of mood states. San Diego, CA: Educational and Industrial Testing Services.

    Google Scholar 

  • Milani, H. S., Azargashb, E., Beyraghi, N., Defaie, S., & Asbaghi, T. (2015). Effect of telephone-based support on postpartum depression: A randomized controlled trial. International Journal of Fertility & Sterility, 9(2), 247.

    CAS  Google Scholar 

  • Mundorf, C., Shankar, A., Peng, T., Hassan, A., & Lichtveld, M. Y. (2017). Therapeutic relationship and study adherence in a community health worker-led intervention. Journal of Community Health, 42(1), 21–29. https://doi.org/10.1007/s10900-016-0220-8.

    Article  PubMed  PubMed Central  Google Scholar 

  • O’hara, M. W., & Swain, A. M. (1996). Rates and risk of postpartum depression-a meta-analysis. International Review of Psychiatry, 8(1), 37–54.

    Article  Google Scholar 

  • Patton, G. C., Romaniuk, H., Spry, E., Coffey, C., Olsson, C., Doyle, L. W.,.. . Brown, S. (2015). Prediction of perinatal depression from adolescence and before conception (VIHCS): 20-year prospective cohort study. The Lancet, 386(9996), 875–883.

    Article  Google Scholar 

  • Raposa, E., Hammen, C., Brennan, P., & Najman, J. (2014). The long-term effects of maternal depression: Early childhood physical health as a pathway to offspring depression. Journal of Adolescent Health, 54(1), 88–93.

    Article  PubMed  Google Scholar 

  • Siu, A. L., Bibbins-Domingo, K., Grossman, D. C., Baumann, L. C., Davidson, K. W., Ebell, M.,.. . Kemper, A. R. (2016). Screening for depression in adults: US Preventive Services Task Force recommendation statement. JAMA, 315(4), 380–387.

    Article  CAS  PubMed  Google Scholar 

  • Spielberger, C. D., & Gorsuch, R. L. (1983). State-trait anxiety inventory for adults: Manual, instrument, and scoring guide. Menlo Park, CA: Mind Garden.

    Google Scholar 

  • Thomas, N., Komiti, A., & Judd, F. (2014). Pilot early intervention antenatal group program for pregnant women with anxiety and depression. Archives of Women’s Mental Health, 17(6), 503–509.

    Article  PubMed  Google Scholar 

  • Ware, J. E., Kosinski, M., & Keller, S. D. (1995). SF-12: How to score the SF-12 physical and mental health summary scales. Boston: Health Institute, New England Medical Center.

    Google Scholar 

  • Wittorf, A., Jakobi, U. E., Bannert, K. K., Bechdolf, A., Müller, B. W., Sartory, G.,.. . Herrlich, J. (2010). Does the cognitive dispute of psychotic symptoms do harm to the therapeutic alliance? The Journal of Nervous and Mental Disease, 198(7), 478–485.

    Article  PubMed  Google Scholar 

  • Women, Infants and Children: WIC Eligibility Requirements. (2015). Retrieved 29 April 2015, from http://www.fns.usda.gov/wic/wic-eligibility-requirements.

  • Zapata, A., Kieltyka, L., Finley, A., Vance, U., Washington, S., & Tran, T. (2009). LaPRAMS: Louisiana pregnancy risk assessment monitoring system 2009 surveillance report. Louisiana: Louisiana Department of Health and Hospitals, Office of Public Health, Bureau of Family Health.

Download references

Acknowledgements

This research was supported by the National Institutes of Health under Grant number 5U19ES020677. This study would have not been possible without the tireless and dedicated work of our community health workers (Starleen Maharaj-Lewis, Christine Dennis, Onita Harris, Courtney Schultheis, Patricia Davis, and Kimisha Sawyer). We would also like to thank Farah Arosemena and Dr. Hannah Covert, for their guidance and expertise during the design and implementation of the study.

Author information

Authors and Affiliations

  1. Department of Sociology, Hiram College, Hiram, OH, USA

    Christopher Mundorf

  2. Department of Biostatistics & Bioinformatics, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA

    Arti Shankar

  3. Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA

    Tracy Moran, Sherry Heller & Anna Hassan

  4. Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA

    Emily Harville

  5. Department of Global Environmental Health Sciences, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA

    Maureen Lichtveld

Authors
  1. Christopher Mundorf
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Arti Shankar
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Tracy Moran
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Sherry Heller
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Anna Hassan
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Emily Harville
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Maureen Lichtveld
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Christopher Mundorf.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Mundorf, C., Shankar, A., Moran, T. et al. Reducing the Risk of Postpartum Depression in a Low-Income Community Through a Community Health Worker Intervention. Matern Child Health J 22, 520–528 (2018). https://doi.org/10.1007/s10995-017-2419-4

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10995-017-2419-4

Keywords

Search

Navigation