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Untreated depression presents a distinct set of risks for pregnancy complications. Past studies have connected antenatal depression with adverse birth outcomes. The purpose of this study was to con...

Screening for perinatal depression is a clinical approach to identifying women in need of mental health diagnoses, referral, and treatment. Many states mandate screening for perinatal depression, b...

BackgroundPerinatal (during pregnancy and up until one year after birth) depression is one of the most common medical complications of pregnancy and is a major public health issue. The common early detection method to identify depression is to systematically administer depression screens to patients during their usual care clinic encounters. This study investigates how prenatal patients perceive depression screening and how screening informs their treatment to meet the specific needs of different racial and ethnic groups within both community and health care settings.MethodsBetween June 2019 and August 2019, semi-structured in-depth interviews were conducted to explore participants' experiences of depression screening with the Edinburgh Postnatal Depression Scale (EPDS). Perinatal women (N = 29) consented to participate in-depth, one-on-one qualitative interviews. Trained patient-researchers (n = 6), women who had previously experienced a perinatal mental health problem, were trained as research team members and facilitated the interviews alongside a research assistant. All interviews were recorded and transcribed verbatim. Data was analyzed with the use of Nvivo12. Thematic network analysis was used to analyze the data.ResultsThrough the in-depth patient engaged qualitative interviews this study uncovered several specific motivators and behaviors related to perinatal depression screening. Using directed content analysis, several themes within a COM-B frame emerged and could be reduced to themes and further divided into two different stages: the depression screening stage and the post-screening stage.ConclusionsThe results of this qualitative study provide information for health care providers to improve, adjust, and assess the process of conducting perinatal depression screening among women. The data also provide information for health care facilities to identify a better screening tool and develop and measure their screening process. These findings are essential to design comprehensive patient-centered screening protocols given the increase in state and federal policies urging universal depression screening.

Maternal mental health (MH) conditions represent a leading cause of preventable maternal death in the US. Neonatal Intensive Care Unit (NICU) hospitalization influences MH symptoms among postpartum women, but a paucity of research uses national samples to explore this relationship. Using national administrative data, we examined the rates of MH diagnoses of anxiety and/or depression among those with and without an infant admitted to a NICU between 2010 and 2018. Using generalized estimating equation models, we explored the relationship between NICU admission and MH diagnoses of anxiety and/or depression, secondarily examining the association of NICU length of stay and race/ethnicity with MH diagnoses of anxiety and/or depression post NICU admission. Women whose infants became hospitalized in the NICU for 2 weeks had 37% higher odds of maternal MH diagnoses (aOR: 1.37 95% CI: 1.128%–1.47%) compared to those whose infants did not have a NICU hospitalization. In adjusted analyses, compared to white women, all other race/ethnicities had significantly lower odds of receiving a maternal MH condition diagnosis [Black (aOR = 0.76, 0.73–0.08), Hispanic (aOR = 0.69, 0.67–0.72), and Asian (aOR: 0.32, 0.30–0.34)], despite higher rates of NICU hospitalization. These findings suggest a need to target the NICU to improve maternal MH screening, services, and support while acknowledging the influence of social determinants, including race and ethnicity, on health outcomes.

Higher rates of depression and anxiety are reported among women who belong to racial and ethnic minority groups, contributing to adverse birth outcomes, and remains a taboo topic within the global Muslim community. Non-pharmacological coping mechanisms such as prayer may be employed to reduce perinatal depression and anxiety, however the literature is sparse on the use of this intervention among pregnant Muslim women. Therefore, we aimed to conduct a scoping review examining the use of Muslim faith practices on anxiety and depression in perinatal period. Nine studies were identified that demonstrate that Muslim faith practices reduce perinatal anxiety and depression symptoms. These studies demonstrate that prayers and other faith-based practices, including reciting parts of the Quran, saying a Dua, and listening to audio recordings of prayers are all effective in decreasing anxiety, depression, stress, pain and fear in Muslim women during pregnancy, during childbirth, during an unexpected cesarean section, and when experiencing infant loss. Despite the scoping review's small sample size, findings confirm that incorporation of faith practices effectively reduces perinatal depression and anxiety among Muslim women and should be utilized in clinical settings for non-pharmacological management of perinatal mood disorders.

Background Racial/ethnic minorities experience a greater burden of mental health problems than white adults in the United States. The collaborative care model is increasingly being adopted to improve access to services and to promote diagnosis and treatment of psychiatric diseases. Objective This systematic review seeks to summarize what is known about collaborative care on depression outcomes for racial/ethnic minorities in the United States. Methods This review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses method. Collaborative care studies were included if they comprised adults from at least one racial/ethnic minority group, were located in primary care clinics in the United States, and had depression outcome measures. Core principles described by the University of Washington Advancing Integrated Mental Health Solutions Center were used to define the components of collaborative care. Results Of 398 titles screened, 169 full-length articles were assessed for eligibility, and 19 studies were included in our review (10 randomized controlled trials, 9 observational). Results show there is potential that collaborative care, with or without cultural/linguistic tailoring, is effective in improving depression for racial/ethnic minorities, including those from low socioeconomic backgrounds. Conclusions Collaborative care should be explored as an intervention for treating depression for racial/ethnic minority patients in primary care. Questions remain as to what elements of cultural adaptation are most helpful, factors behind the difficulty in recruiting minority patients for these studies, and how the inclusion of virtual components changes access to and delivery of care. Future research should also recruit individuals from less studied populations.

BACKGROUND AND OBJECTIVES Postpartum women represent a large population with opioid exposure who also have an increased risk of experiencing mood and anxiety disorders. However, the effect that mood and anxiety disorders have on opioid use postpartum has received little attention in the literature. Therefore, the objective of this study was to examine the association of mood and anxiety disorders with filling opioid prescriptions within the first 3 months postpartum. METHODS A retrospective cohort study (n = 25 279) was completed using claims data for a sample of privately insured women who gave birth in the state of Iowa. The interactive effects of mood and anxiety disorders and delivery mode on filling at least one and two or more opioid prescriptions were examined in logistic regression models. RESULTS The presence of mood and anxiety disorders among women who delivered vaginally increased their odds of filling at least one opioid fill by nearly 50% (odds ratio [OR]: 1.48, 95% confidence interval [CI]: 1.35-1.63) and by 20% (OR: 1.20, 95% CI: 1.00-1.43) among women with cesarean delivery. DISCUSSION AND CONCLUSION Postpartum women with mood and anxiety disorders were more likely to fill opioid prescriptions postpartum compared to women without these conditions. SCIENTIFIC SIGNIFICANCE This study extends prior research by examining the intersection of risk of mood and anxiety disorders and opioid use postpartum. Findings from this study support the need for future research to identify the drivers of increased opioid use among postpartum women with mood and anxiety disorders. (Am J Addict 2020;29:463-470).

Background: Networks for building and developing community systems to support early childhood rely upon volunteer efforts of organization and leadership efforts of coordinators to bring together relevant stakeholders.Aims: The purpose of this study was to explore the perspectives of network coordinators from 10 different communities in the All Our Kids Early Childhood Networks initiative in and across one Midwestern state.Methods: We conducted two focus group interviews with 10 participants who worked as network coordinators in public health district offices. A semi-structured focus group interview guide was used to examine community coordinators’ perceptions related to lessons learned with community systems development efforts around early childhood outcomes. All interviews were audio recorded and transcribed verbatim. Thematic network analysis was used to analyze all focus group data. Results: From interviews with network coordinators, three salient themes emerged: (1) strengths of networks to build systems; (2) challenges for coordinators, such as burnout; and (3) the importance of the networks’ role within the community.Conclusions: The study contributes to the existing literature by identifying success and hindering factors that impact the implementation process to sustain long-term impact. The findings can be useful for other ongoing state-supported community-based programs across the US.

We examined how breastfeeding advice in the context of cannabis use differed by race and ethnicity. Data from the 2017-2018 PRAMS (Pregnancy Risk Assessment Monitoring System) survey were used to assess differences in breastfeeding guidance related to cannabis use among 1,213 individuals who self-reported cannabis use 3 months before or during pregnancy. A multivariable logistic regression model was specified to examine the extent to which the odds of receiving prenatal advice against breastfeeding if using cannabis differed by self-reported race and ethnicity. We found that non-Hispanic Black people were four times more likely than non-Hispanic White people to be advised against breastfeeding if using cannabis (adjusted odds ratio 4.1, 95% CI 2.1-8.2). Pregnant non-Hispanic Black people were disproportionately advised not to breastfeed if using cannabis.

Food insecurity and perinatal depression are significant public health concerns for perinatal services, however descriptive research examining their association is limited. The purpose of this study was to examine the views and perspectives of staff from the Special Supplemental Nutrition Program for Women, Infants and Children (WIC) program on the relationship between food insecurity and perinatal depression among their WIC clients. Four, semi-structured focus groups with WIC staff (n = 24) were conducted across four diverse nonmetropolitan public health districts in Midwestern counties in the United States. WIC staff included social workers, nurses, nutritionists and ancillary staff. All interviews were audio-recorded, transcribed, and verified, and data were organized using NVivo 11.4.2. Thematic networking analysis was employed as the qualitative analysis to identify organizing themes. Three themes emerged including (1) depression experienced by clients; (2) food insecurity experienced by clients; and (3) barriers preventing clients from accessing services for themselves and their children. Research on food insecurity and perinatal depression is sparse, with fewer studies having included health staff of low-income women. Our findings suggest that the association between food insecurity and mental health needs among WIC clients is a significant public health issue to which policy change and interventions are required.

Untreated depression presents a distinct set of risks for pregnancy complications. Past studies have connected antenatal depression with adverse birth outcomes. The purpose of this study was to conduct an updated systematic review and meta-analysis examining the relationship between depression during pregnancy and associated adverse birth outcomes in US populations during the period 2010-20. As a trend, disparities in adverse pregnancy outcomes and maternal morbidities for Black pregnant people compared with those for White pregnant people continue to rise. Addressing mental health conditions during pregnancy has the potential to ameliorate a large and excessive burden on adverse birth outcomes among childbearing people and their offspring. Policy solutions to encourage, mandate, and reimburse universal depression screening during pregnancy are warranted.

Objective: To address health disparities in the perinatal period (i.e., during pregnancy and through one year after birth) by exploring the intersectional experiences of perinatal Black, Indigenous, and other People of Color (BIPOC) women during the COVID-19 pandemic. In this study, participants were asked if and how COVID-19 had impacted their experiences of receiving healthcare, whether they had faced any challenges during this time, how they had navigated these challenges, and what recommendations they had for improving perinatal healthcare. Methods: Between November 2021 and March 2022 our team conducted eight virtual focus groups comprising perinatal BIPOC women. A semi-structured interview protocol was used, and interviews were voice recorded and transcribed verbatim. The data were analyzed using reflexive thematic analysis. Results: Three major themes common in BIPOC perinatal healthcare experiences during COVID-19 were generated through engaging in reflexive thematic analysis: (1) an overwhelming lack of support from providers, (2) experiences of blame and shame, and (3) difficulties navigating institutional policies that were unclear or ever-changing during the COVID-19 pandemic. Recommendations from participants included greater empathic communication from providers in the face of uncertainty during COVID-19, greater access to information and guidance for caring for themselves and their babies, and an overall request for greater compassion while navigating an exciting and busy time. Relevance: These findings have implications for trauma-informed and inclusive perinatal care that can reduce the impacts of systemic inequalities for perinatal BIPOC women. This study offers a discussion of implications for future training for maternal health providers and implications for community-based programs.

Background Evidence suggests that subjective (perceived) social status (SSS) may predict health outcomes more strongly than objective social status, but little is known about the relationship between SSS and cardiovascular health (CVH). This study focuses on this relationship among diverse Hispanic/Latino adults because while poor CVH profiles are prevalent in this population, immigration complicates attempts to measure their social status. Methods and Results We analyzed baseline HCHS/SOL (Hispanic Community Health Study/Study of Latinos) data on 15 374 Hispanic/Latino adults aged 18 to 74 years in 2008 to 2011. SSS was assessed using the McArthur Scale, a 10‐rung “social ladder.” CVH was based on levels of 7 metrics defined by the American Heart Association. Linear and logistic regressions were used to examine cross‐sectional associations of SSS with CVH (overall and single metrics) after adjusting for objective social status, demographic, and health factors. Less than half of the population (46%) had Ideal scores in ≥4 metrics of CVH. In multivariable‐adjusted models, an increase in SSS was associated with a higher overall CVH score (β=0.04; 95% CI, 0.01–0.06) and greater likelihood of Ideal levels of body mass index, physical activity, and fasting blood glucose levels. Nativity and time in the United States modified the association between SSS and Ideal smoking. Conclusions Subjective measures of social status can enhance an understanding of CVH among Hispanic/Latino people. Future studies should explore the stability of SSS over time in comparison with objective social status and the mechanisms through which SSS may influence CVH.

BACKGROUND: The objective of the present study is to evaluate the association of postpartum depression and low maternal confidence in a sample of women who had depression during pregnancy. METHODS: Cross-sectional study performed from 2013 to 2015 with 346 postpartum women who had participated in an intervention to treat their depression during pregnancy. This study used the Maternal Confidence Questionnaire and the Patient Health Questionnaire 9-item scale. The prevalence ratio, adjusted and non-adjusted, and the 95% CI were calculated using Poisson regression with robust variance. Multivariate models estimated the Prevalence Ratios between postpartum depression and low maternal confidence adjusted for socio-demographic variables and maternal characteristics. Statistical analysis was performed with the STATA12. RESULTS: Among a sample of women who were depressed during pregnancy, only 19% had probably moderate to severe depression and nearly half, 48%, reported high maternal confidence in the postpartum period. In the fully adjusted model, women with moderate/severe probable depression showed increased risk of lower maternal confidence in comparison to women without probable depression Prevalence Ratio=1.37 (95% CI 1.10–1.71). CONCLUSIONS: The results reinforce the importance of the evaluation of maternal confidence feelings in primary care particularly for women with more severe forms of depression.

Background Suicidal ideation (SI) during pregnancy is a major maternal health concern, however few examinations report findings on the burden of SI among low-income women. The aim of this study is to estimate the prevalence and correlates of suicidal ideation among a sample of low-income women. Methods A cross-sectional analysis of 736 low-income pregnant women enrolled in a Women Infant and Children supplemental nutrition program and a perinatal depression registry between 2013 and 2015. All participants provided informed consent. SI was captured from Edinburgh Postnatal Depression Scale (EPDS) screens administered during standard clinic visits. Results The prevalence of suicidal ideation was 4.6%. After adjusting for smoking, women with depression were 13 times as likely to report SI. Limitations SI was measured using a single item from the EPDS during pregnancy. Conclusions This study indicates that most, but not all, women with SI reported elevated depressive symptoms.

Disparities in maternal mental health outcomes persist despite the myriad of existing evidence based treatments and recent public health prevention policy efforts. Integrated health care delivery models such as Collaborative Care and patient medical home models have the potential to reduce health disparities in clinic settings. These evidence-based approaches require multidisciplinary teams for successful implementation and to provide quality care to improve specified patient outcomes. However, strategies for successful collaboration and steps for critical reflection are often overlooked in clinical and health services research. Furthermore, a shared vision of social justice is essential in the process of building and sustaining patient-centered care models, but is often understated. The purpose of this paper is to describe the development and implementation of a social justice-informed hospital-based perinatal depression registry to address maternal health disparities. Our partnership is informed by community-based participatory research (CBPR) principles for carrying out health services research. We describe the steps for building a sustainable university-hospital collaboration between traditional and non-traditional researchers using principles from CBPR in a clinic setting.

Maternal health services research yields the potential to improve global health outcomes across countries. Many of the low-cost and effective clinical innovations to improve maternal mental health outcomes are implemented in the Global South. However, there remains a lack of collaboration from the Global South to the Global North. In this qualitative narrative, we use a collaborative autoethnographical approach to describe a doctoral training health services research experience between North America and South America. In this paper, we describe the ways power and privilege manifest in a South American research training program and our particular positionality as North American women of color. We will also describe the role of cultural humility and awareness of colonization as it translates to research training across the North and South. In conclusion, we will share lessons learned in forming skills to establish partnerships and where our maternal health collaboration aims to continue to build mutual collaboration across countries.

Incluye: Correction: Burden of injury along the development spectrum: associations between the Socio-demographic Index and disability-adjusted life year estimates from the Global Burden of Disease Study 2017. Inj Prev. 2020 Oct;26(Supp 1):i164. doi: 10.1136/injuryprev-2019-043296corr1. Epub 2020 Sep 28. PMID: 32989004 Background: The epidemiological transition of non-communicable diseases replacing infectious diseases as the main contributors to disease burden has been well documented in global health literature. Less focus, however, has been given to the relationship between sociodemographic changes and injury. The aim of this study was to examine the association between disability-adjusted life years (DALYs) from injury for 195 countries and territories at different levels along the development spectrum between 1990 and 2017 based on the Global Burden of Disease (GBD) 2017 estimates. Methods: Injury mortality was estimated using the GBD mortality database, corrections for garbage coding and CODEm-the cause of death ensemble modelling tool. Morbidity estimation was based on surveys and inpatient and outpatient data sets for 30 cause-of-injury with 47 nature-of-injury categories each. The Socio-demographic Index (SDI) is a composite indicator that includes lagged income per capita, average educational attainment over age 15 years and total fertility rate. Results: For many causes of injury, age-standardised DALY rates declined with increasing SDI, although road injury, interpersonal violence and self-harm did not follow this pattern. Particularly for self-harm opposing patterns were observed in regions with similar SDI levels. For road injuries, this effect was less pronounced. Conclusions: The overall global pattern is that of declining injury burden with increasing SDI. However, not all injuries follow this pattern, which suggests multiple underlying mechanisms influencing injury DALYs. There is a need for a detailed understanding of these patterns to help to inform national and global efforts to address injury-related health outcomes across the development spectrum. Funding for GBD 2017 was provided by the Bill and Melinda Gates Foundation. Sí

The study examines how family structure and race/ethnicity are jointly associated with the discrepancy of adolescent past-year Major Depressive Episode (MDE) rates and the use of mental health services and psychotropic medications. Results through analyzing data from the National Survey on Drug Use and Health (2009–2016, N = 131,777) show that past-year MDE rates were low for adolescents in two-parent families (9.68%) relative to those in one-parent (11.09%) and non-parent families (12.26%, p

Purpose: Although variations in breastfeeding initiation are well documented, the contributing role of maternal race remains poorly understood, especially among the multiracial—two or more races—population. The purpose of this study is to examine differences in breastfeeding initiation among a racially and ethnically diverse population of low-income women. Methods: Participants for this study (n=1010) were enrolled in the supplemental nutrition program for women, infant, and children and concurrently enrolled in a perinatal depression registry at a public health clinic in the Midwest. Race was obtained from medical records. Breastfeeding initiation was gathered through a clinical interview during the first postpartum visit. Logistic regression was conducted using STATA 14.2. Results: Sixty-eight percent of study participants reported breastfeeding initiation. The bivariate analysis demonstrated that there were significant differences in rates of breastfeeding initiation by race/ethnicity. The logistic regression models showed that after adjusting for maternal education, age, income, nativity, parity, body mass index, and antenatal smoking, Black (odds ratio [OR] 0.47; confidence interval [95% CI] 0.34–0.66), multiracial (OR 0.21; 95% CI 0.07–0.65), and Latina women (OR 0.48; 95% CI 0.26–0.86) were significantly less likely to initiate breastfeeding compared with White women. Conclusion: These findings highlight the need for further understanding of the underlying barriers to the initiation of breastfeeding among low-income Black, multiracial, and Latina women. Moreover, breastfeeding should remain a priority for intervention and policy development, particularly among racially and ethnically diverse low-income women.

OBJECTIVES: Older Hispanic/Latino adults are more likely to be sedentary and display higher rates of depression compared to aged-matched peers of European descent. A critical factor may be that older Hispanic/Latino adults have lower expectations for aging, i.e., they are more likely to attribute age-associated problems such as disability and depression to aging. Thus, we examined the prospective effects of an evidence-based exercise intervention on depressive symptoms in older Hispanics/Latinos and the potential synergistic effects (if any) of an attribution-retraining component to counter negative ascriptions to the aging process. METHOD: We analyzed baseline, 1-, 12-, 24-month data collected from Hispanics/Latinos ≥60 years participating in an exercise intervention (¡Caminemos!) across 27 senior centers (N=572). All participants were given 4 weekly 1-hour group-based exercise classes targeting strength training, endurance, balance and flexibility. In addition, they were randomly assigned to one of two conditions: a) treatment group–a 1-hour attribution retraining session in which participants were taught that aging does not mean one inevitably becomes sedentary, or b) control group–generic health education. The Geriatric Depression Scale was used to assess depressive symptoms. Covariates included age, sex, education, income, marital status, acculturation, and number of chronic conditions. RESULTS: In prospective analyses, participants in both trial arms displayed lower scores for depressive symptoms at the 12- (β(1)=−0.17, p=0.04) and 24-month (β(2)=−0.33, p

OBJECTIVE: The multiracial adult population is one of the fastest growing segments of the U.S. population, yet much remains to be learned about multiracial health. Considerable research finds racial/ethnic disparities in self-rated health, however subgroups within the multiracial population have not been consistently described. DESIGN: We use data from the National Longitudinal Survey of Adolescent Health (Add Health) and multivariate logistic regression analyses to compare self-rated health of multiracial and monoracial young adults (n=7880). RESULTS: Overall, there were no significant differences in poor self-rated health status of multiracial adults as a single group odds ratio 0.84 (95% CI: 0.52–1.36) compared to monoracial White adults. Analyses further revealed important variations in health-status by specific subgroups and show that some multiracial subgroups may not fit existing patterns of health disparities. For instance, Asian-White multiracial adults do not fit documented patterns of health disparities and report better health than monoracial Asian and monoracial White adults. CONCLUSION: This study illustrates that the inclusion of specific multiracial categories provides evidence to enhance understanding of the pathways that are linked to health outcomes and the implications for health disparities.

Objective: Given the lifelong implications of extended postpartum depression (PPD), research is needed to examine the social factors implicated in its development (such as relationship quality) and associated predictors. This study sought to examine the association of partner relationship quality (PRQ) and decline of sexual life (DSL) with maternal PPD at 12-15 months after childbirth. Methods: Prospective study of 294 low-income postpartum women. A structured questionnaire and the Patient Health Questionnaire-9 (PHQ-9) captured responses for the main outcome variable and covariates. Results: The prevalence of the main outcome (PPD at 12-15 months) was 19.1%. Using logistic regression models, low PRQ (risk ratio [RR] = 1.58, 95%CI 1.01-2.49) and DSL (RR = 1.97, 95%CI 1.23-3.15) were associated with PPD at 12-15 months even after controlling for perinatal depression. Conclusions: Late PPD (12 to 15 months after giving birth) is very common among low-income women, and is independently associated with different aspects of the couple’s relationship. Improving PRQ may prevent late PPD. Future investigations are warranted.

Perinatal tobacco smoking remains a public health concern and is associated with smoking related morbidity and mortality. This study aims to report the prevalence and correlates of smoking during pregnancy among low-income women. The study sample comprised 729 pregnant women who were enrolled in a perinatal depression registry in a public health WIC program between 2013 and 2015. Smoking risks were obtained from the clinical USDA Risk Assessment. STATA 14.2 was used for analyses. 15.1% of women reported smoking during pregnancy. Compared to White women, Black women were less likely to smoke odds ratio (OR 0.45 [95% CI 0.25–0.81]). Foreign-born women and women living in non-smoking homes remained at a lower risk for smoking during pregnancy. Smoking during pregnancy is prevalent among low-income women. In addition to prenatal education on smoking cessation, supportive measures to help deliver smoking cessation interventions should be provided to household members.

Background: We evaluated the association between mother–child bonding and maternal depression at 6–8 months after birth with bonding impairment at 12–15 months in a sample of mothers at high risk o...

IMPORTANCE: Suicide deaths are a leading cause of maternal mortality in the US, yet the prevalence and trends in suicidality (suicidal ideation and/or intentional self-harm) among childbearing individuals remain poorly described. OBJECTIVE: To characterize trends in suicidality among childbearing individuals. DESIGN, SETTING, AND PARTICIPANTS: This serial cross-sectional study analyzed data from a medical claims database for a large commercially insured population in the US from January 2006 to December 2017. There were 2714 diagnoses of suicidality 1 year before or after 698 239 deliveries among 595 237 individuals aged 15 to 44 years who were continuously enrolled in a single commercial health insurance plan. Data were analyzed from October 2019 to September 2020. MAIN OUTCOMES AND MEASURES: The primary outcome was diagnosis of suicidality in childbearing individuals 1 year before or after birth based on the identification of relevant International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) and ICD-10-CM diagnosis codes during at least 1 inpatient or 2 outpatient visits. RESULTS: Of 595 237 included childbearing individuals, the mean (SD) age at delivery was 31.9 (6.4) years. A total of 40 568 individuals (6.8%) were Asian, 52 613 (8.6%) were Black, 73 172 (12.1%) were Hispanic, 369 501 (63.1%) were White, and 59 383 (9.5%) had unknown or missing race/ethnicity data. A total of 2683 individuals were diagnosed with suicidality 1 year before or after giving birth for a total of 2714 diagnoses. The prevalence of suicidal ideation increased from 0.1% per 100 individuals in 2006 to 0.5% per 100 individuals in 2017 (difference, 0.4%; SE, 0.03; P

Objective This study aims to identify the prevalence of suicidal ideation (SI) and elevated depressive symptoms (depression) in the immediate postpartum period, defined as the first three days after delivery. Methods This cross-sectional study includes 10,401 women screened for depressive symptoms using the Edinburgh Postnatal Depression Scale immediately after giving birth in a major delivery hospital in Illinois between 2012 and 2016. We used chi-square tests and logistic regression models to compare outcomes across demographic groups in the study. Results Of the women screened, 709 (7.7%) women had elevated depressive symptoms and 240 (2.3%) reported SI immediate postpartum period. We found significantly different rates of depressive symptoms and suicidal ideation across self-reported racial/ethnic groups. For depression, when compared to White women, Black and Asian women reported higher rates elevated depressive symptoms, but these differences were not significant in the adjusted logistic regression model. For SI, after adjustments, Asian women remained 8.98 times as likely and Black women 2.11 times as likely to report SI compared to their White counterparts. Discussion Results suggests that elevated depressive symptoms are common among women after giving birth and recovering in the maternity unit. Thus, the maternity unit may play a critical role in early detection of women, but translation into referral, treatment, and follow-up from inpatient to outpatient settings remains to be determined.

Background: Among Hispanics/Latinos, there is substantial heterogeneity in the prevalence of depressive symptoms and diabetes by background. This study aimed to examine the association between depressive symptoms and incident diabetes among Hispanic/Latino adults of diverse backgrounds. Methods: The Hispanic Community Health Study/Study of Latinos (HCHS/SOL) is a prospective, community-based study of 16,415 self-identified Hispanic/Latino adults aged 18-74 years at Visit 1 (2008-2011) and 10,914 who have also completed the Visit 2 examination by August 2017. This analysis includes 8,804 participants who were free from diabetes at baseline and attended both Visits. Baseline depressive symptoms were assessed using the CES-D 10-item depression scale and divided into quartiles. Incident diabetes was defined by fasting glucose ≥126mg/dL, 2-hour postload glucose 140-199mg/dL, HbA1c ≥6.5%, or self-report. Accounting for HCHS/SOL complex survey design, we used Poisson regression models to estimate diabetes incidence density ratios (Table). Results: Baseline BMI was associated with both depressive symptoms and incident diabetes. Overall, 876 participants developed diabetes. In analyses stratified by Hispanic/Latino background, the association between baseline depressive symptoms and incident diabetes was significant for South Americans, Central Americans, and Mexicans. No significant associations between depressive symptoms and diabetes were seen among Hispanics/Latinos of Dominican, Cuban, or Puerto Rican backgrounds. Conclusions: These findings suggest that the association between depressive symptoms and incident diabetes in Hispanics/Latinos may differ by their background, with South and Central Americans at the highest risk. This difference may be partly explained by variation in participants’ understanding of CES-D questions by Hispanic/Latino background. Future research is needed to understand these novel findings fully and explore their implications for practice and policy.

Although intimate partner violence (IPV) during perinatal period is more common than during other maternal health conditions, it receives less attention within research on maternal mortality rates. Given the risks for maternal mortality because of suicidality, the purpose of this investigation is to examine the risk of suicidal ideation (SI) among postpartum women exposed to IPV.In this cross-sectional study, participants were recruited between May 2005 and March 2007 from primary care clinics in São Paulo, Brazil. A total of 701 postpartum women were included in the analysis. Postpartum SI was assessed using the clinical interview schedule-revised. IPV was assessed using a structured questionnaire previously validated in Brazilian populations. Crude and adjusted risk ratios with 95% confidence intervals (95% CI) were estimated using Poisson regression with robust variance to examine the association between IPV and the risk for postpartum SI.The prevalence of postpartum SI was 4%. Among those with postpartum SI, 70% reported IPV during the postpartum period. Compared with non-IPV counterparts, postpartum women who reported IPV had an increased risk for SI (relative risk [RR] 7.25, 95% CI: 3.23-16.27). In the fully adjusted model, the risk for SI remained significantly higher for women who experienced IPV than for those who did not (RR 3.02, 95% CI: 1.29-7.07).Postpartum women exposed to violence had a threefold greater risk of having suicidal thoughts.

Obtaining accurate assessment data from adolescents in treatment aids clinical decision making and facilitates more accurate outcome evaluations. However, findings could be biased due to underreported substance use and mental health symptoms. This article compares self-reports of youth in non-White matched client-assessor dyads and those in nonmatched dyads. There were no differences on self-reported substance use, but matched youth reported significantly fewer attention deficit/hyperactivity disorder symptoms versus the comparison group. One possible reason for these findings is the effect of in-group stereotype threat. Future studies should examine the potential effect that in-group stereotyping and perceived racism have on the therapeutic relationship.

Addressing disparities in health services utilization remains critical for improving minority health; however, most studies do not report on the health service use of multiracial young adults (age 22-34). This study compares past year health service use of self-identified multiracial (two or more races) young adults with monoracial White young adults. Weighted survey data from Add Health (N = 7296) and multivariate logistic regression analyses were used. Compared to monoracial White young adults, Black-White multiracial [OR 0.40, 95 % CI (0.17-0.90)] and Black-Native American multiracial [OR 0.23, 95 % CI (0.09-0.63)] young adults are less likely to report primary care service use in the past year. Multiracial young adults have different health care service utilization than their White monoracial peers with Black-Native American young adults appearing to be particularly vulnerable to under-utilization of primary care services. It is important to examine multiracial subgroups when studying patterns of health services utilization.

After-school programs function especially well in improving academic and behavioral outcomes for disadvantaged children in general. However, little is known about the effectiveness of after-school programs in improving outcomes among Latino children in particular. Latino children from immigrant families are disadvantaged and vulnerable due to limited English skills and fewer educational resources. We hypothesized that Latino children of immigrant families in after-school programs would have stronger academic performance and fewer behavioral problems than their counterparts who were not in after-school programs. Using the 2005 National Household Education Surveys Program's After-School Programs and Activities survey, we examined whether children in community- or school-based after-school programs (n = 192) presented differences in academic development (i.e., higher grades and fewer schoolwork problems) and behavioral development (i.e., fewer behavioral problems, in-school and out-of-school suspensions) than children who were not enrolled in after-school programs (n = 720). We found that there were no significant differences in academic and behavioral domains between Latino children in after-school programs compared to students not in after-school programs. FINDINGS from this study provide an opportunity to reflect on whether typical after-school programs are appropriate for Latino children from immigrant families. These findings also highlight the need to integrate culturally valid components into the program for areas where a large number of immigrant Latino families reside.

Latinos are the fastest growing minority in the United States (US). Currently, Latinos make up 17.3% of the total US population and 49% are foreign born. After migration to the US, Latinos face a myriad of changes to which they need to adapt quickly. Some of the changes have health consequences, such as changes in feeding practices that have contributed to the high rates of childhood and adult obesity in this population. Although there is substantial research on lifestyle changes among Latinos, little research has been conducted in the Midwest, particularly in new growth communities that have experienced a significant influx of Latino immigrants in recent decades. The purpose of this study was to better understand Latina mothers’ perceptions of how their family feeding practices changed after they migrated to the U.S and how living in a new growth community played a role. A total of 30 semi-structured interviews were conducted with a purposive sample of immigrant mothers from Latin American countries who ...

The Eastern Mediterranean Region (EMR) is witnessing an increase in chronic disorders, including mental illness. With ongoing unrest, this is expected to rise. This is the first study to quantify the burden of mental disorders in the EMR. We used data from the Global Burden of Disease study (GBD) 2013. DALYs (disability-adjusted life years) allow assessment of both premature mortality (years of life lost-YLLs) and nonfatal outcomes (years lived with disability-YLDs). DALYs are computed by adding YLLs and YLDs for each age-sex-country group. In 2013, mental disorders contributed to 5.6% of the total disease burden in the EMR (1894 DALYS/100,000 population): 2519 DALYS/100,000 (2590/100,000 males, 2426/100,000 females) in high-income countries, 1884 DALYS/100,000 (1618/100,000 males, 2157/100,000 females) in middle-income countries, 1607 DALYS/100,000 (1500/100,000 males, 1717/100,000 females) in low-income countries. Females had a greater proportion of burden due to mental disorders than did males of equivalent ages, except for those under 15 years of age. The highest proportion of DALYs occurred in the 25-49 age group, with a peak in the 35-39 years age group (5344 DALYs/100,000). The burden of mental disorders in EMR increased from 1726 DALYs/100,000 in 1990 to 1912 DALYs/100,000 in 2013 (10.8% increase). Within the mental disorders group in EMR, depressive disorders accounted for most DALYs, followed by anxiety disorders. Among EMR countries, Palestine had the largest burden of mental disorders. Nearly all EMR countries had a higher mental disorder burden compared to the global level. Our findings call for EMR ministries of health to increase provision of mental health services and to address the stigma of mental illness. Moreover, our results showing the accelerating burden of mental health are alarming as the region is seeing an increased level of instability. Indeed, mental health problems, if not properly addressed, will lead to an increased burden of diseases in the region.

For adolescents with substance use problems, it is unknown whether the provision of normative feedback is a necessary active ingredient in motivational interviewing (MI). This study investigated the impact of normative feedback on adolescents’ readiness to change and perceptions of MI quality. Adolescents referred for substance use disorder (SUD) assessments were randomized to MI with normative feedback (NF; MI + NF, n = 26) or MI only (MI, n = 22). There were no significant differences between the MI + NF or MI conditions with reference to changes in readiness, and although not significant, there was a decline in readiness for the overall sample. Treatment satisfaction and ratings of MI quality were generally high with no between-group differences. Post hoc analyses revealed a nonsignificant trend where race interacted with treatment condition. Larger replication studies are needed to further study the effects of NF and potential NF by participant characteristic interactions.

Tobacco use during pregnancy is a global health concern. To date the majority of research originates in developed countries, thus we have a need to better understand factors related to maternal health in developing countries. We examine the prevalence and correlates of smoking by ethnicity in a sample of pregnant primary care patients in São Paulo, Brazil.Data were obtained from completed surveys during perinatal care visits in primary care clinics. We examine a sample of 811 pregnant women surveyed during 20-30 weeks of pregnancy. Multiple logistic regression was used to obtain odds ratios (OR) and 95% confidence intervals (95% CI).We found significant ethnic differences in smoking during pregnancy. Compared to White women, Black women were more likely to use tobacco during pregnancy (OR: 1.95; 95% CI: 1.16-3.27). In the fully adjusted model, when accounting for common mental disorders, differences in smoking during pregnancy by ethnicity remained (OR: 1.96; 95% CI: 1.14-3.36).There are ethnic differences in tobacco use during pregnancy. Clinical implications including universal screening for tobacco use during pregnancy and culturally relevant approaches to smoking cessation are suggested.

Background Although depressive disorders are associated with increased health care utilization in the elderly living in high-income countries, few studies have examined this relationship in Latin America. Method The present study is part of the Sao Paulo Ageing and Health Study, a population-based epidemiological study of mental disorders in 2072 low-income adults ≥ 65 years old living in Sao Paulo, Brazil. Depressive disorders defined as major depressive disorder (MDD) and clinically relevant depressive symptoms (CRDS) were assessed with the Geriatric Mental State and the Neuropsychiatric Inventory. We examined the association between depressive disorders/symptoms and health care utilization (outpatient visits, hospital admissions and medication use in the past 3 months) using count models. Results The prevalence of MDD and CRDS was 4.9% and 21.4%, respectively. In the fully adjusted model, older adults with MDD were 36% more likely to have one more outpatient visit (RM: 1.36, 95% CI: 1.11–1.67), while older adults with CRDS were 14% more likely to have one more outpatient visit (RM: 1.14, 95% CI: 1.02–1.28). Elderly individuals with MDD had a prevalence of hospital admissions in the previous 3 months that was twice that of those without depression (PR=2.02, 95% CI: 1.09–3.75). Significant differences were not found for medication use. Conclusion Among low-income older adults living in Brazil, those with MDD are more likely to have a recent hospital admission and outpatient service use than those without depression. Future studies are needed to examine the effectiveness of depression treatments for this population in order to both decrease the burden of illness as well as to minimize health care utilization related to depression.

While there is a growing interest in addressing social determinants of health in clinical settings, there are limited data on the relationship between unstable housing and both obstetric outcomes and health care utilization.The objective of the study was to investigate the relationship between unstable housing, obstetric outcomes, and health care utilization after birth.This was a retrospective cohort study. Data were drawn from a database of liveborn neonates linked to their mothers' hospital discharge records (2007-2012) maintained by the California Office of Statewide Health Planning and Development. The analytic sample included singleton pregnancies with both maternal and infant data available, restricted to births between the gestational age of 20 and 44 weeks, who presented at a hospital that documented at least 1 woman as having unstable housing using the International Classification of Diseases, ninth edition, codes (n = 2,898,035). Infants with chromosomal abnormalities and major birth defects were excluded. Women with unstable housing (lack of housing or inadequate housing) were identified using International Classification of Diseases, ninth edition, codes from clinical records. Outcomes of interest included preterm birth (37 weeks' gestational age), early term birth (37-38 weeks gestational age), preterm labor, preeclampsia, chorioamnionitis, small for gestational age, long birth hospitalization length of stay after delivery (vaginal birth,2 days; cesarean delivery,4 days), emergency department visit within 3 months and 1 year after delivery, and readmission within 3 months and 1 year after delivery. We used exact propensity score matching without replacement to select a reference population to compare with the sample of women with unstable housing using a one-to-one ratio, matching for maternal age, race/ethnicity, parity, prior preterm birth, body mass index, tobacco use during pregnancy, drug/alcohol abuse during pregnancy, hypertension, diabetes, mental health condition during pregnancy, adequacy of prenatal care, education, and type of hospital. Odds of an adverse obstetric outcome were estimated using logistic regression.Of 2794 women with unstable housing identified, 83.0% (n = 2318) had an exact propensity score-matched control. Women with an unstable housing code had higher odds of preterm birth (odds ratio, 1.2, 95% confidence interval, 1.0-1.4, P.05), preterm labor (odds ratio, 1.4, 95% confidence interval, 1.2-1.6, P.001), long length of stay (odds ratio, 1.6, 95% confidence interval, 1.4-1.8, P.001), emergency department visits within 3 months (odds ratio, 2.4, 95% confidence interval, 2.1-2.8, P.001) and 1 year after birth (odds ratio, 2.7, 95% confidence interval, 2.4-3.0, P.001), and readmission within 3 months (odds ratio, 2.7, 95% confidence interval, 2.2-3.4, P.0014) and 1 year after birth (odds ratio, 2.6, 95% confidence interval, 2.2-3.0, P.001).Unstable housing documentation is associated with adverse obstetric outcomes and high health care utilization. Housing and supplemental income for pregnant women should be explored as a potential intervention to prevent preterm birth and prevent increased health care utilization.

Introduction Female sex is a risk factor for heart failure with preserved ejection fraction (HFpEF). Previous literature suggests that some diastolic dysfunction (DD) develops during pregnancy and may persist postdelivery. Our objective was to examine the relationship between parity and cardiac structure and function in a population-based cohort. Methods Participants included 1172 Hispanic/Latina women, aged ≥45 years, enrolled in the Echocardiographic Study of Latinos from four US communities (Bronx, Miami, San Diego and Chicago). Standard echocardiographic techniques were used to measure cardiac volumes, left ventricular mass, systolic and diastolic function. Using sampling weights and survey statistics, multivariable linear and logistic regression models were constructed adjusting for age, body mass index, diabetes or prediabetes, systolic blood pressure, use of antihypertensive medications, smoking, total cholesterol and high-density lipoprotein cholesterol. Results In the target population, 5.0% were nulliparous (no live births) and 10.5% were grand multiparous (≥5 live births). Among the nulliparous women, 46% had DD as compared with 51%–58% of women with 1–4 live births and 81% of women with ≥5 live births (p

Background The collaborative care model has been found to be effective for depression management in various primary care populations; however, no review has synthesized trials tailored to treat women. Objective The purpose of this systematic review is to evaluate the current evidence for collaborative depression care for women. Methodology We searched for English language articles via MEDLINE, CINAHL, PsycINFO, EMBASE, Cochrane Library, and reference lists of key articles. Published English language studies were included if they described collaborative care models that targeted women, regardless of study design. Studies were excluded if components of collaborative care were absent (based on criteria described by the Advancing Integrated Mental Health Solutions Center at the University of Washington), if the focus of the intervention was not women, if the studies were not conducted in primary care or gynecological settings, or if there were no outcome data. Results This review resulted in 7 articles that met the inclusion criteria. Included studies were 6 randomized controlled trials and 1 observational study. Among those, 4 studies focused on pregnant or postpartum women. In general, collaborative care interventions focusing on women were more effective than usual care for the management of depressive disorders in women with 5 of the 6 randomized studies showing positive depression outcomes. Conclusions There is evidence that collaborative care interventions are effective for treating depressed women in nonmental health settings. Future studies should examine differences in implementation of collaborative care in "real world" settings and define modifications needed based on a woman's reproductive life stage.

The purpose of this study was to assess trends in health care utilization among adults with serious psychological distress (SPD) from 2003 to 2014 and compare utilization patterns between adults with and without SPD.The study sample came from the 2003-2014 National Health Interview Survey series. SPD was measured by the six-item Kessler Psychological Distress Scale. Logistic regressions were performed to test the overall trends in health care utilization stratified by SPD status. Postestimation methods were used to obtain predicted changes in the percentages of adults with and without SPD who utilized health care services.Adjusted analyses showed that from 2003 through 2014, the percentage of adults with four or more outpatient office visits per year decreased by .4% each year among adults without SPD and by .5% among adults with SPD. The percentage of adults with a hospital admission each year decreased by .1% among adults without SPD and .3% among adults with SPD. The percentage of adults with two or more emergency department (ED) visits each year decreased by .1% among adults without SPD and increased significantly by .2% among adults with SPD. Supplementary analyses suggested that the increasing trends in ED utilization among adults with SPD had leveled off since 2011.Adults with SPD utilized outpatient, inpatient, and emergency care at higher rates compared with adults without SPD. In particular, utilization of ED visits increased significantly over the past decade among adults with SPD, indicating a widening gap in the adequacy of services for this population.

Background— Physiological adaptations occurring across successive pregnancies may increase the risk of adverse cardiovascular health outcomes in later life. Methods and Results— The association between parity and metabolic syndrome was examined among 7467 Hispanic/Latina women of diverse backgrounds, aged 18 to 74 years, who participated in the Hispanic Community Health Study/Study of Latinos (HCHS/SOL) from 2008 to 2011. Metabolic syndrome components were defined according to American Heart Association/National Heart, Lung, and Blood Institute criteria and included abdominal obesity, elevated triglycerides, low high-density lipoprotein cholesterol, high blood pressure, and elevated fasting glucose. Logistic regression models estimated odds ratios (ORs) adjusting for sociodemographic, behavioral, and reproductive characteristics. At HCHS/SOL baseline, women reported none (21.1%), 1 (19.9%), 2 (25.7%), 3 (18.6%), 4 (8.8%), and ≥5 (5.9%) live births. When compared with women with 1 birth, those with 4 births had the highest odds of abdominal obesity (OR, 2.0; 95% confidence interval, 1.5–2.8) and overall metabolic syndrome (OR, 1.4; 95% confidence interval, 1.0–2.0) and those with ≥5 births had the highest odds of low high-density lipoprotein cholesterol (OR, 1.5; 95% confidence interval, 1.2–2.0) and elevated fasting glucose (OR, 1.6; 95% confidence interval, 1.1–2.4), after adjusting for age, background, education, marital status, income, nativity, smoking, physical activity, menopause, oral contraceptive use, hormone therapy, and field center. Further adjustment for percent body fat attenuated these associations. No associations were observed between parity and elevated triglycerides or high blood pressure. Conclusions— Higher parity is associated with an increased prevalence of selected components of the metabolic syndrome among Hispanic/Latina women in the US. High parity among Hispanics/Latinas with a high prevalence of abdominal obesity suggests high risk for metabolic dysregulation.

The aim of this study was to estimate the prevalence and correlates of suicidal ideation among low-income pregnant women living in Brazil. We performed a cross-sectional analysis of 831 women surveyed during 20 to 30 weeks of pregnancy using the Self-Report Questionnaire-20. The prevalence of suicidal ideation was 6.3%. The factors associated with suicidal ideation were common mental disorders, single partner status, past psychiatric history, and smoking tobacco. All cases of suicidal ideation were associated with common mental disorders.