Sandraluz Lara-Cinisomo|Crystal T. Clark|Jonathan Wood
Increasing Diagnosis and Treatment of Perinatal Depression in Latinas and African American Women: Addressing Stigma Is Not Enough
University of Illinois Urbana-Champaign|Northwestern University|University College London
perinatal depression pnd major depressive episode pregnancy first postpartum year american psychiatric association 2013american psychiatric associationdiagnostic statistical manual mental disorders dsm5 american psychiatric publishing arlington va2013crossref google scholar gavin et al 2005gavin ni gaynes bn lohr kn meltzerbrody gartlehner g swinson perinatal depression systematic review prevalence incidenceobstetrics gynecology 2005 106 10711083crossref pubmed scopus 1905 google scholar estimated occur 12 19 general us population gavin et al 2005gavin ni gaynes bn lohr kn meltzerbrody gartlehner g swinson perinatal depression systematic review prevalence incidenceobstetrics gynecology 2005 106 10711083crossref pubmed scopus 1905 google scholar ohara mccabe 2013ohara mw mccabe je postpartum depression current status future directionsannual review clinical psychology 2013 9 379407crossref pubmed scopus 732 google scholar however rates pnd substantially higher among immigrant usborn latinas living united states 11 50 kuo et al 2004kuo wh wilson te holman fuentesafflick e osullivan mj minkoff h depressive symptoms immediate postpartum period among hispanic women three us citiesjournal immigrant health 2004 6 145153crossref pubmed scopus 68 google scholar lara et al 2009lara le hn letechipia g hochhausen l prenatal depression latinas us mexicomaternal child health journal 2009 13 567576crossref pubmed scopus 53 google scholar latinas important group high fertility rates passel et al 2013passel js livingston g dvera c explaining minority births outnumber white birthswwwpewsocialtrendsorg20120517explainingwhyminoritybirthsnowoutnumberwhitebirthsdate 2013google scholar high psychosocial risk factors high rates poverty laracinisomo et al 2016laracinisomo girdler ss grewen k meltzerbrody biopsychosocial conceptual framework postpartum depression risk immigrant usborn latina mothers united stateswomens health issues 2016 26 336343abstract full text full text pdf pubmed scopus 21 google scholar another vulnerable group african american women whose estimates pnd range 7 28 beeghly et al 2003beeghly olson kl weinberg mk pierre sc downey n tronick ez prevalence stability sociodemographic correlates depressive symptoms black mothers first 18 months postpartummaternal child health journal 2003 7 157168crossref pubmed scopus 114 google scholar melville et al 2010melville jl gavin guo fan katon wj depressive disorders pregnancy prevalence risk factors large urban sampleobstetrics gynecology 2010 116 1064crossref pubmed scopus 188 google scholar richedwards et al 2006richedwards jw kleinman k abrams harlow bl mclaughlin tj joffe h gillman mw sociodemographic predictors antenatal postpartum depressive symptoms among women medical group practicejournal epidemiology community health 2006 60 221227crossref pubmed scopus 393 google scholar much like latinas african american women experience increased rates economic hardship psychosocial stressors increase risk pnd ohara mccabe 2013ohara mw mccabe je postpartum depression current status future directionsannual review clinical psychology 2013 9 379407crossref pubmed scopus 732 google scholar given complex psychosocial risk factors among groups increased efforts diagnose treat latinas african american women needed despite number reliable screening tools national efforts increasing detection pnd siu et al 2016siu al bibbinsdomingo k grossman dc baumann lc davidson kw ebell kemper ar et alscreening depression adults us preventive services task force recommendation statementjama 2016 315 380387crossref pubmed scopus 681 google scholar rates diagnosis treatment continue low among latinas african american women das et al 2006das ak olfson mccurtis hl weissman mm depression african americans breaking barriers detection treatment communitybased studies tend ignore highrisk groups african americansjournal family practice 2006 55 3040pubmed google scholar geier et al 2015geier ml hills n gonzales tum k finley pr detection treatment rates perinatal depression state medicaid populationcns spectrums 2015 20 1119crossref pubmed scopus 30 google scholar laracinisomo et al 2009laracinisomo griffin ba daugherty l disparities detection treatment history among mothers major depression los angeleswomens health issues 2009 19 232242abstract full text full text pdf pubmed scopus 21 google scholar stigma limited access psychoeducation pnd might help explain disparities although factors explored individually examined simultaneously limiting understanding effect wellunderstood stigma negatively impacts treatmentseeking behaviors latinas african american women nadeem et al 2007nadeem e lange jm edge fongwa belin miranda j stigma keep poor young immigrant usborn black latina women seeking mental health carepsychiatric services 2007 58 15471554crossref pubmed scopus 168 google scholar many pregnant women mental health concerns fear perceived crazy worry losing child disclose depressive symptoms health care professionals nadeem et al 2007nadeem e lange jm edge fongwa belin miranda j stigma keep poor young immigrant usborn black latina women seeking mental health carepsychiatric services 2007 58 15471554crossref pubmed scopus 168 google scholar fear losing child exacerbated poverty immigration status chaudron et al 2005chaudron lh kitzman hj peifer kl morrow perez lm newman mc selfrecognition provider response maternal depressive symptoms lowincome hispanic womenjournal womens health 2002 2005 14 331338crossref pubmed scopus 35 google scholar among latinas concerns stigma might complicated practice marianismo notion mother must put children family first sacrifice wellbeing family shown limit treatmentseeking behaviors callister et al 2011callister lc beckstrand rl corbett c postpartum depression helpseeking behaviors immigrant hispanic womenjournal obstetric gynecologic neonatal nursing 2011 40 440449abstract full text full text pdf pubmed scopus 54 google scholar sirulnik et al 2014sirulnik l laracinisomo wisner kl meltzerbrody culture treating latinas postpartum depression two case reportsin perinatal depression among spanishspeaking latin american women springer new york2014 111122crossref scopus 3 google scholar however giving mother attitude belief less explored examined context diagnosis treatment among african american women evidence suggest need tough strong black woman discourages treatmentseeking behaviors amankwaa 2003amankwaa lc postpartum depression among africanamerican womenissues mental health nursing 2003 24 297316crossref pubmed scopus 78 google scholar outside postpartum period amankwaa 2003amankwaa lc postpartum depression among africanamerican womenissues mental health nursing 2003 24 297316crossref pubmed scopus 78 google scholar reflects cultural beliefs depression preventable resolvable strength religious faith nicolaidis et al 2010nicolaidis c timmons v thomas mj waters wahab mejia mitchell sr dont go tell white people nothing african american womens perspectives influence violence race depression depression careamerican journal public health 2010 100 14701476crossref pubmed scopus 89 google scholar understanding notion strong womanmother provide insight approaches increase diagnosis treatment aspects stigma reduce diagnosis treatment differences description depressive symptoms evidence suggest latinas african american women likely report somatic symptoms eg head stomach pain mood symptoms eg sadness likely culturally acceptable lewisfernandez et al 2005lewisfernandez r das ak alfonso c weissman mm olfson depression us hispanics diagnostic management considerations family practicejournal american board family practice 2005 18 282296crossref pubmed scopus 171 google scholar nadeem et al 2009nadeem e lange jm miranda j perceived need care among lowincome immigrant usborn black latina women depressionjournal womens health 2009 18 369375crossref pubmed scopus 52 google scholar fears stigma among latinas african american mothers complicated negative perceptions mental health professionals psychotherapy well belief medication effective treatment depression interian et al 2007interian martinez ie guarnaccia pj vega wa escobar ji qualitative analysis perception stigma among latinos receiving antidepressantspsychiatric services 2007 58 15911594crossref pubmed scopus 79 google scholar laracinisomo et al 2014laracinisomo wisner kl burns rm chavesgnecco perinatal depression treatment preferences among latina mothersqualitative health research 2014 24 232crossref pubmed scopus 17 google scholar leis et al 2011leis ja mendelson perry df tandon sd perceptions mental health services among lowincome perinatal africanamerican womenwomens health issues 2011 21 314319abstract full text full text pdf pubmed scopus 20 google scholar nadeem et al 2008nadeem e lange jm miranda j mental health care preferences among lowincome minority womenarchives womens mental health 2008 11 93crossref pubmed scopus 63 google scholar recommended treatment pnd psychotherapy andor pharmacotherapy choice obtain treatment based discussion patient health care provider patients diagnosis eg major depression also critical determining optimal treatment plan increase diagnosis treatment providers levels must build patient trust important factor womens helpseeking behaviors omahony et al 2012omahony jm donnelly tt bouchal sr este barriers facilitators social supports immigrant refugee women coping postpartum depressionadvances nursing science 2012 35 e42e56crossref pubmed scopus 29 google scholar health care professionals increase patient trust providing psychoeducation pnd includes describing symptoms normalizing condition sharing statistics high prevalence pnd informing patients treatable reminding women pnd fault treated also reduce shame stigma especially given increased risk latinas african american women blame diagnosed minimize effects stigma recommended practitioners aware cultural differences ask mood symptoms patients might initially disclose additionally practitioners health educators increase womens health literacy pnd numerous strategies developed reduce mental health stigma increase education pnd namely contact education rsch et al 2005rsch n angermeyer mc corrigan pw mental illness stigma concepts consequences initiatives reduce stigmaeuropean psychiatry 2005 20 529539abstract full text full text pdf pubmed scopus 750 google scholar although public campaigns designed increase contact provide trusting interaction women seek therefore psychoeducation trusted health care professional effective reducing stigma increasing diagnosis promoting use effective treatments factors consider provide education delivered provided health care settings public health agencies serve highrisk women eg low income marginalized ideal given pnd occur point perinatal period health care providers opportunity inform act practitioners frequent contact perinatal women eg obstetricians family physicians nurse practitioners midwives especially wellpositioned educate women pnd example qualitative study latinas nurses identified practitioners trusted deliver brief targeted information women level contact patients laracinisomo et al 2014laracinisomo wisner kl burns rm chavesgnecco perinatal depression treatment preferences among latina mothersqualitative health research 2014 24 232crossref pubmed scopus 17 google scholar ensure success psychoeducation programs designed increase screening treatment pnd latinas african american women obstetricians gynecologists family medicine providers physician assistants nurses well mental health providers must trained equipped provide necessary referrals resources patient education also delivered active manner eg via conversation versus handing brochure recommended information provided delivery pnd education seems effective particularly among depressed women clatworthy 2012clatworthy j effectiveness antenatal interventions prevent postnatal depression highrisk womenjournal affective disorders 2012 137 2534abstract full text full text pdf pubmed scopus 46 google scholar antenatal education must emphasized given priority mothers give infant wellness checks health visits however infant wellness checks also prime opportunities providers reinforce introduce key information pnd frequency psychoeducation matters one survey postpartum women found psychoeducation pnd passive patients recommended information provided points contact garg et al 2005garg morton heneghan hospital survey postpartum depression education time deliveryjournal obstetric gynecologic neonatal nursing 2005 34 587594abstract full text full text pdf pubmed scopus 14 google scholar although perinatal psychoeducation initiatives delivered nurses shown effective reducing risk pnd ngai et al 2009ngai fw chan swc ip wy effects childbirth psychoeducation program learned resourcefulness maternal role competence perinatal depression quasiexperimentinternational journal nursing studies 2009 46 12981306abstract full text full text pdf pubmed scopus 60 google scholar studies found nurses frontline staff necessary sources guide women requested additional information horowitz goodman 2005horowitz ja goodman jh identifying treating postpartum depressionjournal obstetric gynecologic neonatal nursing 2005 34 264273abstract full text full text pdf pubmed scopus 69 google scholar therefore health care providers treat perinatal women must equipped tools allow provide women necessary resources information need effectiveness various interventions treatments cost privacy providing latinas african american women accurate information directing useful resources also positively impact treatment adherence websites mothertobabyorg womensmentalhealthorg use accessible supportive language provide information symptoms treatment options pnd major barrier adhering pharmacotherapy many latinas african american women limited information safety efficacy psychotropic medications leis et al 2011leis ja mendelson perry df tandon sd perceptions mental health services among lowincome perinatal africanamerican womenwomens health issues 2011 21 314319abstract full text full text pdf pubmed scopus 20 google scholar thus consistent clear concise information side effects effectiveness safety medications mother baby well time commitments involved psychotherapyinterventions benefits treatments needed english spanish mothers discern preferred treatment approach related providers trained objective conversations patients regarding risks benefits medications antidepressants efficacy psychotherapy avoid bias toward particular treatment similarly information various forms treatments interventions available effectiveness number required target sessions level privacy counter bias stigma among latinas african american women trusted educated health care provider deliver information time referral risk depression expected woman expresses interest providing treatment options affordable culturally appropriate equally important given evidence latinas african american women experience remission treatment takes account cultural linguistic needs tandon et al 2014tandon sd leis ja mendelson perry df kemp k sixmonth outcomes randomized controlled trial prevent perinatal depression lowincome home visiting clientsmaternal child health journal 2014 18 873881crossref pubmed scopus 53 google scholar optimize treatment engagement adherence servicesprograms must sensitive cultural beliefs systemic barriers must addressed example many african american women believe personally responsible healing oneself mental health problems resolve might reduce use mental health services adherence recommended treatments anglin et al 2008anglin dm alberti pm link bg phelan jc racial differences beliefs effectiveness necessity mental health treatmentamerican journal community psychology 2008 42 1724crossref pubmed scopus 71 google scholar healthseeking behaviors complicated religious beliefs although religious faith associated positive mental health guinn vincent 2002guinn b vincent v health intervention latina spiritual wellbeing constructs evaluationhispanic journal behavioral sciences 2002 24 379391crossref scopus 8 google scholar koenig 2009koenig hg research religion spirituality mental health reviewcanadian journal psychiatry 2009 54 283291crossref pubmed scopus 634 google scholar mann et al 2008mann jr mckeown bacon j vesselinov r bush f antenatal religious spiritual factors impact risk postpartum depressive symptomsjournal womens health 2008 17 745755crossref pubmed scopus 30 google scholar also associated poorer outcomes less helpseeking behaviors mann et al 2010mann jr mannan j quiones la palmer aa torres religion spirituality social support perceived stress pregnant postpartum hispanic womenjournal obstetric gynecologic neonatal nursing 2010 39 645657abstract full text full text pdf pubmed scopus 41 google scholar example evidence suggest african americans spiritual religious less likely seek mental health treatment colbert et al 2009colbert lk jefferson jl gallo r davis r study religiosity psychological wellbeing among african americans implications counseling psychotherapeutic processesjournal religion health 2009 48 278289crossref pubmed scopus 8 google scholar latinas religious beliefs might associated selfblame depression belief punished previous wrongdoing sirulnik et al 2014sirulnik l laracinisomo wisner kl meltzerbrody culture treating latinas postpartum depression two case reportsin perinatal depression among spanishspeaking latin american women springer new york2014 111122crossref scopus 3 google scholar although area requires investigation given need psychoeducation training key health care providers call action policymakers recommend direct funds build capacity among health care providers via training described herein increase diagnosis urge policymakers invest training providers use reliable screening tools perinatal women shortage mental health providers skilled caring perinatal women underserved areas must improved increase appropriate diagnosis treatment adherence additionally federal state local funding directed building capacity providing funding education training perinatal health professionals levels also recommend development culturally linguistically appropriate resources better inform women treatment options strategies include early frequent psychoeducation primary care settings perinatal latinas african american women likely increase diagnosis finally access culturally acceptable evidencedbased treatments important treatment adherence therefore federal funding allocated development assessment interventions download xml 0 mb help xml files data profile sandraluz laracinisomo edm phd assistant professor university illinois urbanachampaign research focuses mental health disparities racially ethnically diverse women military populations studying neural substrates pain processing postpartum depression crystal clark md msc assistant professor psychiatry behavioral sciences obstetrics gynecology northwestern university feinberg school medicine focuses mood anxiety disorders across reproductive lifecycle research focuses dosing lamotrigine lithium pregnancy jayme wood ms completed bachelor science biology university north carolina chapel hill master science bioarcheology forensic anthropology university college london pursuing medical degree