Low-income and ethnic minority women have been described as at risk for experiencing depression during and around the time of pregnancy, a finding complicated by low levels of mental health service use within this population. This study retrospectively examined data from a community-based perinatal depression project targeting low-income women in which many barriers to care were removed and a range of services could be elected from social work, specialty mental health, primary care, and peer support. The study focused on 206 women who self-referred to the project after community-based screening. In this sample, the mean age was 25.49 years, with 53% of participants identified as women of color, and 76% had income at or below 185% of the poverty level. The characteristics within this sample most strongly associated with service use varied among sectors of care. Women of color and women with elevated psychosocial risk were significantly more likely to use social work home visiting, whereas current depressive symptom level predicted specialty mental health sector treatment but not other sectors of care. Findings from this study compel future research to consider the complex factors influencing women's use of mental health services among multiple sectors of care.
KEY WORDS: community-based research; depression; mental health services; service utilization; women
An estimated 15% or more of all women who become pregnant experience depression (Edwards et al., 2006; Evans, Heron, Francomb, Oke, & Golding, 2001). Reviews of both medical and social-behavioral research in this area have placed a needed emphasis on emerging clinical trends in identification and treatment (that is, American College of Obstetricians and Gynecologists, 2008; Bledsoe & Grote, 2006). However, elevated risk for mental health challenges for pregnant women may also collide with barriers to full use of mental health services and, thus, jeopardize the receipt of accessible, affordable, and culturally congruent care (Alegria et al., 2002; Anderson et al., 2006; Song, Sands, & Wong, 2004).
Currently, there is a gap in knowledge about where and why low-income pregnant and newly parenting women with depression choose to seek mental health services when services are made available to them across sectors of care. The present study begins to address this gap by examining demographics, current symptoms, and psychosocial risk factors and their influence on service use patterns within one specific community program serving low-income, rural women during and around the time of pregnancy. This study supports Abrams and Curran's (2007) assertion that social work's research agenda for perinatal and maternal depression must be positioned to highlight the experiences of diverse groups of women within a biopsychosocial context.
DOMAINS OF RISK FOR DEPRESSION
A substantive body of literature illustrates demographic risk factors for perinatal and maternal depression. Elevated rates of depressive symptoms, for example, have been detected early in the postpartum period for African American and Latina women (Howell, Mora, Horowitz, & Leventhal, 2005), as have both-prevalence and continuity of elevated symptoms for African American mothers through 18 months postpartum (Beeghly et al., 2003). In addition, low socioeconomic status reportedly increases the risk for ethnic minority women (Beeghly et al., 2003; Miranda et al., 2003; Rosen, Tolman, & Warner, 2004).
Life stressors and psychosocial challenges also contribute to increased risk for depression. In a recent meta-analysis, depression or anxiety during pregnancy, prior mental health history, stressful life events, and lack of adequate social support were identified as moderate to strong predictors of elevated risk for postpartum depression (Robertson, Grace, Wallington, & Stewart, 2004). Several specific forms of stress have been identified as potentially affecting the emotional well-being of women during and around pregnancy, including perinatal loss (Price, 2008), family violence and abuse (Martin et al. …