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Boama-Nyarko E, Flahive J, Zimmermann M, Allison JJ, Person S, Moore Simas TA, Byatt N. Examining racial/ethnic inequities in treatment participation among perinatal individuals with depression. Gen Hosp Psychiatry 2024; 88:23-29. [PMID: 38452405 DOI: 10.1016/j.genhosppsych.2024.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 02/13/2024] [Accepted: 02/13/2024] [Indexed: 03/09/2024]
Abstract
OBJECTIVE A cluster randomized controlled trial (RCT) of two interventions for addressing perinatal depression treatment in obstetric settings was conducted. This secondary analysis compared treatment referral and participation among Minoritized perinatal individuals compared to their non-Hispanic white counterparts. METHODS Among perinatal individuals with depression symptoms, we examined rates of treatment 1) referral (i.e., offered medications or referred to mental health clinician), 2) initiation (i.e., attended ≥1 mental health visit or reported prescribed antidepressant medication), and 3) sustainment (i.e., attended >1 mental health visit per study month or prescribed antidepressant medication at time of study interviews). We compared non-Hispanic white (NHW) (n = 149) vs. Minoritized perinatal individuals (Black, Asian, Hispanic/Latina, Pacific Islander, Native American, Multiracial, and white Hispanic/Latina n = 157). We calculated adjusted odds ratios (aOR) for each outcome. RESULTS Minoritized perinatal individuals across both interventions had significantly lower odds of treatment referral (aOR = 0.48;95% CI = 0.27-0.88) than their NHW counterparts. There were no statistically significant differences in the odds of treatment initiation (aOR = 0.64 95% CI:0.36-1.2) or sustainment (aOR = 0.54;95% CI = 0.28-1.1) by race/ethnicity. CONCLUSIONS Perinatal mental healthcare inequities are associated with disparities in treatment referrals. Interventions focusing on referral disparities across race and ethnicity are needed.
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Affiliation(s)
- Esther Boama-Nyarko
- Department of Psychiatry, University of Massachusetts Chan Medical School, 55 Lake Avenue, Worcester, MA 01655, United States of America; Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, 55 Lake Avenue, Worcester, MA 01655, United States of America.
| | - Julie Flahive
- Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, 55 Lake Avenue, Worcester, MA 01655, United States of America.
| | - Martha Zimmermann
- Department of Psychiatry, University of Massachusetts Chan Medical School, 55 Lake Avenue, Worcester, MA 01655, United States of America.
| | - Jeroan J Allison
- Department of Psychiatry, University of Massachusetts Chan Medical School, 55 Lake Avenue, Worcester, MA 01655, United States of America.
| | - Sharina Person
- Department of Psychiatry, University of Massachusetts Chan Medical School, 55 Lake Avenue, Worcester, MA 01655, United States of America.
| | - Tiffany A Moore Simas
- Department of Psychiatry, University of Massachusetts Chan Medical School, 55 Lake Avenue, Worcester, MA 01655, United States of America; Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, 55 Lake Avenue, Worcester, MA 01655, United States of America; Department of Obstetrics & Gynecology, University of Massachusetts Chan Medical School, 55 Lake Avenue, Worcester, MA 01655, United States of America; Department of Pediatrics, University of Massachusetts Chan Medical School, 55 Lake Avenue, Worcester, MA 01655, United States of America; Department of Obstetrics & Gynecology, UMass Memorial Health Care, Worcester, MA 01655, United States of America.
| | - Nancy Byatt
- Department of Psychiatry, University of Massachusetts Chan Medical School, 55 Lake Avenue, Worcester, MA 01655, United States of America; Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, 55 Lake Avenue, Worcester, MA 01655, United States of America; Department of Obstetrics & Gynecology, University of Massachusetts Chan Medical School, 55 Lake Avenue, Worcester, MA 01655, United States of America; Department of Psychiatry, UMass Memorial Health Care, Worcester, MA 01655, United States of America.
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Baumgartel K, Saint Fleur A, Prescott S, Fanfan D, Elliott A, Yoo JY, Koerner R, Harringon M, Dutra SO, Duffy A, Ji M, Groer MW. Social Determinants of Health Among Pregnant Hispanic Women and Associated Psychological Outcomes. J Racial Ethn Health Disparities 2023:10.1007/s40615-023-01852-7. [PMID: 37973772 PMCID: PMC11186463 DOI: 10.1007/s40615-023-01852-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 10/17/2023] [Accepted: 10/24/2023] [Indexed: 11/19/2023]
Abstract
BACKGROUND There has been a concerning surge in maternal mortality among Hispanic women in recent years. Compromised mental health is present in nearly half of all maternal deaths, and risk factors include poor social support and depression. OBJECTIVE Among Hispanic women who were born in the USA versus those not born in the USA, we sought to describe and compare social determinants of health and maternal psychological outcomes. METHODS Hispanic pregnant women (n = 579) were recruited from two clinics in Tampa, FL, and completed various questionnaires related to social determinants of health, depression, stress, and social support. STATISTICAL ANALYSIS Descriptive statistics, t-tests, and chi-square analyses were used to compare relationships between maternal nativity and subsequent psychosocial outcomes. Pearson correlations were used to explore associations between variables. RESULTS Hispanic pregnant women who were not born in the USA had lower incomes (χ2 = 5.68, p = 0.018, df = 1), were more likely to be unemployed (χ2 = 8.12, p = 0.004, df = 1), and were more likely to be married (χ2 = 4.79, p = 0.029, df = 1) when compared with those born in the USA. Those not born in the USA reported lower social support (t = 3.92, p<0.001), specifically the tangible (t = 4.18, p < 0.001) and emotional support subscales (t = 4.4, p<0.001). When compared with those born in the USA, foreign-born Hispanic women reported less stress (t = 3.23, p = 0.001) and depression (t = 3.3, p = 0.002). CONCLUSION Pregnant Hispanic women not born in the USA are at increased risk for suboptimal social determinants of health, including less social support. US-born women were more stressed and depressed and had higher BMIs.
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Affiliation(s)
- Kelley Baumgartel
- University of South Florida College of Nursing, 12912 USF Health Dr, Tampa, FL, 33612, USA.
| | - Angeline Saint Fleur
- University of South Florida College of Nursing, 12912 USF Health Dr, Tampa, FL, 33612, USA
| | - Stephanie Prescott
- University of South Florida College of Nursing, 12912 USF Health Dr, Tampa, FL, 33612, USA
| | - Dany Fanfan
- University of Florida College of Nursing, 1225 Center Drive, Gainesville, FL, 32619, USA
| | - Amanda Elliott
- University of Florida College of Medicine Psychiatry and Behavioral Neurosciences, 3515 Ave Tampa, Fletcher, FL, 33613, USA
| | - Ji Youn Yoo
- University of Tennessee Knoxville College of Nursing, 1412 Circle Dr, Knoxville, TN, 37996, USA
| | - Rebecca Koerner
- University of South Florida College of Nursing, 12912 USF Health Dr, Tampa, FL, 33612, USA
| | - Monalisa Harringon
- University of South Florida College of Nursing, 12912 USF Health Dr, Tampa, FL, 33612, USA
| | - Samia Ozorio Dutra
- University of Hawaii at Manoa Nancy Atmospera-Walch School of Nursing, 2528 McCarthy Mall, Webster Hall 440, Honolulu, HI, 96822, USA
| | - Allyson Duffy
- University of South Florida College of Nursing, 12912 USF Health Dr, Tampa, FL, 33612, USA
| | - Ming Ji
- University of New Mexico Health Sciences, 2500 Marble Ave NE, Albuquerque, NM, 87106, USA
| | - Maureen W Groer
- University of Tennessee Knoxville College of Nursing, 1412 Circle Dr, Knoxville, TN, 37996, USA
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The global burden of perinatal common mental health disorders and substance use among migrant women: a systematic review and meta-analysis. Lancet Public Health 2023; 8:e203-e216. [PMID: 36841561 DOI: 10.1016/s2468-2667(22)00342-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 12/16/2022] [Accepted: 12/20/2022] [Indexed: 02/25/2023]
Abstract
BACKGROUND There are one billion migrants globally, of whom 82 million are forced migrants. Pregnant migrants face pre-migration stressors such as conflict, transit stressors including poverty, and post-migration stressors including navigating the immigration system; these stressors can make them vulnerable to mental illness. We aimed to assess the global prevalence of and risk factors for perinatal mental health disorders or substance use among women who are migrants. METHODS In this systematic review and meta-analysis, we searched OVID MEDLINE, Embase, PsycINFO, CENTRAL, Global Health, Scopus, and Web of Science for studies published from database inception until July 8, 2022. Cohort, cross-sectional, and interventional studies with prevalence data for any mental illness in pregnancy or the postnatal period (ie, up to a year after delivery) or substance use in pregnancy were included. The primary outcome was the prevalence of perinatal common mental health disorders among women who are migrants, globally. Data for study quality and risk factors were also extracted. A random-effects meta-analysis was used to calculate pooled prevalence estimates, when appropriate. Sensitivity analyses were conducted according to study quality, sample representativeness, and method of outcome assessment. Risk factor data were synthesised narratively. This study is registered with PROSPERO, CRD42021226291. FINDINGS 18 650 studies were retrieved, of which 135 studies comprising data from 621 995 participants met the inclusion criteria. 123 (91%) of 135 studies were conducted in high-income host countries. Five (4%) of 135 studies were interventional, 40 (30%) were cohort, and 90 (66%) were cross-sectional. The most common regions of origin of participants were South America, the Middle East, and north Africa. Only 26 studies presented disaggregated data for forced migrants or economic migrants. The pooled prevalence of perinatal depressive disorders was 24·2% (range 0·5-95·5%; I2 98·8%; τ2 0·01) among all women who are migrants, 32·5% (1·5-81·6; 98·7%; 0·01) among forced migrants, and 13·7% (4·7-35·1; 91·5%; 0·01) among economic migrants (p<0·001). The pooled prevalence of perinatal anxiety disorders was 19·6% (range 1·2-53·1; I2 96·8%; τ2 0·01) among all migrants. The pooled prevalence of perinatal post-traumatic stress disorder (PTSD) among all migrant women was 8·9% (range 3·2-33·3; I2 97·4%; τ2 0·18). The pooled prevalence of perinatal PTSD among forced migrants was 17·1% (range 6·5-44·3; I2 96·6%; τ2 0·32). Key risk factors for perinatal depression were being a recently arrived immigrant (ie, approximately within the past year), having poor social support, and having a poor relationship with one's partner. INTERPRETATION One in four women who are migrants and who are pregnant or post partum experience perinatal depression, one in five perinatal anxiety, and one in 11 perinatal PTSD. The burden of perinatal mental illness appears higher among women who are forced migrants compared with women who are economic migrants. To our knowledge, we have provided the first pooled estimate of perinatal depression and PTSD among women who are forced migrants. Interpreting the prevalence estimate should be observed with caution due to the very wide range found within the included studies. Additionally, 66% of studies were cross-sectional representing low quality evidence. These findings highlight the need for community-based routine perinatal mental health screening for migrant communities, and access to interventions that are culturally sensitive, particularly for forced migrants who might experience a higher burden of disease than economic migrants. FUNDING UK National Institute for Health Research (NIHR); March of Dimes European Preterm Birth Research Centre, Imperial College; Imperial College NIHR Biomedical Research Centre; and Nuffield Department of Population Health, University of Oxford.
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Ifatunji MA, Faustin Y, Lee W, Wallace D. Black Nativity and Health Disparities: A Research Paradigm for Understanding the Social Determinants of Health. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:9166. [PMID: 35954520 PMCID: PMC9367942 DOI: 10.3390/ijerph19159166] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 07/07/2022] [Accepted: 07/13/2022] [Indexed: 11/16/2022]
Abstract
After more than a century of research and debate, the scientific community has yet to reach agreement on the principal causes of racialized disparities in population health. This debate currently centers on the degree to which "race residuals" are a result of unobserved differences in the social context or unobserved differences in population characteristics. The comparative study of native and foreign-born Black populations represents a quasi-experimental design where race is "held constant". Such studies present a unique opportunity to improve our understanding of the social determinants of population health disparities. Since native and foreign-born Black populations occupy different sociocultural locations, and since populations with greater African ancestry have greater genetic diversity, comparative studies of these populations will advance our understanding of the complex relationship between sociocultural context, population characteristics and health outcomes. Therefore, we offer a conceptual framing for the comparative study of native and foreign-born Blacks along with a review of 208 studies that compare the mental and physical health of these populations. Although there is some complexity, especially with respect to mental health, the overall pattern is that foreign-born Blacks have better health outcomes than native-born Blacks. After reviewing these studies, we conclude with suggestions for future studies in this promising area of social and medical research.
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Affiliation(s)
- Mosi Adesina Ifatunji
- Departments of African American Studies and Sociology, College of Letters and Science, University of Wisconsin at Madison, Madison, WI 53706, USA
| | - Yanica Faustin
- Department of Public Health Studies, College of Arts and Sciences, Elon University, Elon, NC 27244, USA;
| | - Wendy Lee
- Department of Sociology, College of Letters and Science, University of Wisconsin at Madison, Madison, WI 54706, USA;
| | - Deshira Wallace
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA;
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