A study by the University of Iowa published in the journal Social Psychiatry and Psychiatric Epidemiology reports that low-income women in Iowa are much more likely to suffer from postpartum depression than wealthier women.

University of Iowa psychologist Lisa Segre and colleagues studied 4,332 new mothers from four Iowa counties. The researchers collected sociodemographic data and the participants completed the Inventory to Diagnose Depression in the late 1990s. The mothers had given birth an average of 4.6 months before the survey.

Main findings include:
  • 40 percent of Iowa mothers with a household income less than $20,000 suffered from clinically significant postpartum depression
  • 13 percent of new mothers with a household income of $80,000 or more were clinically depressed.
Segre points out that, "forty percent of Iowa's lowest-income mothers are facing the double burden of being depressed and being poor."

"Women who are poor already have a lot of stress, ranging from poor living conditions to concerns about paying the bills. The birth of an infant can represent additional financial and emotional stress, and depression negatively impacts the woman's ability to cope with these already difficult circumstances."

Segre and colleagues also studied the link between post-natal depression and race among Iowans. She found that compared to white mothers, African-American mothers are more likely to experience depression after having a baby. However, Latina mothers are not as likely to experience depressed moods.

For the study on race, researchers used data from the Iowa Barriers to Prenatal Care Project Survey, which mothers take while they are in the maternity wards of hospitals in Iowa. Mothers are asked if they felt sad or miserable during the prior two weeks. In 2001-02, 26,877 English-speaking mothers completed the survey, and the results were published in the Journal of Reproductive and Infant Psychology.

Segre writes: "Other research indicates that strong social support can serve as a buffer against postpartum depression, and that poor social support is a major predictor of postpartum depression. Past studies have also shown that Latina mothers tend to have more social support, while African-American women tend to have weaker support networks." The author believes that racial differences in the rate of post-natal depressed moods might be due to these ethnic differences in social support.

The results of both of Segre's studies suggest that low-income and African-American women have an increased risk of post-natal depression, early identification programs are needed. Segre and co-author Michael O'Hara, a co-author of the studies beginning work to help mothers suffering from postpartum depression.

Segre and colleagues believe that screening for postpartum depression is a first step. They have joined with Healthy Start in Des Moines - a program funded by the federal government that educates and supports families in communities where the infant mortality rate is above the national average. Healthy Start is designed to teach caseworkers and nurses to provide depression screenings for new mothers. In two years, Segre and O'Hara have trained 31 social workers to screen new mothers for depression who trained several other people in their own agencies.

Segre and O'Hara are also working with Healthy Start to implement and evaluate an intervention for depressed mothers called "listening visits." Mildly to moderately depressed mothers are provided an opportunity to talk to a trained caseworker or nurse. This program is similar to the "health visitors" program in the United Kingdom. Mothers are able to work collaboratively with a professional whom they already know and trust. This eliminates barriers to mental health treatment like cost, waiting lists, stigma or lack of providers.

"A listening visitor is not a trained psychologist, but sometimes just having someone take the time to sit down and take a keen interest in what's going on with your life is enough," Segre comments. "I'm not saying the listening visits are the cure-all, but for mild to moderate depression, they're a good start. And even if women need more treatment beyond the listening visits, our hope is that the listening visits will
serve as an ice-breaker, helping women feel more comfortable with the idea of mental health treatment."

The prevalence of postpartum depression: The relative significance of three social status indices
Lisa S. Segre, Michael W. O'Hara, Stephan Arndt, and Scott Stuart
Social Psychiatry and Psychiatric Epidemiology. (2007). Vol. 42, No. 4: pp. 316-321.
Click Here for Abstract

Race/ethnicity and perinatal depressed mood
Lisa S. Segre, Michael W. O'Hara, Mary E. Losch
Journal of Reproductive and Infant Psychology. (2006). Vol. 24, No. 2. pp. 99 - 106.
Click Here for Abstract

Written by: Peter M Crosta