Mental Health Care Among Low-Income Pregnant Women with Depressive Symptoms: Facilitators and Barriers to Care Access and the Effectiveness of Financial Incentives for Increasing Care

  • Rebecca M. Sacks
  • Jessica Greene
  • Ryan Burke
  • Erin C. Owen
Original Article


Access to mental health care is suboptimal for low-income pregnant women. Using in-depth interviews, we examined barriers and facilitators to accessing care among 42 low income pregnant women with depressive symptoms. To pilot whether financial incentives would increase utilization during pregnancy, half the women were randomized to receive $10 gift cards after mental health visits. Women reported external and internal barriers to accessing mental health care, and internal and interpersonal facilitators. Financial incentives did not impact how often the women visited mental health providers, suggesting that small incentives are not sufficient to catalyze mental health care use for this population.


Perinatal depression Financial incentives Mental health care access Medicaid 



This research was supported by a Grant from the Northwest Health Foundation, which is a nonprofit foundation based in Portland, Oregon that seeks to advance, support, and promote health in Oregon and Southwest Washington. We would like to thank Amanda Cobb at Trillium Community Health Plan for all of her assistance in this project. We would also like to thank the women who participated in this study for sharing their experiences and stories with the research team.

Supplementary material

10488_2014_562_MOESM1_ESM.docx (23 kb)
Supplementary material 1 (DOCX 23 kb)


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Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  • Rebecca M. Sacks
    • 1
  • Jessica Greene
    • 1
  • Ryan Burke
    • 2
  • Erin C. Owen
    • 3
  1. 1.School of NursingGeorge Washington UniversityPortlandUSA
  2. 2.Health Policy Research NorthwestEugeneUSA
  3. 3.Slocum Research & Education FoundationEugeneUSA

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