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

Abstract

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.

Keywords

Perinatal depression Financial incentives Mental health care access Medicaid 

Notes

Acknowledgments

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)

References

  1. Austin, M. P., Priest, S. R., & Sullivan, E. A. (2008). Antenatal psychosocial assessment for reducing perinatal mental health morbidity. Cochrane Database of Systematic Reviews. doi:10.1002/14651858.CD005124.pub2.PubMedCentralPubMedGoogle Scholar
  2. Christensen, H., Griffiths, K. M., & Jorm, A. F. (2004). Delivering interventions for depression by using the internet: Randomised controlled trial. BMJ. doi:10.1136/bmj.37945.566632.EE.Google Scholar
  3. Cox, J. L., Holden, J. M., & Sagovsky, R. (1987). Detection of postnatal depression. Development of the 10-item Edinburgh Postnatal Depression Scale. British Journal of Psychiatry, 150, 782–786.PubMedCrossRefGoogle Scholar
  4. Cutler, C. B., Legano, L. A., Dreyer, B. P., Fierman, A. H., Berkule, S. B., Lusskin, S. I., et al. (2007). Screening for maternal depression in a low education population using a two item questionnaire. Archives of Women’s Mental Health, 10, 277–283. doi:10.1007/s00737-007-0202-z.PubMedCrossRefGoogle Scholar
  5. Deci, E. L., Koestner, R., & Ryan, R. M. (1999). A meta-analytic review of experiments examining the effects of extrinsic rewards on intrinsic motivation. Psychology Bulletin, 125(6), 627–668.CrossRefGoogle Scholar
  6. Donatelle, R., Hudson, D., Dobie, S., Goodall, A., Hunsberger, M., & Oswald, K. (2004). Incentives in smoking cessation: Status of the field and implications for research and practice with pregnant smokers. Nicotine & Tobacco Research, 6(Suppl 2), S163–S179. doi:10.1080/14622200410001669196.CrossRefGoogle Scholar
  7. Donatelle, R. J., Prows, S. L., Champeau, D., & Hudson, D. (2000). Randomised controlled trial using social support and financial incentives for high risk pregnant smokers: Significant other supporter (SOS) program. Tobacco Control, 9(Suppl 3), III67–III69.PubMedCentralPubMedGoogle Scholar
  8. Feinberg, E., Smith, M. V., Morales, M. J., Claussen, A. H., Smith, D. C., & Perou, R. (2006). Improving women’s health during internatal periods: Developing an evidenced-based approach to addressing maternal depression in pediatric settings. Journal of Women’s Health (Larchmt), 15(6), 692–703. doi:10.1089/jwh.2006.15.692.CrossRefGoogle Scholar
  9. Field, T., Hernandez-Reif, M., & Diego, M. (2011). Depressed mothers’ newborns are less responsive to animate and inanimate stimuli. Infant and Child Development, 20(1), 94–105.CrossRefGoogle Scholar
  10. Flynn, H. A., Blow, F. C., & Marcus, S. M. (2006). Rates and predictors of depression treatment among pregnant women in hospital-affiliated obstetrics practices. General Hospital Psychiatry, 28(4), 289–295. doi:10.1016/j.genhosppsych.2006.04.002.PubMedCrossRefGoogle Scholar
  11. Gavin, N. I., Gaynes, B. N., Lohr, K. N., Meltzer-Brody, S., Gartlehner, G., & Swinson, T. (2005). Perinatal depression: A systematic review of prevalence and incidence. Obstetrics and Gynecology, 106(5 Pt 1), 1071–1083. doi:10.1097/01.AOG.0000183597.31630.db.PubMedCrossRefGoogle Scholar
  12. Giacomini, M. K., Cook, D. J., & Evidence-Based Medicine Working Group. (2000). Users’ guides to the medical literature: XXIII. Qualitative research in health care A. Are the results of the study valid? JAMA, 284(3), 357–362.Google Scholar
  13. Goodman, J. H., & Tyer-Viola, L. (2010). Detection, treatment, and referral of perinatal depression and anxiety by obstetrical providers. Journal of Women’s Health (Larchmt), 19(3), 477–490. doi:10.1089/jwh.2008.1352.CrossRefGoogle Scholar
  14. Greene, J. (2011). Using consumer incentives to increase well-child visits among low-income children. Medical Care Research and Review, 68(5), 579–593. doi:10.1177/1077558711398878.PubMedCrossRefGoogle Scholar
  15. Grote, N. K., Bridge, J. A., Gavin, A. R., Melville, J. L., Iyengar, S., & Katon, W. J. (2010). A meta-analysis of depression during pregnancy and the risk of preterm birth, low birth weight, and intrauterine growth restriction. Archives of General Psychiatry, 67(10), 1012–1024. doi:10.1001/archgenpsychiatry.2010.111.PubMedCentralPubMedCrossRefGoogle Scholar
  16. Health Coverage and Uninsured: Distribution of Nonelderly with Medicaid by Race/Ethnicity. (2011). State Health Facts. Google Scholar
  17. Higgins, S. T., Washio, Y., Heil, S. H., Solomon, L. J., Gaalema, D. E., Higgins, T. M., et al. (2012). Financial incentives for smoking cessation among pregnant and newly postpartum women. Preventive Medicine, 55(Suppl), S33–S40. doi:10.1016/j.ypmed.2011.12.016.PubMedCentralPubMedCrossRefGoogle Scholar
  18. Jeffery, R. W. (2012). Financial incentives and weight control. Preventive Medicine, 55(Suppl), S61–S67. doi:10.1016/j.ypmed.2011.12.024.PubMedCentralPubMedCrossRefGoogle Scholar
  19. John, L. K., Loewenstein, G., Troxel, A. B., Norton, L., Fassbender, J. E., & Volpp, K. G. (2011). Financial incentives for extended weight loss: A randomized, controlled trial. Journal of General Internal Medicine, 26(6), 621–626. doi:10.1007/s11606-010-1628-y.PubMedCentralPubMedCrossRefGoogle Scholar
  20. Kane, R. L., Johnson, P. E., Town, R. J., & Butler, M. (2004). A structured review of the effect of economic incentives on consumers’ preventive behavior. American Journal of Preventive Medicine, 27(4), 327–352.PubMedCrossRefGoogle Scholar
  21. Kessler, R. C., McGonagle, K. A., Swartz, M., Blazer, D. G., & Nelson, C. B. (1993). Sex and depression in the National Comorbidity Survey. I: Lifetime prevalence, chronicity and recurrence. Journal of Affective Disorders, 29(2–3), 85–96.PubMedCrossRefGoogle Scholar
  22. Kopelman, R. C., Moel, J., Mertens, C., Stuart, S., Arndt, S., & O’Hara, M. W. (2008). Barriers to care for antenatal depression. Psychiatric Services (Washington, D. C.), 59(4), 429–432. doi:10.1176/appi.ps.59.4.429.CrossRefGoogle Scholar
  23. Lee, A. M., Lam, S. K., Lau, S. M. S. M., Chong, C. S. Y., Chui, H. W., & Fong, D. Y. T. (2007). Prevalence, course, and risk factors for antenatal anxiety and depression. Obstetrics & Gynecology, 110(5), 1102–1112. doi:10.1097/01.AOG.0000287065.59491.70.CrossRefGoogle Scholar
  24. Loewenstein, G., Asch, D. A., & Volpp, K. G. (2013). Behavioral economics holds potential to deliver better results for patients, insurers, and employers. Health Affairs (Millwood), 32(7), 1244–1250. doi:10.1377/hlthaff.2012.1163.CrossRefGoogle Scholar
  25. Löwe, B., Kroenke, K., & Gräfe, K. (2005). Detecting and monitoring depression with a two-item questionnaire (PHQ-2). Journal of Psychosomatic Research, 58(2), 163–171. doi:10.1016/j.jpsychores.2004.09.006.PubMedCrossRefGoogle Scholar
  26. Marcus, S. M., Flynn, H. A., Blow, F. C., & Barry, K. L. (2003). Depressive symptoms among pregnant women screened in obstetrics settings. Journal of Women’s Health (Larchmt), 12(4), 373–380. doi:10.1089/154099903765448880.CrossRefGoogle Scholar
  27. Medicaid Incentives for Prevention of Chronic Diseases. (2011). Centers for Medicare and Medicaid Services Center for Strategic Planning. http://innovation.cms.gov.
  28. O’Mahen, H., & Flynn, H. (2008a). Preferences and perceived barriers to treatment for mood disorders during the perinatal period. Journal of Women’s Health, 17(8), 1301–1309.PubMedCrossRefGoogle Scholar
  29. O’Mahen, H. A., & Flynn, H. A. (2008b). Preferences and perceived barriers to treatment for depression during the perinatal period. Journal of Women’s Health (Larchmt), 17(8), 1301–1309. doi:10.1089/jwh.2007.0631.CrossRefGoogle Scholar
  30. Sandelowski, M. (2000). Whatever happened to qualitative description. Research in Nursing & Health, 23, 334–340.CrossRefGoogle Scholar
  31. Volpp, K. G., Levy, A. G., Asch, D. A., Berlin, J. A., Murphy, J. J., Gomez, A., et al. (2006). A randomized controlled trial of financial incentives for smoking cessation. Cancer Epidemiology, Biomarkers & Prevention, 15(1), 12–18.CrossRefGoogle Scholar
  32. Volpp, K. G., Loewenstein, G., Troxel, A. B., Doshi, J., Price, M., Laskin, M., et al. (2008). A test of financial incentives to improve warfarin adherence. BMC Health Services Research, 8, 272. doi:10.1186/1472-6963-8-272.PubMedCentralPubMedCrossRefGoogle Scholar
  33. Volpp, K. G., Troxel, A. B., Pauly, M. V., Glick, H. A., Puig, A., Asch, D. A., et al. (2009). A randomized, controlled trial of financial incentives for smoking cessation. The New England Journal of Medicine, 360(7), 699–709. doi:10.1056/NEJMsa0806819.PubMedCrossRefGoogle Scholar
  34. Zenner, D., Molinar, D., Nichols, T., Riha, J., Macintosh, M., & Nardone, A. (2012). Should young people be paid for getting tested? A national comparative study to evaluate patient financial incentives for chlamydia screening. BMC Public Health, 12, 261. doi:10.1186/1471-2458-12-261.PubMedCentralPubMedCrossRefGoogle Scholar

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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