Clinical Social Work Journal

, Volume 41, Issue 4, pp 387–394 | Cite as

Treatment Engagement Using Motivational Interviewing for Low-Income, Ethnically Diverse Mothers with Postpartum Depression

  • McClain Sampson
  • Luis H. Zayas
  • Sarah Beth Seifert
Original Paper

Abstract

Postpartum depression (PPD) places women, and their children, at risk for many untoward outcomes including lack of responsivity, low self-efficacy, and insecure infant attachment. Especially at risk for untreated PPD are low-income, ethnically diverse mothers. Seeking and accepting treatment for depression may be impeded by the many psychological and social barriers that mothers may bring with them. Obstacles might include a lack of resources (e.g., lack of transportation or child care), stigma, distrust, and a lack of knowledge about stress and depression. To reduce these and other barriers to treatment, this paper points to the value of utilizing motivational interviewing techniques to engage and retain low-income, ethnically diverse women for treatment of PPD. Following a review of PPD and related barriers to treatment, a case study is presented with example dialogue. The suggestions for practice represent starting points for effective engagement of women in any number of treatments provided by social and health services settings. With federal mandates to screen for depression in many settings and to provide treatment, using motivational interviewing may be an effective prelude to treatment adherence.

Keywords

Postpartum depression Motivational interviewing Barriers to treatment Low-income Ethnic diversity Mothers 

References

  1. Abrams, L. S., & Curran, L. (2007). Not just a middle-class affliction: Crafting a social work research agenda on postpartum depression. Health and Social Work, 32(4), 289–296.PubMedCrossRefGoogle Scholar
  2. Abrams, L. S., Dornig, K., & Curran, L. (2009). Barriers to service use for postpartum depression symptoms among low-income ethnic minority mothers iamann the United States. Qualitative Health Research, 19, 535–551.PubMedCrossRefGoogle Scholar
  3. Amankwaa, L. C. (2003). Postpartum depression, culture and African American women. Journal of Cultural Diversity, 10(1), 23–37.PubMedGoogle Scholar
  4. American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed.). Washington, DC: American Psychiatric Publishing.Google Scholar
  5. Anderson, C. M., Robins, C. S., Greeno, C. G., Cahalane, H., Copeland, V., & Andrews, R. (2006). Why lower income mothers do not engage with the formal mental health care system: Perceived barriers to care. Qualitative Health Research, 16(7), 926–943. doi:10.1177/1049732306289224.PubMedCrossRefGoogle Scholar
  6. Beck, C. T. (2001). Predictors of postpartum depression: An update. Nursing Research, 50, 275–285.PubMedCrossRefGoogle Scholar
  7. Beck, A. T., Steer, R. A., & Garbin, M. G. (1988). Psychometric properties of the beck depression inventory: Twenty five years of evaluation. Clinical Psychology Review, 8, 77–100.CrossRefGoogle Scholar
  8. Boyce, P. M. (2003). Risk factors for postnatal depression: A review and risk factors in Australian populations. Archives of Women’s Mental Health, 6, s43–s50.PubMedCrossRefGoogle Scholar
  9. Boyd, R. C., Zayas, L. H., & McKee, M. D. (2006). Mother-infant interaction, life events and prenatal and postpartum depressive symptoms among urban minority women in primary care. Maternal and Child Health Journal, 10(2), 139–148.PubMedCrossRefGoogle Scholar
  10. Burke, B. L., Arkowitz, H., & Menchola, M. (2003). The efficacy of motivational interviewing: A meta-analysis of controlled clinical trials. Journal of Consulting and Clinical Psychology, 71, 843–861.PubMedCrossRefGoogle Scholar
  11. Cox, J. L., Holden, J. M., & Sagovsky, R. (1987). Detection of postnatal depression: Development of the 10-item Edinburgh postnatal depression scale. The British Journal of Psychiatry, 150, 782–786.PubMedCrossRefGoogle Scholar
  12. Dawson, G., Frey, K., Panagiotides, H., Yamada, E., Hessl, D., & Osterling, J. (1999). Infants of depressed mothers exhibit atypical frontal electrical brain activity during interactions with mother and with a familiar nondepressed adult. Child Development, 70(5), 1058–1066.PubMedCrossRefGoogle Scholar
  13. DeNavas-Walt, C., Proctor, B. D., & Hill-Lee, C. (2006). Income, poverty, and health insurance coverage in the United States: 2005. Washington, DC: U.S. Census Bureau, U.S. Government Printing Office.Google Scholar
  14. Dennis, C. L., & Chung-Lee, L. (2006). Postpartum depression help seeking barriers and maternal treatment preferences: A qualitative systemic review. Birth, 33(4), 323–331.PubMedCrossRefGoogle Scholar
  15. DiClemente, C. C. & Velasquez, M. M. (2002). Motivational interviewing and the stages of change. In W. R. Miller & S. Rollnick (Eds.). Motivational interviewing, second edition: Preparing people for change. New York: Guilford Publications, Inc.Google Scholar
  16. Garcia-Esteve, L., Ascaso, C., Ojuel, C., & Navarro, P. (2003). Validation of the Edinburgh postnatal depression scale (EPDS) in Spanish mothers. Journal of Affective Disorders, 75, 71–76.PubMedCrossRefGoogle Scholar
  17. Grace, S. L., Evindar, A., & Stewart, D. E. (2003). The effect of postpartum depression on child cognitive development and behavior: A review and critical analysis of the literature. Archives of Women’s Mental Health, 6, 263–274.PubMedCrossRefGoogle Scholar
  18. Grote, N. K., Bledsoe, S. E., Swartz, H. A., & Frank, E. (2004). Feasibility of providing culturally relevant, brief interpersonal psychotherapy for antenatal depression in an obstetrics clinic: A pilot study. Research on Social Work Practice, 14, 397–407.CrossRefGoogle Scholar
  19. Grote, N. K., Swartz, H. A., Geibel, S. L., Zuckoff, A., Houck, P. R., & Frank, E. (2009). A randomized controlled trial of culturally relevant, brief interpersonal psychotherapy for perinatal depression. Psychiatric Services, 60(3), 313–321.PubMedCrossRefGoogle Scholar
  20. Grote, N. K., Zuckoff, A., Swartz, H., Bledsoe, S. E., & Geibel, S. (2007). Engaging women who are depressed and economically disadvantaged in mental health treatment. Social Work, 52(4), 295–308.PubMedCrossRefGoogle Scholar
  21. Halbreich, U., & Karkun, S. (2006). Cross-cultural and social diversity of prevalence of postpartum depression and depressive symptoms. Journal of Affective Disorders, 91, 97–111.PubMedCrossRefGoogle Scholar
  22. Hay, D. F., Pawlby, S., Sharp, D., Asten, P., Mills, A., & Kumar, R. (2003). Intellectual problems shown by 11-year-old children whose mothers had postnatal depression. Journal of Child Psychology and Psychiatry, 42, 871–889.CrossRefGoogle Scholar
  23. Hettema, J., Steele, J., & Miller, W. R. (2005). Motivational interviewing. Annual Review of Clinical Psychology, 1, 91–111.PubMedCrossRefGoogle Scholar
  24. Hobfoll, S. E., Ritter, C., Lavin, J., Hulsizer, M. R., & Cameron, R. P. (1995). Depression prevalence and incidence among inner-city pregnant and postpartum women. Journal of Consulting and Clinical Psychology, 63(3), 445–453.PubMedCrossRefGoogle Scholar
  25. Hoffman, S., & Hatch, M. C. (2000). Depressive symptomatology during pregnancy: Evidence for association with decreased fetal growth in pregnancies of lower social class women. Health Psychology, 9(6), 535–543.CrossRefGoogle Scholar
  26. Marcus, S. M., Flynn, H. A., Blow, F. C., & Barry, K. L. (2003). Depressive symptoms among pregnant women screened in obstetrics setting. Journal of Women’s Health, 12(4), 373–380.PubMedCrossRefGoogle Scholar
  27. Martinez, M., Campetella, M. A., & Zayas, L. H. (2011). Moving research and researchers closer to the real world. Manuscript submitted for publication.Google Scholar
  28. Martins, C., & Gaffan, E. A. (2000). Effects of early maternal depression on patterns of infant-mother attachment: A meta-analytic investigation. Journal of Child Psychology and Psychiatry, 41(6), 737–746.PubMedCrossRefGoogle Scholar
  29. Mercer, R. T. (1995). Becoming a mother: Research on maternal identity form Rubin to the present. New York: Springer Publishing Company.Google Scholar
  30. Miller, A. R., Barr, R. G., & Eaton, W. O. (1993). Crying and mother behavior of six-week-old infants and postpartum maternal mood. Pediatrics, 92, 551–558.PubMedGoogle Scholar
  31. Miller, W. R., & Rollnick, S. (2002). Motivational interviewing: Preparing people for change (Vol. 2). New York: Guilford.Google Scholar
  32. Miranda, J., Chung, J. Y., Green, B. L., Krupnick, J., Siddique, J., Revicki, D. A., et al. (2003). Treating depression in predominantly low-income young, minority women. A randomized controlled trial. Journal of the American Medical Association, 29(1), 57–65.CrossRefGoogle Scholar
  33. Muñoz, R. F., Le, H., Ippen, C. G., Diaz, M. A., Urizar, G. G., Soto, J., et al. (2007). Prevention of postpartum depression in low-income women: Development of the Mamás y Bebés/mothers and babies course. Cognitive and Behavioral Practice, 14, 70–83.CrossRefGoogle Scholar
  34. O’Hara, M. W. (2009). Postpartum depression: What we know. Journal of Clinical Psychology, 65(12), 1258–1269.PubMedCrossRefGoogle Scholar
  35. O’Hara, M. W., & Swain, A. M. (1996). Rates and risk of postpartum depression: A meta analysis. International Review of Psychiatry, 8, 37–54.CrossRefGoogle Scholar
  36. Pieters, H. C., & Heilemann, M. V. (2010). “I can’t do it on my own”: Motivation to enter therapy for depression among low income, second generation, Latinas. Issues in Mental Health Nursing, 31, 279–287.PubMedCrossRefGoogle Scholar
  37. Rich-Edwards, J. W., Kleinman, K., Abrams, A., Harlow, B. L., McLaughlin, T. J., Joffe, H., et al. (2006). Sociodemographic predictors of antenatal and postpartum depressive symptoms among women in a medical group practice. Journal Epidemiology Community Health, 60, 221–227. doi:10.1136/jech.2005.039370.CrossRefGoogle Scholar
  38. Robertson, E., Grace, S., Wallington, T., & Stewart, D. E. (2004). Antenatal risk factors for postpartum depression: A synthesis of recent literature. General Hospital Psychiatry, 26, 289–295.PubMedCrossRefGoogle Scholar
  39. Scholle, S. H., Hasket, R. F., Hanusa, B. H., Pincus, H. A., & Kupfer, D. J. (2003). Addressing depression in obstetrics/gynecology practice. General Hospital Psychiatry, 25, 83–90.PubMedCrossRefGoogle Scholar
  40. Spinelli, M. G., & Endicott, J. (2003). Controlled clinical trial of interpersonal therapy versus parenting education program for depressed pregnant women. American Journal of Psychiatry, 160, 555–562.PubMedCrossRefGoogle Scholar
  41. Spitzer, R. L., Kroenke, K., & Williams, J. B. W. (1999). Patient health questionnaire study group. Validity and utility of a self-report version of PRIME-MD: the PHQ primary care study. Journal of the American Medical Association, 282, 1737–1744.PubMedCrossRefGoogle Scholar
  42. Swartz, H. A., Frank, E., Zuckoff, A., Cyranowski, J. M., Houck, P. R., Cheng, Y., et al. (2008). Brief interpersonal psychotherapy for depressed mothers whose children are receiving psychiatric treatment. American Journal of Psychiatry, 165, 1155–1162.PubMedCrossRefGoogle Scholar
  43. Swartz, H. A., Zuckoff, A., Frank, E., Spielvogle, H. N., Shear, M. K., Fleming, M. A. D., et al. (2006). An open-label trial of enhanced brief interpersonal psychotherapy in depressed mothers whose children are receiving psychiatric treatment. Depression and Anxiety, 23, 398–404.PubMedCrossRefGoogle Scholar
  44. U.S. Department of Health and Human Services. (2006). Health resources and services administration-child and maternal health. Programs A-Z. Retrieved from http://mchb.hrsa.gov/AZ/azdescriptions.html.
  45. Wisner, K., Parry, B. L., & Piontek, C. M. (2002). Postpartum depression. The New England Journal of Medicine, 347, 194–199.PubMedCrossRefGoogle Scholar
  46. Zajicek-Farber, M. L. (2009). Postnatal depression and infant health practices among high risk women. Journal of Child and Family Studies, 18, 236–245.CrossRefGoogle Scholar
  47. Zajicek-Farber, M. L., Mayer, L. M., & Daughtery, L. G. (2010). Connections among parental mental health, stress, child routines, and early emotional behavioral regulation of preschool children in low-income families. Journal of the Society for Social Work and Research, 3(1), 31–50.Google Scholar
  48. Zayas, L. H., Cunningham, M., McKee, M. D., & Jankowski, K. R. B. (2002). Depression and negative life events among pregnant African American and Hispanic women. Women’s Health, 12, 16–22.CrossRefGoogle Scholar
  49. Zlotnick, C., Johnson, C. L., Miller, I. W., Pearlstein, T., & Howard, M. (2001). Postpartum depression in women receiving public assistance: Pilot study of an interpersonal therapy-oriented group intervention. American Journal of Psychiatry, 158, 638–640.PubMedCrossRefGoogle Scholar
  50. Zubaran, C., & Foresti, K. (2011). Investigating quality of life and depressive symptoms in the postpartum period. Women and Birth, 24, 10–16.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2012

Authors and Affiliations

  • McClain Sampson
    • 1
  • Luis H. Zayas
    • 2
  • Sarah Beth Seifert
    • 3
  1. 1.Graduate College of Social WorkUniversity of HoustonHoustonUSA
  2. 2.School of Social WorkUniversity of Texas at AustinAustinUSA
  3. 3.University of Texas at AustinAustinUSA

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