Skip to main content

Neighborhood Deprivation and Maternal Psychological Distress During Pregnancy: A Multilevel Analysis

Maternal and Child Health Journal volume 19, pages 1142–1151 (2015)Cite this article

Abstract

Maternal psychosocial distress is conceptualized as an important factor underlying the association between neighborhood deprivation and pregnancy outcomes. However, empirical studies to examine effects of neighborhood deprivation on psychosocial distress during pregnancy are scant. Based on a large multicenter cohort of pregnant women in Montreal, we examined (1) the extent to which psychosocial distress is clustered at the neighborhood-level, (2) the extent to which the clustering is explained by neighborhood material or social deprivation, and (3) whether associations between neighborhood deprivation and psychosocial distress persist after accounting for neighborhood composition (individual-level characteristics) using multilevel analyses. For 5,218 women residing in 740 neighborhoods, a prenatal interview at 24–26 gestational weeks measured both general and pregnancy-related psychological distress using well-validated scales: perceived stress, social support, depressive symptoms, optimism, commitment to the pregnancy, pregnancy-related anxiety, and maternal locus-of-control. Neighborhood deprivation indices were linked to study participants by their residential postal code. Neighborhood-level clustering (intraclass correlation) ranged from 1 to 2 % for perceived stress (lowest), optimism, pregnancy-related anxiety, and commitment to pregnancy to 4–6 % for perceived social support, depressive symptoms, and maternal locus of control (highest). Neighborhood material deprivation explained far more of the clustering (23–75 %) than did social deprivation (no more than 4 %). Although both material and social deprivation were associated with psychological distress in unadjusted analyses, the associations disappeared after accounting for individual-level socioeconomic characteristics. Our results highlight the importance of accounting for individual-level socioeconomic characteristics in studies of potential neighborhood effects on maternal mental health.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

USD 39.95

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

References

  1. Pearl, M., Braveman, P., & Abrams, B. (2001). The relationship of neighborhood socioeconomic characteristics to birthweight among 5 ethnic groups in California. American Journal of Public Health, 91(11), 1808–1814.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  2. Kaufman, J. S., Dole, N., Savitz, D. A., & Herring, A. H. (2003). Modeling community-level effects on preterm birth. Annals of Epidemiology, 13(5), 377–384.

    Article  PubMed  Google Scholar 

  3. Elo, I. T., Culhane, J. F., Kohler, I. V., O’Campo, P., Burke, J. G., Messer, L. C., et al. (2009). Neighbourhood deprivation and small-for-gestational-age term births in the United States. Paediatric and Perinatal Epidemiology, 23(1), 87–96.

    Article  PubMed Central  PubMed  Google Scholar 

  4. Guildea, Z. E., Fone, D. L., Dunstan, F. D., Sibert, J. R., & Cartlidge, P. H. (2001). Social deprivation and the causes of stillbirth and infant mortality. Archives of Disease in Childhood, 84(4), 307–310.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  5. Metcalfe, A., Lail, P., Ghali, W. A., & Sauve, R. S. (2011). The association between neighbourhoods and adverse birth outcomes: A systematic review and meta-analysis of multi-level studies. Paediatric and Perinatal Epidemiology, 25(3), 236–245.

    Article  PubMed  Google Scholar 

  6. Luo, Z. C., Wilkins, R., & Kramer, M. S. (2006). Effect of neighbourhood income and maternal education on birth outcomes: A population-based study. CMAJ, 174(10), 1415–1420.

    Article  PubMed Central  PubMed  Google Scholar 

  7. O’Campo, P., Xue, X., Wang, M. C., & Caughy, M. (1997). Neighborhood risk factors for low birthweight in Baltimore: A multilevel analysis. American Journal of Public Health, 87(7), 1113–1118.

    Article  PubMed Central  PubMed  Google Scholar 

  8. Agyemang, C., Vrijkotte, T. G. M., Droomers, M., van der Wal, M. F., Bonsel, G. J., & Stronks, K. (2009). The effect of neighbourhood income and deprivation on pregnancy outcomes in Amsterdam The Netherlands. Journal of Epidemiology and Community Health, 63(9), 755–760.

    Article  CAS  PubMed  Google Scholar 

  9. Subramanian, S. V., Chen, J. T., Rehkopf, D. H., Waterman, P. D., & Krieger, N. (2006). Comparing individual- and area-based socioeconomic measures for the surveillance of health disparities: A multilevel analysis of Massachusetts births, 1989–1991. American Journal of Epidemiology, 164(9), 823–834.

    Article  CAS  PubMed  Google Scholar 

  10. Farley, T. A., Mason, K., Rice, J., Habel, J. D., Scribner, R., & Cohen, D. A. (2006). The relationship between the neighbourhood environment and adverse birth outcomes. Paediatric and Perinatal Epidemiology, 20(3), 188–200.

    Article  PubMed  Google Scholar 

  11. Schempf, A., Strobino, D., & O’Campo, P. (2009). Neighborhood effects on birthweight: An exploration of psychosocial and behavioral pathways in Baltimore, 1995–1996. Social Science and Medicine, 68(1), 100–110.

    Article  PubMed Central  PubMed  Google Scholar 

  12. Truong, K. D., & Ma, S. (2006). A systematic review of relations between neighborhoods and mental health. The Journal of Mental Health Policy and Economics, 9(3), 137–154.

    PubMed  Google Scholar 

  13. Kim, D. (2008). Blues from the neighborhood? Neighborhood characteristics and depression. Epidemiologic Reviews, 30(1), 101–117.

    Article  CAS  PubMed  Google Scholar 

  14. Pearce, J., Witten, K., Hiscock, R., & Blakely, T. (2007). Are socially disadvantaged neighbourhoods deprived of health-related community resources? International Journal of Epidemiology, 36(2), 348–355.

    Article  PubMed  Google Scholar 

  15. Galobardes, B., Shaw, M., Lawlor, D., Davey Smith, G., & Lynch, J. (2006). Indicators of socioeconomic position. In J. M. Oakes & J. S. Kaufman (Eds.), Methods in social epidemiology (pp. 47–85). San Francisco, CA: Wiley.

    Google Scholar 

  16. Kramer, M. S., Goulet, L., Lydon, J., Seguin, L., McNamara, H., Dassa, C., et al. (2001). Socio-economic disparities in preterm birth: Causal pathways and mechanisms. Paediatric and Perinatal Epidemiology, 15, 104–123.

    Article  PubMed  Google Scholar 

  17. Daniel, M., Kestens, Y. (2007). Montreal epidemiological and geographic analysis of population health outcomes and neighbourhood effects: MEGAPHONE geographic information system (Copyright ®1046898). Montréal: Centre de recherche du Centre hospitalier de l’Université de Montréal (CRCHUM).

  18. Pampalon, R., Hamel, D., Gamache, P., & Raymond, G. (2009). A deprivation index for health planning in Canada. Chronic Diseases in Canada, 29(4), 178–191.

    CAS  PubMed  Google Scholar 

  19. Curtis, S., Setia, M. S., & Quesnel-Vallee, A. (2009). Socio-geographic mobility and health status: A longitudinal analysis using the National Population Health Survey of Canada. Social Science and Medicine, 69(12), 1845–1853.

    Article  PubMed Central  PubMed  Google Scholar 

  20. Ahern, J., & Galea, S. (2011). Collective efficacy and major depression in urban neighborhoods. American Journal of Epidemiology, 173(12), 1453–1462.

    Article  PubMed Central  PubMed  Google Scholar 

  21. Curtis, S., Copeland, A., Fagg, J., Congdon, P., Almog, M., & Fitzpatrick, J. (2006). The ecological relationship between deprivation, social isolation and rates of hospital admission for acute psychiatric care: A comparison of London and New York City. Health Place, 12(1), 19–37.

    Article  PubMed  Google Scholar 

  22. Testi, A., & Ivaldi, E. (2009). Material versus social deprivation and health: A case study of an urban area. The European Journal Of Health Economics, 10(3), 323–328.

    Article  PubMed  Google Scholar 

  23. Cohen, S., Kamarck, T., & Mermelstein, R. (1983). A global measure of perceived stress. Journal of Health and Social Behavior, 24(4), 385–396.

    Article  CAS  PubMed  Google Scholar 

  24. Ministry of Health and Social Services. (1998). Health and social survey. Quebec, Canada: Ministry of Health and Social Services.

    Google Scholar 

  25. Radloff, L. (1977). The CES-D scale: A self report depression scale for research in the general population. Psychological Measurement, 1, 385–401.

    Article  Google Scholar 

  26. Scheier, M. F., & Carver, C. S. (1985). Optimism, coping, and health: Assessment and implications of generalized outcome expectancies. Health Psychology, 4(3), 219–247.

    Article  CAS  PubMed  Google Scholar 

  27. Lydon, J., Dunkel-Schetter, C., Cohan, C. L., & Pierce, T. (1996). Pregnancy decision making as a significant life event: A commitment approach. Journal of Personality and Social Psychology, 71(1), 141–151.

    Article  CAS  PubMed  Google Scholar 

  28. Dunkel-Schetter, C. (1998). Maternal stress and preterm delivery. Prenatal and Neonatal Medicine, 3(1), 39–42.

    Google Scholar 

  29. Tinsley, B. J., & Holtgrave, D. R. (1989). Maternal health locus of control beliefs, utilization of childhood preventive health services, and infant health. Journal of Developmental and Behavioral Pediatrics, 10(5), 236–241.

    Article  CAS  PubMed  Google Scholar 

  30. Daniel, M., Moore, S., & Kestens, Y. (2008). Framing the biosocial pathways underlying associations between place and cardiometabolic disease. Health Place, 14(2), 117–132.

    Article  PubMed  Google Scholar 

  31. Statistics Canada. (1999). Low income cut-offs. Statistics Canada, Ottawa.

  32. Weich, S., Holt, G., Twigg, L., Jones, K., & Lewis, G. (2003). Geographic variation in the prevalence of common mental disorders in Britain: A multilevel investigation. American Journal of Epidemiology, 157(8), 730–737.

    Article  PubMed  Google Scholar 

  33. Theall, K. P., Drury, S. S., & Shirtcliff, E. A. (2012). Cumulative neighborhood risk of psychosocial stress and allostatic load in adolescents. American Journal of Epidemiology, 176(Suppl 7), S164–S174.

    Article  PubMed Central  PubMed  Google Scholar 

  34. O’Campo, P., & Schempf, A. (2005). Racial inequalities in preterm delivery: Issues in the measurement of psychosocial constructs. American Journal of Obstetrics and Gynecology, 192(5 Suppl), S56–S63.

    Article  PubMed  Google Scholar 

  35. Whitley, E., Gunnell, D., Dorling, D., & Smith, G. D. (1999). Ecological study of social fragmentation, poverty, and suicide. BMJ, 319(7216), 1034–1037.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  36. Auger, N., Park, A. L., Gamache, P., Pampalon, R., & Daniel, M. (2012). Weighing the contributions of material and social area deprivation to preterm birth. Social Science and Medicine, 75(6), 1032–1037.

    Article  PubMed  Google Scholar 

  37. Pickett, K. E., & Pearl, M. (2001). Multilevel analyses of neighbourhood socioeconomic context and health outcomes: A critical review. Journal of Epidemiology and Community Health, 55(2), 111–122.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  38. Henderson, C., Roux, A. V. D., Jacobs, D. R., Kiefe, C. I., West, D., & Williams, D. R. (2005). Neighbourhood characteristics, individual level socioeconomic factors, and depressive symptoms in young adults: The CARDIA study. Journal of Epidemiology and Community Health, 59(4), 322–328.

    Article  PubMed Central  PubMed  Google Scholar 

  39. Reijneveld, S. A., & Schene, A. H. (1998). Higher prevalence of mental disorders in socioeconomically deprived urban areas in The Netherlands: Community or personal disadvantage? Journal of Epidemiology and Community Health, 52(1), 2–7.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  40. Beard, J. R., Cerda, M., Blaney, S., Ahern, J., Vlahov, D., & Galea, S. (2009). Neighborhood characteristics and change in depressive symptoms among older residents of New York City. American Journal of Public Health, 99(7), 1308–1314.

    Article  PubMed Central  PubMed  Google Scholar 

  41. Davey Smith, G., Hart, C., Blane, D., Gillis, C., & Hawthorne, V. (1997). Lifetime socioeconomic position and mortality: Prospective observational study. BMJ, 314(7080), 547.

    Article  Google Scholar 

  42. Stafford, M., & Marmot, M. (2003). Neighbourhood deprivation and health: Does it affect us all equally? International Journal of Epidemiology, 32(3), 357–366.

    Article  PubMed  Google Scholar 

  43. Messer, L. C., Vinikoor-Imler, L. C., & Laraia, B. A. (2012). Conceptualizing neighborhood space: Consistency and variation of associations for neighborhood factors and pregnancy health across multiple neighborhood units. Health Place, 18(4), 805–813.

    Article  PubMed  Google Scholar 

  44. Reijneveld, S. A., Verheij, R. A., & de Bakker, D. H. (2000). The impact of area deprivation on differences in health: Does the choice of the geographical classification matter? Journal of Epidemiology and Community Health, 54(4), 306–313.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  45. Kramer, M. S., Wilkins, R., Goulet, L., Séguin, L., Lydon, J., Kahn, S. R., et al. (2009). Investigating socio-economic disparities in preterm birth: Evidence for selective study participation and selection bias. Paediatric and Perinatal Epidemiology, 23(4), 301–309.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Pediatrics, Research Institute of McGill University Health Centre, McGill University, Montreal, QC, Canada

    Seungmi Yang, Mourad Dahhou & Michael S. Kramer

  2. Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, H3A 1A2, Canada

    Seungmi Yang & Michael S. Kramer

  3. Département de Médecine Sociale et Préventive, Université de Montréal, Montreal, QC, Canada

    Yan Kestens

  4. Division of Health Sciences, School of Population Health, University of South Australia, Adelaide, Australia

    Mark Daniel

Authors
  1. Seungmi Yang
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Yan Kestens
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Mourad Dahhou
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Mark Daniel
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Michael S. Kramer
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Seungmi Yang.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Yang, S., Kestens, Y., Dahhou, M. et al. Neighborhood Deprivation and Maternal Psychological Distress During Pregnancy: A Multilevel Analysis. Matern Child Health J 19, 1142–1151 (2015). https://doi.org/10.1007/s10995-014-1623-8

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10995-014-1623-8

Keywords

  • Neighborhood
  • Deprivation
  • Psychological distress
  • Pregnancy
  • Multilevel analysis