Material Hardship and Mental Health Symptoms Among a Predominantly Low Income Sample of Pregnant Women Seeking Prenatal Care
- 504 Downloads
Introduction Although poverty is an established correlate of poorer mental health for pregnant women, limited research has examined the mental health effects of material hardship (i.e., difficulties meeting basic needs such as for food, transportation, or stable housing) during pregnancy. Methods The current research examined rates of material hardship among pregnant women seeking prenatal care and the relationships of both income and material hardship with depression and anxiety during pregnancy. Pregnant women (N = 892) responded to self-report measures of mental health symptoms, annual household income, and current material hardship in the waiting areas of community-based obstetrics/gynecology practices serving primarily financially disadvantaged patients. Results About 56% of the sample reported some form of material hardship. About 19% of the sample reported elevated depression, and 17% reported elevated anxiety. Both depression and anxiety were uniquely associated with lower income and greater material hardship, even after controlling for age, race/ethnicity, relationship status, and number of children in the home. Furthermore, material hardship partially mediated the effect of income on mental health symptoms. Discussion The physical, emotional, and social effects of deprivation of basic daily needs may contribute to pregnant women’s experiences of mental health symptoms. These results converge with the broader literature focused on the social determinants of physical and mental health. When symptoms of depression and anxiety reflect distress related to material hardship, addressing unmet social needs may be more effective than mental health treatment.
KeywordsPregnancy Depression Anxiety Income Material hardship
The authors thank Iwona Juskiewicz, MD, MPH for her contributions to this project. This research was supported by Patient Centered Outcomes Research Institute award number AD-12-4261 and by the University of Rochester CTSA award number UL1 TR000042 from the National Center for Advancing Translational Sciences of the National Institutes of Health. The content is solely the responsibility of the authors and does not necessarily represent the official views of the Patient Centered Outcomes Research Institute nor the National Institutes of Health.
Compliance with Ethical Standards
Conflict of interest
The authors report no conflicts of interest.
- American College of Obstetricians and Gynecologists. (2015). ACOG Committee Opinion No. 630. Screening for perinatal depression. Obstetrics and Gynecology, 125, 1268–1271. Retrieved February 1, 2018 from https://www.acog.org/Clinical-Guidance-and-Publications/Committee-Opinions/Committee-on-Obstetric-Practice/Screening-for-Perinatal-Depression.
- American College of Obstetricians and Gynecologists. (2018). ACOG Committee Opinion No. 729. Importance of social determinants of health and cultural awareness in the delivery of reproductive health care. Obstetrics and Gynecology, 131, e43–e48. Retrieved February 1, 2018 from https://www.acog.org/Clinical-Guidance-and-Publications/Committee-Opinions/Committee-on-Health-Care-for-Underserved-Women/Importance-of-Social-Determinants-of-Health-and-Cultural-Awareness-in-the-Delivery-of-Reproductive.
- Bödecs, T., Szilagyi, E., Cholnoky, P., Sándor, J., Gonda, X., Rihmer, Z., & Horváth, B. (2013). Prevalence and psychosocial background of anxiety and depression emerging during the first trimester of pregnancy: Data from a Hungarian population-based sample. Psychiatria Danubina, 25, 352–358.PubMedGoogle Scholar
- Boushey, H., Brocht, C., Gundersen, B., & Bernstein, J. (2001). Hardships in America: The real story of working families. Accessed January 26, 2017, from http://www.epinet.org/books/hardships.pdf.
- CSDH. (2008). Closing the gap in a generation: Health equity through action on the social determinants of health. Final report of the commission on social determinants of health. Geneva: World Health Organization. Accessed January 26, 2017, http://www.who.int/social_determinants/thecommission/finalreport/en/.
- Fisher, J., Tran, T., Tran, T. D., Dwyer, T., Nguyen, T., Casey, G. J., … Biggs, B. A. (2013). Prevalence and risk factors for symptoms of common mental disorders in early and late pregnancy in Vietnamese women: A prospective population-based study. Journal of Affective Disorders, 146, 213–219. https://doi.org/10.1016/j.jad.2012.09.007.CrossRefPubMedGoogle Scholar
- Flynn, H. A., Sexton, M., Ratliff, S., Porter, K., & Zivin, K. (2011). Comparative performance of the Edinburgh Postnatal Depression Scale and the Patient Health Questionnaire-9 in pregnant and postpartum women seeking psychiatric services. Psychiatry Research, 187, 130–134. https://doi.org/10.1016/j.psychres.2010.10.022.CrossRefPubMedGoogle Scholar
- Grote, N. K., Bridge, J. A., Gavin, A. R., Melville, J. L., Ivengar, 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, 1012–1024. https://doi.org/10.1001/archgenpsychiatry.2010.111.CrossRefPubMedPubMedCentralGoogle Scholar
- Hayes, A. F. (2013). Introduction to mediation, moderation, and conditional process analysis: A regression-based approach. New York: Guilford Press.Google Scholar
- Kessler, R. C., McGonagle, K. A., Zhao, S., Nelson, C. B., Hughes, M., Eshleman, S., … Kendler, K. S. (1994). Lifetime and 12-month prevalence of DSM-III—R psychiatric disorders in the United States: Results from the national comorbidity study. Archives of General Psychiatry, 51, 8–19. https://doi.org/10.1001/archpsyc.1994.03950010008002.CrossRefPubMedGoogle Scholar
- Kroenke, K., Spitzer, R. L., Williams, J. B., Monahan, P. O., & Lowe, B. (2007). Anxiety disorders in primary care: Prevalence, impairment, comorbidity, and detection. Annals of Internal Medicine, 146, 317–325. https://doi.org/10.7326/0003-4819-146-5-200703060-00004.CrossRefPubMedGoogle Scholar
- Lynch, J. W., Smith, G. D., Kaplan, G. A., & House, J. S. (2000). Income inequality and mortality: Importance to health of individual income, psychosocial environment, or material conditions. British Medical Journal, 320, 1200–1204. https://doi.org/10.1136/bmj.320.7243.1200.CrossRefPubMedGoogle Scholar
- Räisänen, S., Lehto, S. M., Nielsen, H. S., Gissler, M., Kramer, M. R., & Heinonen, S. (2014). Risk factors for and perinatal outcomes of major depression during pregnancy: A population-based analysis during 2002–2010 in Finland. British Medical Journal Open, 4, 1–8. https://doi.org/10.1136/bmjopen-2014-004883.CrossRefGoogle Scholar
- Rich-Edwards, J., Kleinman, K., Abrams, A., Harlow, B. L., McLaughlin, T. J., Joffe, H., & Gillman, M. W. (2006). Sociodemographic predictors of antenatal and postpartum depressive symptoms among women in a medical group practice. Journal of Epidemiology and Community Health, 60, 221–227. https://doi.org/10.1136/jech.2005.039370.CrossRefPubMedPubMedCentralGoogle Scholar
- Save the Children. (2015). State of the world’s mothers: The urban disadvantage. Retrieved March 16, 2017, from http://www.savethechildren.org.
- World Health Organization and Calouste Gulbenkian Foundation. (2014). Social determinants of mental health. Geneva: World Health Organization. Retrieved January 30, 2018 from http://apps.who.int/iris/bitstream/10665/112828/1/9789241506809_eng.pdf.
- Zhong, Q., Gelaye, B., Rondon, M. B., Sanchez, S. E., Barrios, Y. V., Simon, G. E., … Williams, M. A. (2014). Comparative performance of Patient Health Questionnaire-9 and Edinburgh Postnatal Depression Scale for screening antepartum depression. Journal of Affective Disorders, 162, 1–7. https://doi.org/10.1016/j.jad.2014.03.028.CrossRefPubMedPubMedCentralGoogle Scholar
- Zhong, Q.-Y., Gelaye, B., Zaslavsky, A. M., Fann, J. R., Rondon, M. B., Sanchez, S. E., & Williams, M. A. (2015). Diagnostic validity of the Generalized Anxiety Disorder-7 (GAD-7) among pregnant women. PLoS ONE, 10, e0125096. https://doi.org/10.1371/journal.pone.0125096.CrossRefPubMedPubMedCentralGoogle Scholar