Material Hardship and Mental Health Symptoms Among a Predominantly Low Income Sample of Pregnant Women Seeking Prenatal Care

Abstract

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.

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Acknowledgements

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.

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Correspondence to Jennifer Katz.

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Katz, J., Crean, H.F., Cerulli, C. et al. Material Hardship and Mental Health Symptoms Among a Predominantly Low Income Sample of Pregnant Women Seeking Prenatal Care. Matern Child Health J 22, 1360–1367 (2018). https://doi.org/10.1007/s10995-018-2518-x

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Keywords

  • Pregnancy
  • Depression
  • Anxiety
  • Income
  • Material hardship