Maternal and Child Health Journal

, Volume 7, Issue 2, pp 95–102 | Cite as

Preferences for Depression Advice Among Low-Income Women

Article

Abstract

Objectives: Because patient reluctance to discuss depression may influence the success of depression interventions, we assessed preferences for the source of depression advice among high-risk women and factors associated with those preferences. Methods: The sample included 147 consecutive patients at a hospital-based obstetrics and gynecology clinic. All were age 18–44, on Medicaid and able to complete a previsit survey and postvisit interview. Women were asked “Where would you prefer to get advice on how you are feeling, whether you are sad or worried?” Responses were grouped as the ob/gyn clinic, general medical provider, mental health/substance abuse provider or no professional advice desired. Results: Many women did not want professional advice on depression: 33% said they preferred to get advice from informal sources and 5% preferred no information. A total of 23% of women preferred to discuss depression with the ob/gyn provider, 14% with a general medical provider, and 25% with a mental health or substance abuse provider. Women were more likely to want advice from a health provider (of any type) if they had previously use mental health care (OR = 3.6, p = 0.005) or had at least one chronic health condition (OR = 3.1, p = 0.013). Women were more likely to want advice from the ob/gyn clinic if it was their primary care provider (OR = 41.8, p = 0.002) or if they had high depressive symptoms (OR = 4.8, p = 0.048) Conclusions: Many women do not want to discuss depression with a health professional, but familiarity with the mental health care system, health status, and relationship with a provider influence women's openness to depression advice.

women depression patient preferences primary care mental health services 

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References

  1. 1.
    Miranda J, Azocar F, Komaromy M, Golding JM. Unmet mental health needs of women in public sector gynecologic clinics. Am J Obstet Gynecol 1998;178:212-217.Google Scholar
  2. 2.
    Kelly RH, Zatzick DF, Anders TF. The detection and treatment of psychiatric disorder and substance use among pregnant women cared for in obstetrics. Am J Psychiatry 2001;158(2):213-19.Google Scholar
  3. 3.
    Spitzer RL, Williams JBW, Kroenke K, Hornyak R, McMurray J. Validity and utility of the PRIME-MD Patient Health Questionnaire in assessment of 3000 obstetric–gynecologic patients: The PRIME-MD Patient Health Questionnaire Obstetrics-Gynecology Study. Am J Obstet Gynecol 2000;183(3):759-69.Google Scholar
  4. 4.
    Yonkers KA, Ramin SM, Rush AJ, Navarrete CA, Carmody T, March D, Heartwell SF, Leveno KJ. Onset and persistence of postpartum depression in an inner-city maternal health clinic system. Am J Psychiatry 2001;158(11):1856-63.Google Scholar
  5. 5.
    Murray CJL, Lopez AD. The global burden of disease and injury series. A comprehensive assessment of mortality and disability from diseases, injuries, and risk factors in 1990 and projected to 2020. Vol. 1. Cambridge, MA: Harvard University Press (on the behalf of the World Health Organization and the World Bank), 1996.Google Scholar
  6. 6.
    Greenberg PE, Stiglin LE, Finkelstein SN, Berndt ER. The economic burden of depression in 1990. J Clin Psychiatry 1993;54:405-18.Google Scholar
  7. 7.
    Orr ST, James SA, Prince CB. Maternal prenatal depressive symptoms and spontaneous preterm births among African American women in Baltimore, Maryland. Am J Epidemiol 2002;156:797-802.Google Scholar
  8. 8.
    Hendrick V, Altshuler L. Management of major depression during pregnancy. Am J Psychiatry 2002;159(10):1667-73.Google Scholar
  9. 9.
    NICHD Early Child Care Research Network. Chronicity of maternal depressive symptoms, maternal sensitivity, and child functioning at 36 months. Dev Psychol 1999;35(5):1297-1310.Google Scholar
  10. 10.
    Wells KB, Sherbourne C, Schoenbaum M, Duan N, Meredith L, Unutzer J, Miranda J, Carney MF, Rubenstein LV. Impact of disseminating quality improvement programs for depression in managed primary care: A randomized controlled trial. JAMA 2000;283(2):212-20.Google Scholar
  11. 11.
    Williams JW, Rost K, Dietrich AJ, Ciotti MC, Zyzanski SJ, Cornell J. Primary care physicians' approach to depressive disorders: Effects of physician specialty and practice structure. Arch Fam Med 1999;8:58-67.Google Scholar
  12. 12.
    Schulberg HC, Block MR, Madonia MJ, Scott CP, Rodriguez E, Imber SD, Perel J, Lave J, Houck PR, Coulehan JL. Treating major depression in primary care practice: Eight-month clinical outcomes. Arch Gen Psychiatry 1996;53(10):913-19.Google Scholar
  13. 13.
    Dwight-Johnson M, Sherbourne CD, Liao D, Wells KB. Treatment preferences among depressed primary care patients. J Gen Int Med 2000;15:527-34.Google Scholar
  14. 14.
    Brody DS, Khaliq AA, Thompson TL. Patients' perspectives on the management of emotional distress in primary care settings. J Gen Int Med 1997;12:403-6.Google Scholar
  15. 15.
    McKeon P, Carrick S. Public attitudes to depression: A national survey. Ir J Psychol Med 1991;8(2):116-21.Google Scholar
  16. 16.
    Dwight-Johnson M, Unutzer J, Sherbourne C, Tang L, Wells KB. Can quality improvement programs for depression in primary care address patient preferences for treatment? Med Care 2001;39(9):934-44.Google Scholar
  17. 17.
    Laube DW, Ling FW. Primary care in obstetrics and gynecology resident education: A baseline survey of residents' perceptions and experiences. Obstet Gynecol 1999;94:632-6.Google Scholar
  18. 18.
    The Henry J. Kaiser Family Foundation. Kaiser Family Foundation Capitol Hill Briefing Series on Women's Health Policy. Washington, DC: The Henry J. Kaiser Family Foundation, 2001.Google Scholar
  19. 19.
    Weisman CS, Cassard SD, Plichta SB. Types of physicians used by women for regular health care: Implications for services received. J Women's Health 1995;4(4):407-16.Google Scholar
  20. 20.
    Scholle SH, Kelleher K. Assessing primary care performance in obstetrics/gynecology clinic. Women Health 2003;37(1):15-30.Google Scholar
  21. 21.
    Beck AT, Steer RA, Carbin MG. Psychometric properties of the Beck Depression Inventory: Twenty-five years of evaluation. Clin Psychol Rev 1988;8(1):77-100.Google Scholar
  22. 22.
    Saunders JB, Aasland OG, Babor TF, Fuente JRDL, Grant M. Development of the Alcohol Use Disorders Identification Test (AUDIT): WHO collaborative project on early detection of persons with harmful alcohol consumption. Addiction 1993;88:791-804.Google Scholar
  23. 23.
    McLellan AT, Luborsky L, Woody GE, O'Brien, CP. An improved diagnostic evaluation instrument for substance abuse patients. J Ner Ment Dis 1980;168:26-33.Google Scholar
  24. 24.
    Starfield, BH. Primary care assessment for the development of a comprehensive primary care system for all children: Consumer/client survey. Baltimore: Child and Adolescent Health Policy Center, The Johns Hopkins University, 1995.Google Scholar
  25. 25.
    Hook MPV. Challenges to identifying and treating women with depression in rural primary care. Soc Work Health Care 1996;23(3):73-92.Google Scholar
  26. 26.
    Alvidrez, J. Ethnic variations in mental health attitudes and service among low-income African American, Latina, and European American young women. Community Ment Health J 1999;35(6):515-30.Google Scholar
  27. 27.
    Cooper-Patrick L, Powe NR, Jenckes MW, Gonzales, JJ, Levine, DM, Ford, DE. Identification of patient attitudes and preferences regarding treatment of depression. J Gen Int Med 1997;12(7):431-8.Google Scholar
  28. 28.
    U.S. Department of Health and Human Services. Mental health: A report of the Surgeon General. Rockville, MD: U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, Center for Mental Health Services, National Institute of Health, National Institute of Mental Health, 1999.Google Scholar
  29. 29.
    Robinson, JW, Roter, DL. Psychosocial problem disclosure by primary care patients. Soc Scie Med 1999;48:1353-1362.Google Scholar

Copyright information

© Plenum Publishing Corporation 2003

Authors and Affiliations

  1. 1.Psychiatry, Pediatrics and Health Services AdministrationUniversity of PittsburghPittsburgh

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