Engaging Pregnant Women At-Risk for Perinatal Depression in Treatment

Abstract

Background: Perinatal depression (PND) disproportionally affects low-income, ethnic minority women (Fisher et al., 2016; Goyal, Gay, & Lee, 2010). Although there are effective treatments for PND (Werner et al., 2015), rates of professional help seeking are low among this vulnerable population (Schmied et al., 2016). Many efforts to improve treatment seeking have neglected patient-level barriers to help seeking, including practical barriers (Buchberg et al., 2015), mental health literacy barriers (Dennis & Chung-Lee, 2006), and cultural barriers (Gary, 2005; Hansotte, Payne, & Babich, 2017). A small number of studies suggested that the Engagement Interview, based on Motivational Interviewing and Ethnographic Interviewing increased service initiation and retention (Swartz et a., 2006). Method: The current study examined the efficacy of the Engagement Interview among a sample of 10 low-income, ethnically diverse pregnant women recruited from local health and social service organizations. The study explored whether attitudes toward mental health, help seeking intentions, and help seeking behavior improved following the Engagement Interview compared to a control condition. In addition, the study examined the utility of psychosocial risk factors to predict anxiety and depression across the perinatal period. Results: Psychosocial risk groups did not adequately predict anxiety and depression across the perinatal period; however, single mothers with low social support and a history of childhood abuse were more likely to show elevated depressive symptoms postpartum. Participants in the Engagement Interview condition did not demonstrate improved attitudes toward mental health, help seeking intentions, or treatment seeking behavior. There was some evidence however, that these women were more likely to seek social support during their third trimester. Strengths and Limitations: Strengths included the representation of low-income, ethnic minority women and recruitment from the community. Limitations included the small sample size and referrals to outside behavioral healthcare settings. Future research should consider investigating the Engagement Interview in an integrated women’s health setting and use of a community-based participatory research methodology. Clinical Implications: Recruitment challenges further demonstrate the need for linguistically and culturally sensitive research and clinical practices. Certain psychosocial variables should be considered when screening and referring perinatal women for treatment, especially low social support and a history of childhood abuse. Stigma related to mental health and cultural factors play a key role, but a one-time brief intervention is not sufficient to improve treatment seeking.