In a new position paper, researchers at the University of Illinois at Urbana-Champaign and Northwestern University urge federal policymakers to appropriate funds toward diagnosis and treatment of perinatal depression in minority women — a group they say has been lacking in such care.
Such a move would include increasing the number of medical providers who are trained in culturally sensitive screening and treatment methods.
Perinatal depression is defined as a major depressive episode occurring during pregnancy or within the first year after giving birth. It is the most common complication of childbearing.
Although perinatal depression is estimated to affect about 12 to 19 percent of women in the general population, rates are believed to be significantly higher among minority women. As many as 43 percent of Latinas and up to 28 percent of African-American women may be affected, according to the researchers.
Yet despite this increased risk for perinatal depression among Latina and African-American women, research has shown that minority females are significantly less likely to be screened or treated for symptoms. And this continues to be the case even with the wide availability of reliable screening tools and national awareness campaigns.
University of Illinois kinesiology and community health professor Sandraluz Lara-Cinisomo, Ph.D., co-wrote the paper with psychiatrist Dr. Crystal T. Clark of the Northwestern University Feinberg School of Medicine, who specializes in perinatal depression in African-American women; and Jayme Wood, then a graduate student at University College London.
The researchers note that along with financial obstacles, including higher poverty rates and lack of health insurance, other barriers such as immigration status may prevent minority women from being screened and treated.
The stigmatization of mental illness and mistrust of the healthcare system that are generally found in American culture are even more pervasive among African-American and Latino communities, according to the paper.
Concerns about stigmatization may be further complicated by cultural beliefs about motherhood and women’s role in the family, the researchers suggest. Among Latinas, for example, the concept of “marianismo” — the belief that mothers should be self-sacrificing, strong women who promote their family members’ well-being over their own — may limit their treatment-seeking.
In a similar fashion, African-American women may feel pressure to live up to the ideal of the strong black woman by toughing it out or by trying to overcome depression through inner strength alone, Lara-Cinisomo said.
A new Illinois law beginning on June 1 will make untreated or undiagnosed postpartum depression or psychosis — a more severe form of the disease — a mitigating factor if it’s found that a woman’s involvement in a crime, such as a life-threatening event with her child, was due to one of these disorders.
“Illinois is breaking new ground in this regard. I feel very proud to live in the state, given the work that’s going on around perinatal mental health,” Lara-Cinisomo said. “However, there are other states that make it a legal risk for women to report. The current political climate makes it very dangerous for Latinas to discuss their depressive symptoms.”
Many low-income minority women have a strong fear that disclosing symptoms of mental illness could cause them to lose custody of their children, and so establishing trust with their healthcare providers is critical, Lara-Cinisomo said.
“It is important to launch campaigns to help mothers feel safe in their reporting of depressive symptoms. Simple education, information and awareness are low-investment, high-benefit actions that providers in health settings serving high-risk women can take,” Lara-Cinisomo said.
“There are a number of opportunities for providers at multiple levels — nurses, nurse practitioners, physicians and obstetrician-gynecologists — to discuss perinatal depression with women.”
Sharing statistics on its prevalence and treatability can help reduce feelings of shame and stigma while building patient trust, she added.
In particular, women need advice on the effectiveness, potential risks to mother and baby, confidentiality and costs associated with the recommended treatments of medications and psychotherapy, the researchers wrote.
Finally, education interventions for perinatal depression seem to be most effective when given to women before delivery, Lara-Cinisomo said.
The paper is published in the journal Women’s Health Issues.