A rural perspective on perinatal depression: prevalence, correlates, and implications for help-seeking among low-income women.
CONTEXT/PURPOSE: To examine a low-income sample of women in the rural Midwest (N = 1,086) who were screened for perinatal depression through the outreach and education activities within a Healthy Start Initiative project. Specifically, we describe the frequency and severity of depressive symptoms, explore social and demographic correlates of depression, and examine help-seeking through patterns of self-referral to a Healthy Start perinatal depression project in a rural, medically underserved community.


METHODS
Depression screening data using the Primary Care Evaluation of Mental Disorders (PRIME-MD) as well as intake records from the project were analyzed in a retrospective analysis to identify important demographic and psychosocial characteristics associated with elevated levels of depressive symptoms and help-seeking patterns.


RESULTS
Thirty-six percent of screened women met criteria for major, minor, or subthreshold depression, with 13% meeting diagnostic criteria for major depression alone. Less than 8% were currently receiving any type of mental health services or treatment at screening. The most significant correlate of self-referral to the Healthy Start project was meeting symptom criteria for major depression, although minor depression, subthreshold depression, and status as low-income/Temporary Aid to Needy Families (TANF)-eligible were all significantly associated with self-referral.


CONCLUSIONS
The findings from this study highlight the potential significance of identifying and addressing the unmet mental health needs of low-income rural women during and around pregnancy. In addition, the study illustrates that low income, in addition to depressive symptoms, impacts mental health service delivery in this rural community with a fragmented mental health service infrastructure.
School of Social Work, Virginia Commonwealth University, Richmond, VA 23284, USA. skprice@vcu.edu
Sarah Kye
SK
Price
Enola K
EK
Proctor
D000293:Adolescent; D000328:Adult; D019052:Depression, Postpartum / Q000453:epidemiology* / Q000628:therapy; D003865:Major Depressive Disorder / Q000453:epidemiology; D005260:Female; D006297:Health Services Accessibility; D006801:Humans; D016015:Logistic Models; D008605:Mental Health Services; D008923:Missouri / Q000453:epidemiology; D016017:Odds Ratio; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data; D011203:Poverty / Q000706:statistics & numerical data; D011247:Pregnancy; D015995:Prevalence; D012424:Rural Population / Q000706:statistics & numerical data; D055815:Young Adult