Measuring Peripartum Depression Symptoms in Latina and Black Women

• In Event: Poster Session 03
  In Poster Session: PS 03 Topic - Family Context & Processes

Abstract

Introduction
Peripartum depression (PeriPD) is characterized by a major depressive episode during the prenatal period or within four weeks postpartum (American Psychiatric Association, 2013). Depressive symptoms may continue and studies often extend up to one-year postpartum (Christensen, 2011; Miller, 2012; Ohara & McCabe, 2013). Latina and Black women are at especially high risk for PeriPD; 37% of these women suffer depressive symptoms compared to 10-15% for all women (Lara et al., 2009; Wilusz et al., 2014). Screening measures for PeriPD sensitive to the unique experiences of Latina and Black women are needed for early detection, diagnosis, and treatment.

Hypotheses
In this small pilot sample we hypothesized: 1) women with higher PeriPD symptoms would be more likely to participate as they would want to engage in an opportunity to talk about their feelings; 2) scores from a prenatal self-report survey would have high concordance with results from a post-partum semi-structured clinical interview. We explored the utility of follow-up questions afforded by a semi-structured interview when working with this population.

Study population
Participants were recruited from the Fair Start birth cohort at Columbia Center for Children’s Environmental Health, an epidemiologic sample of mostly low-income Latina and Black women who delivered at the New York Presbyterian Hospital.

Methods
We administered the Edinburgh Postnatal Depression Scale (EPDS) to screen during the third trimester of pregnancy. The Structured Clinical Interview for Diagnosis (SCID-5) assessed Diagnostic and Statistical Manual-5 (DSM-5) criteria for disorders at 3-months postpartum. In contrast to structured interviews (e.g., Mini International Neuropsychiatric Interview), the semi-structured interview allows for rephrasing of questions through synonymous and colloquial words/phrases to be more inclusive of cultural differences, experiences, and literacy levels, facilitating greater participant comprehension and participation.

Results and Conclusions
Thirty mothers, 6 with high and 24 with low EPDS scores were invited to participate and 16 (nHighEPDS=4, nLowEPDS=12) completed the SCID-5: 11 in English and 5 in Spanish. Mothers with high EPDS scores were at least, if not more likely to participate in research as mothers with low EPDS scores: two thirds (4 of 6) of mothers with high EPDS scores agreed to participate, as did half (12 of 24) of mothers with low EPDS scores.

Of the 4 mothers with high EPDS scores and SCID-5 interview, only one met diagnostic criteria for PeriPD at 3-months postpartum. Three mothers with low EPDS scores also met criteria for PeriPD using the SCID-5. Thus a high score on the Edinburgh only predicted 25% of positive cases whereas a low score predicted 75% of negative cases. The concordance between EPDS and SCID-5 was higher in non-depressed (9/12) than depressed mothers (1/4). During the Spanish administration of the SCID-5, the need to rephrase, change question wording, and add words/phrases was common.

Given the increased risk for PeriPD among Latina and Black women, culturally competent, linguistically accessible, and timely methods of diagnosis are needed to elicit information from these women. Future studies of PeriPD symptoms in these populations should include measures of depressive symptoms across pregnancy and the postpartum period.

Authors

• amarelis raudales, Columbia University
  Presenting Author

• Bruce Ramphal, Columbia University
  Non-Presenting Author

• Julie Herbstman, Columbia University
  Non-Presenting Author

• Beatrice Beebe, New York State Psychiatric Institute
  Non-Presenting Author

• Prudence Fisher, Columbia University
  Non-Presenting Author

• Amy Margolis, Columbia University
  Non-Presenting Author