Pennington Biomedical Research Center, 6400 Perkins Road, Baton Rouge, LA, 70808, USA.
University of Kansas Medical Center, Kansas City, KS, USA.
BMC Public Health. 2024 Nov 21;24(1):3244. doi: 10.1186/s12889-024-20745-w.
Stressful large-scale events, such as the COVID-19 pandemic and natural disasters, impact birthing individuals' postpartum experiences and their mental health. Resultant changes in government assistance, housing, and employment may further exacerbate these impacts, with differences experienced by varying income levels and races. This study aimed to examine maternal depression and anxiety in postpartum individuals by income and race during a stressful large-scale event, and the mediating role of government assistance, housing, and employment.
An explanatory sequential mixed methods study was conducted (QUANT + QUAL). For aim 1 (quantitative), birthing individuals who delivered during peak pandemic (June 2020 - September 2021) completed questionnaires related to their perinatal experiences and mental health. Macrosystem factors (government assistance, housing, and employment changes) were assessed using the Psychosocial Recommended Measures. The Edinburgh Postnatal Depression Scale (EPDS) and the Generalized Anxiety Disorder-7 (GAD7) assessed depression and anxiety, respectively. Serial linear regression models assessed the relationship between race and income with mental health and macrosystem factors. For aim 2 (qualitative), 40 individuals from the quantitative study balanced by income (low vs. high income) and race (Black vs. White) completed one-on-one semi-structured interviews which were analyzed using thematic analysis.
Amongst 1582 birthing individuals, Black individuals had a significantly higher EPDS score compared to White counterparts. Not receiving government assistance, unstable housing, and experiencing various employment changes were all related to worse mental health during stressful large-scale events. In semi-structured interviews, low-income individuals discussed that government assistance helped alleviate a financial and mental burden. Low- and high-income individuals reported varying job changes that impacted their mental health (low-income: job loss, high-income: increased hours).
This research spotlights the negative impact of large-scale events most affected both Black and low-income individuals' postpartum mental health, and the role of government assistance, stable housing, and secure employment in helping to alleviate these disparities between income levels.
COVID-19 大流行和自然灾害等压力大的大规模事件会影响产妇的产后体验和心理健康。政府援助、住房和就业方面的变化可能会进一步加剧这些影响，不同收入水平和种族的人会有不同的经历。本研究旨在探讨在压力大的大规模事件期间，按收入和种族划分的产妇产后抑郁和焦虑情况，以及政府援助、住房和就业的中介作用。
本研究采用解释性顺序混合方法（QUANT+QUAL）进行。目的 1（定量）中，在疫情高峰期（2020 年 6 月至 2021 年 9 月）分娩的产妇完成了与围产期经历和心理健康相关的问卷。宏观系统因素（政府援助、住房和就业变化）使用心理社会推荐措施进行评估。爱丁堡产后抑郁量表（EPDS）和广泛性焦虑障碍 7 项量表（GAD7）分别评估抑郁和焦虑。序列线性回归模型评估种族和收入与心理健康和宏观系统因素之间的关系。目的 2（定性）中，对定量研究中的 1582 名产妇按收入（低收入与高收入）和种族（黑种人与白种人）进行平衡，其中 40 人完成了一对一的半结构化访谈，使用主题分析进行分析。
在 1582 名产妇中，黑种人 EPDS 评分明显高于白种人。在压力大的大规模事件期间，未获得政府援助、住房不稳定和经历各种就业变化与心理健康状况恶化有关。在半结构化访谈中，低收入个体表示政府援助有助于减轻经济和精神负担。低收入和高收入个体报告了不同的工作变化，这些变化影响了他们的心理健康（低收入：失业，高收入：工作时间增加）。
本研究强调了大规模事件对黑人和低收入产妇产后心理健康的负面影响，以及政府援助、稳定住房和稳定就业在缓解收入水平差异方面的作用。
