The Boston Healthy Start Initiative

Depression Among Black Women in the Boston Healthy Start Project Area

Urmi Bhaumik, MBBS, MS, DSc.Local Evaluator, Boston Healthy Start Initiative

Boston Public Health Commission

Maia BrodyField, MPHSenior Manager

Boston Public Health Commission

Objectives of Presentation

To describe the development and implementation of a depression screening initiative among Healthy Start women.

To report on the preliminary findings of the Boston Healthy Start women’s experience of depression during pregnancy and up to 2 years after delivery.

Boston Healthy Start Initiative

A program designed to reduce perinatal disparities in health in Boston areas with the

highest infant mortality rates.

BHSI MODEL

BHSI has a holistic case management model that includes services for mental health and interconceptional care

BHSI relies heavily on its Consortium--a partnership of community residents and agencies, and local government health organizations

Target Population

BHSI targets Black women in Boston neighborhoods experiencing racial disparities in perinatal health

Black women are defined as: African American Haitian Cape Verdean African Black Latinas

Needs Assessment

Focus groups with providers and consumers were conducted prior to the latest phase of the Boston Healthy Start Initiative

Depression was identified to be a major problem among women of color

Mental Health Task Force

Convened to address depression Recruitment done through the BHSI

Consortium Members included:

case managers mental health providers other frontline staff

Depression Screening Tools

BHSI consumers reviewed a number of depression screening tools like the Edinburgh PP and the self-rating Anxiety Scale

The Mental Health Task force decided to use the Beck tool based on consumer recommendation

Women are screened three times: At the point of entry into the program At the end of 8 weeks post-partum At the end of the first year after delivery

Women's Health Questionnaire (WHQ)

In addition women are offered an in-depth health assessment using the WHQ

A self administered tool Assesses health and social problems along with

depression It is offered:

At the point of entry At the end of the 1st year after delivery At the end of the 2nd year after delivery

Depression Prevalence: WHQ

506 women have responded to the Women’s Health Questionnaire at the point of entry

13.4% responded as being depressed at present

24.1% reported they suffered from depression either at present or in the past.

Source: Women’s Health Questionnaire

Depression Prevalence: BDI

During Pregnancy

moderately depressed

10.6%

severely depressed

7.5%

mildly depressed15.6%

nondepressed66.3%

One in three (33.7%) women scored positive for depression using the BDI

Source: Beck Depression Inventory Tool

Depression Prevalence: BDI

At Postpartum Period

Almost two out of ten (19%) women scored positive for depression.

moderately depressed

6%severely

depressed5%

mildly depressed8%

nondepressed81%

Source: Beck Depression Inventory Tool

Depression Prevalence: BDI

At 1-year Interconception

Eighteen percent of BHSI clients scored positive for depression.

moderately depressed

7%

severely depressed

4%

mildly depressed7%

nondepressed82%

Source: Beck Depression Inventory Tool

Depression Prevalence

WHQ vs. BDI-II: During Pregnancy

13.4% N=506

33.7% N=718

WHQ BDI

Depression Prevalence

WHQ vs. BDI-II: During Pregnancy

A notable difference between depression prevalence obtained from WHQ responses compared to BDI-II scoring

Likely reason is that BDI-II is designed to capture depression if present and WHQ is the women’s perception of being depressed or not.

Depression Symptoms

During Pregnancy: Changes in Sleeping

Pattern Loss of Interest in Sex Changes in Appetite Crying Punishment Feelings

Source: Beck Depression Inventory

During Postpartum: Crying Changes in Sleeping

Pattern Loss of Interest in Sex Loss of Interest Agitation

Top 5 symptoms reported as severe:

Depression and Ethnicity

Depression differs across ethnic groups with the lowest prevalence among Haitians

Compared to Haitians: African Americans are eight times more likely

to be depressed Latinos are almost six times more likely to be

depressed All others are three times more likely to be

depressedSource: Women’s Health Questionnaire

Depression and Birthplace

The odds of being depressed are 3.1 times (p-value < 0.001) higher in those born in USA compared

to those born abroad.

Source: Women’s Health Questionnaire

Depression and Other Factors

Adjusting for demographic and socio-economic factors, depression is also associated with:

Family Problem: OR 5.4* Substance Use: OR 4.5* Smoking: OR 2.1, p-value** Health Care Access Problem: OR 1.7***

Source: Women’s Health Questionnaire

* p-value <0.001; ** p-value <0.05

*** p-value <0.1

Attitude Towards Depression

Surveys on attitudes towards depression were administered to providers and clients

Findings show that depression is not perceived as a problem by many women scoring high in the BDI

The BHSI population has a high threshold for depression, being consistently exposed to stress

Denial is a factor for many clients

Don’t want to be labeled as depressed due to fear of the mental health system

Not familiar with variations in mental health issues: “you are crazy or you are not”

Attitude Towards Depression

Interventions

Case managers provide education and support about depression

Referrals are made to community based resources

Women are consistently encouraged and reminded to keep their appointments

Distribution of educational materials on mental health/well-being

BHSI Interventions

Creative approaches for clients to address emotional and physical needs of women:

“Sister’s Circle” – addresses the emotional and spiritual needs of women through monthly meetings and bimonthly individual coaching

“Slim Down Sisters” - focuses on the physical well being of the women

Conclusions

A significant proportion of Black women experience depression; in addition to those who experience postpartum depression, many begin their pregnancies depressed

Holistic case management and creative approaches are needed to address this need among inner city Healthy Start women

Conclusions

suggest a positive effect of screening and subsequent case referral and management.

18 %

19%

34%Pregnancy

Postpartum

Interconception

Decreasing depression prevalence rates across different time points of care

Next Steps….

Continued case management for Healthy Start women, utilizing holistic and creative approaches.

Further evaluation and refinement of BHSI interventions for depression.