Social Determinants of Rural Hispanic Women at Risk for Postpartum Depression

Purpose: Postpartum depression is generally accepted as one of the common phenomena among childbearing women regardless of countries or culture. It is a critical and major problem for rural health. The Hispanic population is the largest and fastest growing minority in the United States. The growth of the Hispanic population is a profound factor to maintain and improve public health. Guided by the Orem’s Self-Care Deficit Theory as a theoretical framework, the purpose of this study was to identify the social determinants of rural Hispanic women at risk for postpartum depression. The specific aims for this study were twofold: (1) examine the relationships between the social factors (maternal age, infant gender, marital status, education, annual household income, job, delivery type, number of children, and religion) and women at risk for postpartum depression, and (2) determine which of the social factors were predictors that contribute to increased risk for postpartum depression in Hispanic women in the rural areas.

Methods: This study was a descriptive cross-sectional design. The sample for the study included Hispanic women who lived in Mecca, Thermal, and North Shore in Southern California. The women were in their postpartum period beginning right after childbirth and extending to 12 months post-delivery. A convenience sample of 223 Hispanic women ranging in age from 18 to 47 years old without medical diagnosis or treatments for mental health issues participated. They spoke either English or Spanish during the data collection. An interview-survey was utilized to collect the data. Based on the results of the Edinburgh Postnatal Depression Scale (EPDS) the study participants were divided into two groups: (1) women not at risk for postpartum depression (n = 128) and (2) women at risk for postpartum depression (n = 95). Descriptive statistics were used to describe the basic features of the data in this study. Chi-square was used to determine the relationships between the social factors (maternal age, infant gender, marital status, education, annual household income, job, delivery type, number of children, and religion) and the EPDS scores. Multiple logistic regression was also performed to determine the significant predictors for postpartum depression among the rural Hispanic women.

Results: The prevalence for Postpartum Depression (PPD) in this sample was about 43%. The average age of the 223 Hispanic women was 28.49 (SD = 6.01). Chi-square statistical test reported the significance in EPDS scores among social characteristics such as education level, delivery type, job condition, and number of children, p < .05. Multiple logistic regression analysis also indicated that four of the predictors were significantly related to the likelihood of having postpartum depression: delivery type (OR= 0.513, 95% CI = .290 - .905, p = .021); number of children (OR = .417, 95% CI = .203 - .858, p = .017); education levels (OR= 2.38, 95% CI =1.023 - 5.570, p = .044), and job condition (OR = 1.86, 95% CI = 1.017 - 3.432, p = .044).

Conclusion: The study findings provided the empirical data for determining the associations among the social determinants for postpartum depression among Hispanic women in rural communities. These findings can provide health care professionals with a better knowledge and understanding in the development of tailored preventive health care interventions or education for rural Hispanic women with postpartum depression, including approaches for self-care. Furthermore, these findings also provide the essential evidence to assist in the development of health policy for rural Hispanic women to enhance public health