the boston healthy start initiative depression among black women in the boston healthy start project...
TRANSCRIPT
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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
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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.
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Boston Healthy Start Initiative
A program designed to reduce perinatal disparities in health in Boston areas with the
highest infant mortality rates.
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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
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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
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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
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Mental Health Task Force
Convened to address depression Recruitment done through the BHSI
Consortium Members included:
case managers mental health providers other frontline staff
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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
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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
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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
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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
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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
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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
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Depression Prevalence
WHQ vs. BDI-II: During Pregnancy
13.4% N=506
33.7% N=718
WHQ BDI
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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.
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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:
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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
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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
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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
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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
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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
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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
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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
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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
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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
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Next Steps….
Continued case management for Healthy Start women, utilizing holistic and creative approaches.
Further evaluation and refinement of BHSI interventions for depression.