A Prospective Study of Social Needs Associated with Mental Health among Postpartum Patients Living in Underserved Communities

Abstract

Objective Given the rising rates of maternal morbidity and mortality in the United States and the contribution of mental illness, especially among individuals living in underresourced communities, the objective was to evaluate the prevalence of unmet health-related social needs and their impact on perinatal mental health outcomes.

Study Design This was a prospective observational study of postpartum patients residing within regions with increased rates of poor perinatal outcomes and sociodemographic disparities. Patients were enrolled in a multidisciplinary public health initiative “extending Maternal Care After Pregnancy (eMCAP)” between October 1, 2020 and October 31, 2021. Unmet health-related social needs were assessed at delivery. Symptoms of postpartum depression and anxiety were evaluated at 1 month postpartum utilizing the Edinburgh Postnatal Depression Scale (EPDS) and Generalized Anxiety Disorder-7 (GAD7) screening tools, respectively. Mean EPDS and GAD7 scores and odds of screening positive (scoring ≥ 10) were compared among individuals with and without unmet health-related social needs with p < 0.05 considered significant.

Results Of participants enrolled in eMCAP, 603 completed at least one EPDS or GAD7 at 1 month. Most had at least one social need, most commonly dependence on social programs for food (n = 413/603; 68%). Individuals lacking transportation to medical (odds ratio [OR]: 4.0, 95% confidence interval [CI]: 1.2–13.32) and nonmedical appointments (OR: 4.17, 95% CI: 1.08–16.03) had significantly higher odds of screening positive on EPDS while participants lacking transportation to medical appointments (OR: 2.73, 95% CI: 0.97–7.70) had significantly higher odds of screening positive on GAD7.

Conclusion Among postpartum individuals in underserved communities, social needs correlate with higher depression and anxiety screening scores. This highlights the need to address social needs to improve maternal mental health.

Key Points

• Social needs are prevalent among underserved patients.

• Needs can be assessed in a structured or freeform manner.

• Unmet needs correlate with poor mental health outcomes.

• Similar needs correlate with depression and anxiety.

Keywords

health-related social needs - Edinburgh Postnatal Depression Scale - extending Maternal Care After Pregnancy - generalized anxiety disorder - maternal morbidity - maternal mortality - mental health - social determinants of health

Publication History

Received: 28 December 2022

Accepted: 19 June 2023

Accepted Manuscript online:
20 June 2023

Article published online:
29 July 2023

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