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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, MPH Senior Manager Boston Public Health Commission.

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The boston healthy start initiative

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, MPH

Senior Manager

Boston Public Health Commission


Objectives of presentation
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
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 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
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
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
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
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
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


DepressionPrevalence: 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
DepressionPrevalence: BDI

During Pregnancy

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

Source: Beck Depression Inventory Tool


Depression prevalence bdi1
DepressionPrevalence: BDI

At Postpartum Period

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

Source: Beck Depression Inventory Tool


Depression prevalence bdi2
DepressionPrevalence: BDI

At 1-year Interconception

Eighteen percent of BHSI clients scored positive for depression.

Source: Beck Depression Inventory Tool


DepressionPrevalence

WHQ vs. BDI-II: During Pregnancy


DepressionPrevalence

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
Depression Symptoms

During Pregnancy:

  • Changes in Sleeping Pattern

  • Loss of Interest in Sex

  • Changes in Appetite

  • Crying

  • Punishment Feelings

Top 5 symptoms reported as severe:

During Postpartum:

  • Crying

  • Changes in Sleeping Pattern

  • Loss of Interest in Sex

  • Loss of Interest

  • Agitation

Source: Beck Depression Inventory


Depression and ethnicity
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 depressed

Source: Women’s Health Questionnaire


Depression and birthplace
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
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***

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

*** p-value <0.1

Source: Women’s Health Questionnaire


Attitude towards depression
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


Attitude Towards Depression

  • 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”


Interventions
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
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
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


Conclusions1
Conclusions

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

  • Decreasing depression prevalence rates across different time points of care


Next steps
Next Steps….

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

  • Further evaluation and refinement of BHSI interventions for depression.


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