Evaluating a Culturally Specific Approach to Perinatal Depression Screening

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Evaluating a Culturally Specific Approach to
Perinatal Depression Screening

• Sarah Kye Price, PhD, MSW
• Sandii Leland Handrick, MPH

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Perinatal Depression Screening Why and Who
Benefits?

• Identify women at elevated risk for depression
• Assist in developing strategies to bridge the gap
  between need and service use
• Critical time period for intervention mothers and
  their infants
• May be the one time in life when routine mental
  health assessment is provided to low-income women

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Cultural Relevance

• Does depression exist in the definition of an
  expert (or instrument) only?
• What does the community believe about depression?
• When is treatment acceptable to the community?
• How do we begin to integrate cultural relevance
  with our efforts to screen and intervene in
  perinatal depression?

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Moving Toward Culturally Informed Depression
Screening

• Mixing Scientific Rigor and Cultural Relevance

From the Projects Perspective Sandiis
Story From the Evaluators Perspective
Sarahs Story
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Steps in the Process

• Joint selection of most appropriate, validated
  depression screener that could identify levels of
  risk
• Addition of 5 tag on questions that reflect the
  communitys own perceptions of depression
• Creation of levels of risk assessment that mesh
  scientific and community standards
• Validity and reliability testing of the original
  instrument and the culturally informed tool to
  evaluate the potential benefit of community items

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Culturally Informed Tag On Questions

• I feel like everyone is against me
• I feel angry or irritable
• I feel like giving up
• I feel like hurting myself, my pregnancy/baby, or
  others
• Im worried that something might happen to myself
  or my baby

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Defining Risk Levels

• High Risk (Immediate Guided Referral)
• CES-D score of 20 or greater OR
• tag on question of harm to self or others at
  2 or greater OR
• tag on question of worry about harm to self or
  child at 2 or greater
• Medium Risk (Referral and Follow-Up)
• Client does not meet High Risk criteria
• CES-D score is 10 or higher OR
• CES-D score of 6 or higher and two tag on
  questions at 2 or higher
• Low Risk (General Support, Referral, or
  Monitoring)
• Client does not meet High or Medium risk, but
  given referral or support if they voice stressful
  life events

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Demographics

• Maternal Race by Category Baseline
  (N139) Follow-Up (N40)
• African-American or Black, non-Hispanic 133
  95.7 37 94.9
• Caucasian or White, non-Hispanic 6
  4.3 2 5.1
• Maternal Age by Category Baseline
  (N139) Follow-Up (N40)
• Under 18 62 44.6 21 53.8
• 19-23 36 25.9 8 20.5
• 24-28 26 18.7 8 20.5
• 29 and over 15 10.8 2 5.1
• Pregnancy and Prenatal Status Baseline
  (N139) Follow-Up (N40)
• Prenatal 37 26.6 11 27.5
• Postpartum 24 17.3 16 40.0
• Missing/Unknown 78 56.1 13
  32.5

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Risk Levels for Participants Completing all
Screening Items

• Baseline (N135) Follow-Up (N39)
• High Risk 23 (16.5) 7 (17.9)
• Medium Risk 25 (18) 6 (15.4)
• Low Risk 87 (62.6) 26 (66.7)
• Baseline perinatal depression screening at time
  of Healthy Start intake follow-up perinatal
  depression screening analyzed for available data
  on participants at 3 months after first intake

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CES-D Alone and Total Score for Project
Participants

• Baseline (N135) Follow-Up (N39)
• CES-D Score (Mean) 7.51 7.63
• Met CES-D
• Cut Off Score of 10 44 (31.7)
  14 (35)
• Total Score (Mean) 9.69 9.69
• (CES-D plus
• Community-informed
• Items)

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Summary of Validity and Reliability Testing

• Community informed screener higher internal
  consistency (Cronbachs alpha .87 versus .80
  for CES-D alone)
• All community-informed items have significant
  inter-item correlation with the CES-D items
  except Im afraid something will happen to
  myself or my baby
• Criterion validity is high with both the CES-D
  cut-off (.61-.74) and the projects high risk
  category (.61-.78)

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Community and Project Response and Receptivity

• Clients are receptive because screening is
  presented in culturally competent way
• --Routine, because
• More women willing to accept help.
• Field reports mostly situational depression and
  more referrals being made

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Implications

• Level of depression in participants exceeds
  population norms (15) but may be consistent with
  other studies of low-income women 1,2,3
• Validity and reliability of community-informed
  screener meets or exceeds that of the CES-D alone
• Integration of community concerns into risk
  levels may help identify women at highest need
  who are most receptive to referral and service
  use, vs. reliance on screening cut off alone

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Questions and Comments