Multilevel Barriers and Facilitators to Addressing Disparities in Perinatal Mental Health Restricted; Files & ToC

Abstract

Background: Black perinatal women face significant mental health disparities. In particular, Black women are at increased risk for trauma and stressor-related disorders, which have been shown to be associated with significantly increased risk for severe maternal morbidity. Few Obstetric departments screen patients for trauma and stressor-related disorders, and Black women are less likely to be insured and have access to perinatal care. To begin to address disparities in unmet trauma and stress needs among Black perinatal women, we conducted a sequential mixed-method study to identify multilevel barriers and facilitators to caring for the mental health of Black perinatal women experiencing trauma and stress. 

Methods: In Study 1, we used data from the National Survey on Drug Use and Health to identify determinants of mental health treatment utilization and perceived unmet mental health needs among a national sample of Black women of reproductive age with serious psychological distress. To contextualize these findings in Study 2, we used a patient centered access framework to qualitatively analyze focus group data with Black perinatal women, a group known to experience disproportionate trauma, stress, and maternal morbidity, to understand their experiences accessing mental health supports and recommendations to address barriers to access. In Study 3, we conducted in-depth interviews with OB/GYN providers and staff to understand their perspectives on provider and system-level barriers and facilitators to conducting trauma and stress-related screening and referrals.

Results: Employment and education were significantly associated with odds of using mental health services among Black women with serious psychological distress. Among those already accessing services, over half still report an unmet mental health need. Qualitative findings highlighted the role of medical mistrust as a core dimension influencing care seeking behaviors and the likelihood of disclosing trauma symptoms to a provider.

Conclusions: The sum of our findings indicates that barriers at multiple levels of the social ecology influence Black perinatal women’s access to trauma screening and services. To address disparities in access, programs and policies should invest in integrating mental health specialists and more robust social services in perinatal clinics and OB/GYN departments. This work should be in tandem with efforts to train OB/GYN providers and staff in best practices around implementation of culturally responsive trauma screening and services.  

Table of Contents

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About this Dissertation

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School	Laney Graduate School
Department	Behavioral Sciences and Health Education
Degree	Ph.D.
Submission	Dissertation
Language	English
Research Field	Health Sciences, Public Health Health Sciences, Mental Health
Palabra Clave	Perinatal Mental Health Trauma Health Equity Social Determinants of Health
Committee Chair / Thesis Advisor	Wood-Jaeger, Briana, Emory University
Committee Members	Sales, Jessica, Emory University Livingston, Melvin, Emory University

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