Article Critique: Postpartum depression in mothers
FULL REFERENCE:
Kozhimannil, K. B., Trinacty, C. M., Busch, A. B., Huskamp, H. A., & Adams, A. S. (2011). Racial and ethnic disparities in postpartum depression care among low-income women. Psychiatric Services.
RESEARCH QUESTION:
Are there are racial or ethnic differences and disparities in the prevalence of postpartum depression among African American, Hispanic, Native American, and White women?
RESEARCH HYPOTHESIS:
In the context that there exist significant knowledge and evidence gaps on other ethnic and racial groups in regard to the prevalence of post-partum depression, there is a high correlation between postpartum depression in low income African American women as compared to their White counterparts.
RESEARCH DESIGN:
The researchers utilized a risk analysis and correlation methods that sought to analyze the risk of a participant to post-partum depression and how that is influenced by the racial and ethnic status of the participant.
SAMPLING TECHNIQUE:
The researchers utilized a convenient sampling technique in which the sample was drawn from a region with comparable socio-economic status and where most of the other demographic variables were closely related. The sample was also picked in a region that would offer adequate numbers for each ethnic and racial group that was to be studied. The decision to abandon the random sampling technique was based on the fact that the setting from where the sample population was picked served a majority of people from underrepresented regions and thus leading got a case where a more convenient sample would reflect the status of the setting and the intentions of the study hypothesis. For instance there were significantly higher ratios of Native American and Hispanic women and on the other hand lower ratios for White.
INTERVENTION:
The researchers did not indicate any interventions for their study and the purpose was solely to determine the disparity and differences between the ethnic and racial groups in terms of post-partum depression prevalence.
DATA COLLECTION METHODS:
The researchers utilized a Post Partum Depression Screening Scale was utilized. The self-reported tool was used to identify the women at risk of post partum depression development. The PDSS has a total of 35 items that would measure depression and a further ten items that would record the demographic characteristics of the participants.
OUTCOME MEASURE(S):
The primary 35 items were grouped into seven subtypes or subscales for symptoms namely anxiety/insecurity, sleeping and eating disturbances, mental confusion, emotional lability, guilt/shame, loss of self as well as suicidal thoughts.
DATA ANALYSIS TECHNIQUES:
For the first seven items, if the score was recorded as less than 14, the full screening was not conducted as the participant was noted to be within normal adjustment. A score higher than 14 or equal to 14 would require the client to complete the other 28 items on the same day. Once completed, the score of between 60 and 79 would classify the participant as having minor depression while anything higher would be regarded as major depression. In these two cases if major and minor depression, the participant is classified ad appropriate to receive treatment. Factor analysis was then employed to determine the similarities between the African American, Hispanic, Native American, and White populations.
SAMPLE:
Initially, the sample included a total of 1, 145 post-partum clients but only a total of 586 individuals were considered eligible for the study and the data required. Based on the results of the PDSS, the participants were referred to subsequent referrals as would be necessary for each of them.
RESULTS:
Lower depression rates of up to 2.5% were recorded for the Hispanic women than within any other group. There were no statistically significant differences in major depression among Native Americans, African Americans and Whites but there was a indication that the Whites has higher incidences of minor depression. On the other hand, the Native American women were recorded as having higher incidences of major depression at approximately 18.7% as well as average minor depression of up to10.5%. While the study does offer not significant differences in the racial and ethnic cases, there is a string correlation between depression with breastfeeding history and depression history. The cause for this has not been investigated and the researchers are of the view that this is an area that future research should focus to ascertain these correlations.
FULL REFERENCE:
Wei, G., Greaver, L. B., Marson, S. M., Herndon, C. H., & Rogers, J. (2008). Postpartum depression: Racial differences and ethnic disparities in a tri-racial and bi-ethnic population. Maternal and Child Health Journal, 12(6), 699-707.
RESEARCH QUESTION:
While the researchers do not necessarily present any particular research question, the background, introduction and purpose of the study seek to answer the question; “Are there any relatable racial and ethnic differences in utilization of mental healthcare services for post-partum depression?”
RESEARCH HYPOTHESIS:
The researchers have not included any hypothesis that guides the research. However, strong indications from the choice of literature utilized in the background in section show that the researchers have a predetermined narrative that blacks and Latino women were less likely to utilize mental health services even when accessible to them as compared to the Whites.
RESEARCH DESIGN:
The researchers utilized a retrospective cohort study in which all participants are deemed to share common pre-disposure or exposure factors and then compared to another group that is not entirely or in any way exposed to the factors determined as influencing the variables. This method was appropriate for this study as it would among other things investigate how the exposure factors independently and collaboratively influence the behavior under investigation.
SAMPLING TECHNIQUE:
The study utilized convenient sampling methodology based on the administrative claims records for the New Jersey’s Medicaid system. While this study may have limited the diversity of the sample population, it was appropriate since it offered a chance to include the racial and ethnic populations which were the most important variable under investigation on their influence to access to mental care services.
INTERVENTION:
The study is a correlation study that sought to determine the causal variables and does not investigate the interventions. The researchers intended to unearth the causal effects from which the results would then be used to develop responsive interventions in future research.
DATA COLLECTION METHODS:
The researchers identified the pharmacy claims for depressants for the sample population from the national drug codes as well as the First DataBank. This was also augmented with data from the American Hospital Formulary Service. to investigate the outpatient mental health utilization, the researchers opted for the International Classification of Diseases, Ninth Revision(ICD-9) coding and standards while all other individual, group or family visits to an outpatient psychotherapy professional were considered outpatient mental health visits if not coded otherwise. The utilization of the coding methods and standards was based on the need to have credible evidence considering that a large sample population was being utilized and raw data would be prone to errors and misses.
OUTCOME MEASURE(S):
The study had three primary outcomes namely mental health treatment commencement or initiation, receipt for continued care and follow-up. There was special focus on the need to have the time from delivery to initiation of treatment for post partum depression since it would indicate the willingness within the racial and ethnic groups since early visits have been determined as being for effective than late visits.
DATA ANALYSIS TECHNIQUES:
The researchers opted for logistic regression to estimate the racial and ethnic differences for the commencement for outpatient mental health visits in the first six months post-delivery, initiation/commencement of antidepressant medication, follow-up issues such as second visit and prescription refills as well as continued mental assessment and healthcare.
SAMPLE:
The study utilized data of up to 29, 601 women who had delivered babies in the period between July 2004 and October 20007 and were within the Medicaid program. The sample included 13, 416 Blacks, 13, 001 Whites and 3, 184 Latinas. The inclusion of the three races was based on the fact that they present the numbers that can offer substantive data and eliminate any discrepancies that would be experienced with a small sample and a convenient sampling technique.
RESULTS:
The black women had the lowest rates for initiation to postpartum mental healthcare at only 4%, followed by Latinos as 5%and the whites as 9%. When clinical factors were controlled, there were significantly lower odds for black women (adjusted odd ratios = .43) and Latinos (adjusted odd ratios = .59) as compared to the whites on initiation of treatment. The odds for follow-up treatment were lower in Blacks (adjusted odd ratios = .66) and Latinos (adjusted odd ratios = .67) as compared to whites. The same was noted for the odds for continued care with blacks (adjusted odd ratios = .81) and Latinas (adjusted odd ratios = .67) indicating lower odds than the whites. For those that initiate treatment with antidepressants, the chances of prescription refill was lower in blacks and Latinos and significantly higher in their white counterparts.
