Major depression affects over 600,000 pregnant women annually and has been consistently linked with numerous adverse consequences for mothers and developing infants, including higher rates of spontaneous abortion, preeclampsia, operative delivery, and postpartum depression. Although promising interventions have been developed to treat the disorder, treatment-seeking rates remain alarmingly low, particularly among pregnant women from low-income and racial/ethnic minority backgrounds. A critical need exists to find ways to increase appropriate treatment-seeking in depressed pregnant women, particularly those from poor and minority backgrounds. Prior to developing interventions or implementing system changes that attempt to increase treatment seeking rates, we must first understand the barriers that exist to treatment utilization. Given the lack of any published research in this area, researchers currently know little about these barriers, or how these barriers may differentially affect pregnant women from underserved groups. We propose an exploratory mixed methods study that will be the first empirical investigation of barriers to depression treatment during pregnancy, with a particular focus on identifying issues of most relevance to certain underserved patient groups. Specifically, this investigation will target low-income depressed Latina and non-Latina White patients at an obstetrical clinic serving financially disadvantaged women. We will integrate quantitative and qualitative methods to explore women's attitudes regarding depression treatment-seeking, and to clarify processes by which symptoms are recognized and treatment decisions are made. Our research will address three primary aims: (1) To identify specific factors and barriers that lead low-income, depressed pregnant women to pursue depression treatment, or to not pursue treatment;(2) To evaluate the acceptability of specific treatments for antenatal depression;(3) To develop a preliminary model of the processes by which depressed pregnant women interpret symptoms and choose whether or not to seek treatment. On a more exploratory basis, we will examine whether or not differences are observed between Latina and non-Latina White women with regard to each of the primary aims. Depression during pregnancy is associated with numerous adverse consequences for mothers and their developing infants;however, the majority of depressed pregnant women do not receive any treatment. This study will examine the reasons why some pregnant women seek help for their depression, and others do not. Results will help provide the basis for better, more acceptable, and accessible services for this vulnerable group of women.
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