Is Postpartum Patient Navigation Uniquely Beneficial for Women with Antenatal Depressive Symptoms?

 

 Buy Article Permissions and Reprints

Abstract

Objective Women with depression benefit substantively from the comprehensive postpartum visit yet are less likely to attend such visits. Postpartum patient navigation has been associated with improved postpartum visit attendance. Thus, the objective of this study was to determine whether patient navigation was associated with differential postpartum visit attendance for low-income, largely racial/ethnic minority women with antenatal depressive symptoms.

Study Design This is a secondary analysis of a prospective postpartum patient navigation program for adult, low-income, largely racial/ethnic minority women receiving prenatal care at a single university clinic (n = 474). Patient navigators assumed supportive and logistical responsibilities for patients between delivery and postpartum visit completion (“navigation cohort”); women in the navigation cohort were compared with women who would have been eligible for patient navigation but received care the year before program implementation (“pre-navigation cohort”). Women were considered to have antenatal depressive symptoms if they had a Patient Health Questionnaire-9 score above 9 prior to delivery. The primary outcome was attendance at the comprehensive postpartum visit by 12 weeks. Factors associated with this outcome were assessed in a prenavigation cohort of women and were subsequently evaluated in the total cohort (prenavigation and navigation groups) using multivariable models. An interaction term between antenatal depressive symptoms and navigation status was generated to evaluate for effect modification.

Results In the prenavigation cohort, antenatal depressive symptoms were more frequent among women who did not attend the postpartum visit (25.0 vs. 10.2%, p = 0.002) and remained a risk factor for postpartum visit nonattendance on multivariable analysis (adjusted odds ratio [aOR]: 0.39, 95% confidence interval [CI]: 0.18–0.83). In the navigation cohort (n = 218), the presence of antenatal depressive symptoms was not associated with attendance (p = 0.117). In multivariable analyses of the total cohort, the interaction term between antenatal depressive symptoms and navigation was statistically significant (aOR: 11.06, 95% CI: 1.21–101.08).

Conclusion Postpartum patient navigation appears particularly beneficial among women with antenatal depressive symptoms for increasing postpartum appointment attendance.

Key Points

• Patient navigation has been associated with improved postpartum visit attendance.

• Among low-income women, antenatal depressive symptoms are a risk factor for postpartum visit nonattendance.

• Postpartum patient navigation appears particularly beneficial among women with antenatal depressive symptoms.

Note

This abstract was presented as a poster presentation at the 39th Annual Meeting of the Society for Maternal-Fetal Medicine in Las Vegas, NV, on February 11–16, 2019.

Publication History

Received: 29 April 2020

Accepted: 04 November 2020

Article published online:
15 December 2020

© 2020. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

• References

• 1 Bennett HA, Einarson A, Taddio A, Koren G, Einarson TR. Prevalence of depression during pregnancy: systematic review. Obstet Gynecol 2004; 103 (04) 698-709
  CrossrefPubMedGoogle Scholar
• 2 Andersson L, Sundström-Poromaa I, Bixo M, Wulff M, Bondestam K, åStröm M. Point prevalence of psychiatric disorders during the second trimester of pregnancy: a population-based study. Am J Obstet Gynecol 2003; 189 (01) 148-154
  CrossrefPubMedGoogle Scholar
• 3 Lee AM, Lam SK, Sze Mun Lau SM, Chong CS, Chui HW, Fong DY. Prevalence, course, and risk factors for antenatal anxiety and depression. Obstet Gynecol 2007; 110 (05) 1102-1112
  CrossrefPubMedGoogle Scholar
• 4 Ramos-Marcuse F, Oberlander SE, Papas MA, McNary SW, Hurley KM, Black MM. Stability of maternal depressive symptoms among urban, low-income, African American adolescent mothers. J Affect Disord 2010; 122 (1-2): 68-75
  CrossrefPubMedGoogle Scholar
• 5 Orr ST, Blazer DG, James SA. Racial disparities in elevated prenatal depressive symptoms among black and white women in eastern North Carolina. Ann Epidemiol 2006; 16 (06) 463-468
  CrossrefPubMedGoogle Scholar
• 6 Lara MA, Le HN, Letechipia G, Hochhausen L. Prenatal depression in Latinas in the U.S. and Mexico. Matern Child Health J 2009; 13 (04) 567-576
  CrossrefPubMedGoogle Scholar
• 7 Mukherjee S, Trepka MJ, Pierre-Victor D, Bahelah R, Avent T. Racial/ethnic disparities in antenatal depression in the United States: a systematic review. Matern Child Health J 2016; 20 (09) 1780-1797
  CrossrefPubMedGoogle Scholar
• 8 Gavin AR, Melville JL, Rue T, Guo Y, Dina KT, Katon WJ. Racial differences in the prevalence of antenatal depression. Gen Hosp Psychiatry 2011; 33 (02) 87-93
  CrossrefPubMedGoogle Scholar
• 9 Leigh B, Milgrom J. Risk factors for antenatal depression, postnatal depression and parenting stress. BMC Psychiatry 2008; 8: 24
  CrossrefPubMedGoogle Scholar
• 10 Shakespeare J, Knight M. Maternal health in pregnancy: messages from the 2014 UK Confidential Enquiry into Maternal Death. Br J Gen Pract 2015; 65 (638) 444-445
  CrossrefPubMedGoogle Scholar
• 11 Metz TD, Rovner P, Hoffman MC, Allshouse AA, Beckwith KM, Binswanger IA. Maternal deaths from suicide and overdose in Colorado, 2004-2012. Obstet Gynecol 2016; 128 (06) 1233-1240
  CrossrefPubMedGoogle Scholar
• 12 Aoyagi SS, Tsuchiya KJ. Does maternal postpartum depression affect children's developmental outcomes?. J Obstet Gynaecol Res 2019; 45 (09) 1809-1820
  CrossrefPubMedGoogle Scholar
• 13 Kingston D, Tough S, Whitfield H. Prenatal and postpartum maternal psychological distress and infant development: a systematic review. Child Psychiatry Hum Dev 2012; 43 (05) 683-714
  CrossrefPubMedGoogle Scholar
• 14 ACOG Committee Opinion No. ACOG Committee Opinion No. 736: optimizing postpartum care. Obstet Gynecol 2018; 131 (05) e140-e150
  CrossrefPubMedGoogle Scholar
• 15 Aber C, Weiss M, Fawcett J. Contemporary women's adaptation to motherhood: the first 3 to 6 weeks postpartum. Nurs Sci Q 2013; 26 (04) 344-351
  CrossrefPubMedGoogle Scholar
• 16 Bennett WL, Chang HY, Levine DM. et al. Utilization of primary and obstetric care after medically complicated pregnancies: an analysis of medical claims data. J Gen Intern Med 2014; 29 (04) 636-645
  CrossrefPubMedGoogle Scholar
• 17 Prenatal and Postpartum Care. Accessed November 24, 2020 at: https://www.medicaid.gov/state-overviews/scorecard/state-health-system-performance/communication-and-coordination/prenatal-postpartum/index.html
  PubMedGoogle Scholar
• 18 Rankin KM, Haider S, Caskey R, Chakraborty A, Roesch P, Handler A. Healthcare utilization in the postpartum period among Illinois women with Medicaid paid claims for delivery, 2009-2010. Matern Child Health J 2016; 20 (Suppl. 01) 144-153
  CrossrefPubMedGoogle Scholar
• 19 Wilcox A, Levi EE, Garrett JM. Predictors of non-attendance to the postpartum follow-up visit. Matern Child Health J 2016; 20 (Suppl. 01) 22-27
  CrossrefPubMedGoogle Scholar
• 20 Danilack VA, Brousseau EC, Paulo BA, Matteson KA, Clark MA. Characteristics of women without a postpartum checkup among PRAMS participants, 2009-2011. Matern Child Health J 2019; 23 (07) 903-909
  CrossrefPubMedGoogle Scholar
• 21 Gregory EF, Upadhya KK, Cheng TL, Psoter KJ, Mistry KB. Enabling factors associated with receipt of interconception health care. Matern Child Health J 2020; 24 (03) 275-282
  CrossrefPubMedGoogle Scholar
• 22 Shim JY, Stark EL, Ross CM, Miller ES. Multivariable analysis of the association between antenatal depressive symptomatology and postpartum visit attendance. Am J Perinatol 2019; 36 (10) 1009-1013
  Article in Thieme ConnectPubMedGoogle Scholar
• 23 Albaugh AS, Friedman SH, Yang SN, Rosenthal M. Attendance at mental health appointments by women who were referred during pregnancy or the postpartum period. J Obstet Gynecol Neonatal Nurs 2018; 47 (01) 3-11
  CrossrefPubMedGoogle Scholar
• 24 Paskett ED, Dudley D, Young GS. et al; PNRP Investigators. Impact of patient navigation interventions on timely diagnostic follow up for abnormal cervical screening. J Womens Health (Larchmt) 2016; 25 (01) 15-21
  CrossrefPubMedGoogle Scholar
• 25 Battaglia TA, Darnell JS, Ko N. et al. The impact of patient navigation on the delivery of diagnostic breast cancer care in the National Patient Navigation Research Program: a prospective meta-analysis. Breast Cancer Res Treat 2016; 158 (03) 523-534
  CrossrefPubMedGoogle Scholar
• 26 Rodday AM, Parsons SK, Snyder F. et al. Impact of patient navigation in eliminating economic disparities in cancer care. Cancer 2015; 121 (22) 4025-4034
  CrossrefPubMedGoogle Scholar
• 27 McKenney KM, Martinez NG, Yee LM. Patient navigation across the spectrum of women's health care in the United States. Am J Obstet Gynecol 2018; 218 (03) 280-286
  CrossrefPubMedGoogle Scholar
• 28 Yee LM, Martinez NG, Nguyen AT, Hajjar N, Chen MJ, Simon MA. Using a patient navigator to improve postpartum care in an urban women's health clinic. Obstet Gynecol 2017; 129 (05) 925-933
  CrossrefPubMedGoogle Scholar
• 29 Kroenke K, Spitzer RL, Williams JB. The PHQ-9: validity of a brief depression severity measure. J Gen Intern Med 2001; 16 (09) 606-613
  CrossrefPubMedGoogle Scholar
• 30 Sidebottom AC, Harrison PA, Godecker A, Kim H. Validation of the Patient Health Questionnaire (PHQ)-9 for prenatal depression screening. Arch Women Ment Health 2012; 15 (05) 367-374
  CrossrefPubMedGoogle Scholar
• 31 Flynn HA, Sexton M, Ratliff S, Porter K, Zivin K. Comparative performance of the Edinburgh Postnatal Depression Scale and the Patient Health Questionnaire-9 in pregnant and postpartum women seeking psychiatric services. Psychiatry Res 2011; 187 (1-2): 130-134
  CrossrefPubMedGoogle Scholar
• 32 Marsiglia FF, Bermudez-Parsai M, Coonrod D. Familias Sanas: an intervention designed to increase rates of postpartum visits among Latinas. J Health Care Poor Underserved 2010; 21 (3, Suppl): 119-131
  CrossrefPubMedGoogle Scholar
• 33 Bryant AS, Haas JS, McElrath TF, McCormick MC. Predictors of compliance with the postpartum visit among women living in healthy start project areas. Matern Child Health J 2006; 10 (06) 511-516
  CrossrefPubMedGoogle Scholar
• 34 DiBari JN, Yu SM, Chao SM, Lu MC. Use of postpartum care: predictors and barriers. J Pregnancy 2014; 2014: 530769
  CrossrefPubMedGoogle Scholar
• 35 Bowser DM, Utz S, Glick D, Harmon R. A systematic review of the relationship of diabetes mellitus, depression, and missed appointments in a low-income uninsured population. Arch Psychiatr Nurs 2010; 24 (05) 317-329
  CrossrefPubMedGoogle Scholar
• 36 Weinger K, McMurrich SJ, Yi JP, Lin S, Rodriguez M. Psychological characteristics of frequent short-notice cancellers of diabetes medical and education appointments. Diabetes Care 2005; 28 (07) 1791-1793
  CrossrefPubMedGoogle Scholar
• 37 Ell K, Sanchez K, Vourlekis B. et al. Depression, correlates of depression, and receipt of depression care among low-income women with breast or gynecologic cancer. J Clin Oncol 2005; 23 (13) 3052-3060
  CrossrefPubMedGoogle Scholar
• 38 Costas-Muniz R, Leng J, Diamond L, Aragones A, Ramirez J, Gany F. Psychosocial correlates of appointment keeping in immigrant cancer patients. J Psychosoc Oncol 2015; 33 (02) 107-123
  CrossrefPubMedGoogle Scholar
• 39 Masho SW, Cha S, Karjane N. et al. Correlates of postpartum visits among Medicaid recipients: an analysis using claims data from a managed care organization. J Womens Health (Larchmt) 2018; 27 (06) 836-843
  CrossrefPubMedGoogle Scholar
• 40 Diaz-Linhart Y, Silverstein M, Grote N. et al. Patient navigation for mothers with depression who have children in head start: a pilot study. Soc Work Public Health 2016; 31 (06) 504-510
  CrossrefPubMedGoogle Scholar
• 41 Byatt N, Biebel K, Friedman L, Debordes-Jackson G, Ziedonis D, Pbert L. Patient's views on depression care in obstetric settings: how do they compare to the views of perinatal health care professionals?. Gen Hosp Psychiatry 2013; 35 (06) 598-604
  CrossrefPubMedGoogle Scholar
• 42 Kim JJ, La Porte LM, Corcoran M, Magasi S, Batza J, Silver RK. Barriers to mental health treatment among obstetric patients at risk for depression. Am J Obstet Gynecol 2010; 202 (03) 312.e1-312.e5
  CrossrefPubMedGoogle Scholar
• 43 Goodman JH. Women's attitudes, preferences, and perceived barriers to treatment for perinatal depression. Birth 2009; 36 (01) 60-69
  CrossrefPubMedGoogle Scholar
• 44 Henderson V, Stumbras K, Caskey R, Haider S, Rankin K, Handler A. Understanding factors associated with postpartum visit attendance and contraception choices: listening to low-income postpartum women and health care providers. Matern Child Health J 2016; 20 (Suppl. 01) 132-143
  CrossrefPubMedGoogle Scholar
• 45 Is a Patient Navigation Program More Helpful than a Referral Program for Reducing Depression and Improving Quality of Life among Women Living in Neighborhoods with Few Resources?. Accessed November 24, 2020 at: https://www.pcori.org/research-results/2013/patient-navigation-program-more-helpful-referral-program-reducing-depression
  PubMedGoogle Scholar