Glauco Souza and Dr. Lynn Clark Callister, Nursing
Purpose
The purpose of this qualitative descriptive study was to describe the experience of having symptoms of postpartum depression (PPD) and identify help seeking behaviors in immigrant Hispanic women.
Background
Hispanics are the largest and fastest growing minority group living in the United States. Between 2000 and 2006, Hispanics accounted for 50% of the nation’s growth. Hispanic women have the highest fertility rate of all ethnic/racial groups, comprising 23% of the births in the United States (US Census Bureau, 2007). PPD is pervasive across culturally diverse women, and while it is prevalent among disadvantaged Hispanic women, it is not readily detected by women or their clinicians. A recent study documented the incidence of symptoms of PPD in Hispanic women in a community health center in a western state. The incidence of PPD was over 50% using the Beck PPD Screening Scale-Spanish version (PDSS). This scale has an alpha reliability in Mexican women of .94, and the majority of women seen in the clinic are of Mexican descent. Many of the women declined to make appointments for mental health services, and shared with the researchers the multiple stressors they were experiencing in their lives.
Based on this study, the need was identified to gain and understanding of the experience of having symptoms of PPD in immigrant Hispanic women, and to assess why these women often decline to seek mental health services.
Method
Twenty women were recruited from a sample of 100 immigrant Hispanic women receiving services at a community health center in a western state. Inclusion criteria included having a cutoff score above 60 on the PPDSS-Spanish Version. The purposive sample included women of varying ages and educational levels, some of which were first-time mothers and others who had more than one child. Following informed consent, the women participated either in a focus group or individual audio-taped interviews with Spanish speaking members of the research team. Data were transcribed and translated, then analyzed individually and collectively by members of the research team.
Initial Results
Some women did not recognize and/or denied their symptoms, attributing them to our stressors in their lives, such as financial concerns and family concerns. Women sought help from their families rather than healthcare providers, but many were isolated and lacked social support and continue to experience symptoms of PPD. They stated it was not culturally common to seek mental health services in their countries of origin. Barriers identified included personal barriers (beliefs about emotional health, the perceived stigma of mental illness and hesitancy to seek treatment for symptoms of PPD, and cultural beliefs about motherhood and the role of women. They also identified social barriers (such as lack of social support, immigration status, or limited English proficiency) and health care delivery barriers (including financial constraints and lack of childcare and transportation.)
Implications for Clinical Practice
Limited social networks and barriers to health care, including mental health services, should be addressed in order to foster positive outcomes in these vulnerable women. Focusing on the protective strength factors in these women, such as resiliency and life satisfaction in designing interventions is essential.
Funding
Brigham Young University ORCA grant
Glauco Souza conducted, translated from Spanish and transcribed all of the interviews for the study and participated in analysis of the data. Findings have been presented at the Western Institute of Nursing Research Conference April 2010 and will be presented at the Brigham Young University College of Nursing Research Conference October 2010.
A manuscript is being prepared for submission to the Journal of Obstetric, Gynecologic, and Neonatal Nursing with Glauco Souza as a co-author with his faculty mentor.