California Border Healthy Start Project: Improving maternal mental health

Depression during and after pregnancy has long-term negative consequences for women and their children. For children these include: cognitive delays, school behavior problems, sudden infant death syndrome and increased visits to emergency departments. One in seven Hispanic mothers experiences depression. Project Concern International (PCI) is addressing depression during pregnancy among Hispanic women as part of its comprehensive Health Resources and Services Administration-funded California Border Healthy Start (CBHS) program. CBHS works with eight core partners to provide pregnancy and interconceptional care to high risk women in the eleven zip codes with the poorest birth outcomes and highest levels of poverty in San Diego. The depression component of CBHS is an extension of PCI's successful Project HEAL (Health Education and Action for Latinas) methodology, conducted from 2001-2004. In this model, community health workers (“promotoras”) lead a series of six small group sessions designed around the theme of “Es Dificil Ser Mujer?” (“Is it Difficult to be a Woman?)” These support groups help women to identify areas of their lives they wish to change or improve. Sessions address stress and depression and provide women with the information, skills, and support necessary to deal appropriately with these issues. The sessions reduce stigma surrounding mental health issues and promote communication, self-efficacy, empowerment, self-care, and general well-being. The curriculum introduces concrete empowerment and expanded self-care strategies, including proper nutrition, exercise and general well-being. Project HEAL reached 690 Latinas and resulted in a pre- to post-test reduction in mean scores on the PRIME-MD Patient Health Questionnaire-9 depression assessment of almost 40%.