Understanding perinatal depression in diverse communities: A prerequisite for effective screening

Background: Maternal and child health programs screen racially and ethnically diverse women of low socioeconomic status for perinatal depression using tools validated among middle-class white women. This research explored how racially and ethnically diverse women of low socioeconomic status understand perinatal depression symptoms to evaluate the validity of perinatal depression and related measures in diverse communities. Methods: Four focus groups were conducted with a purposive sample of 32 pregnant (31%) or postpartum (69%) women receiving community-based services, who self-identified as African American (n=11), Caucasian (n=4), Hmong (n=8, 6 Hmong-speaking), or Latina (n=9, 8 Spanish-speaking). Women responded to open-ended questions about their perinatal physical, cognitive, and somatic experiences, and their perceptions of self and life. Focus groups were transcribed and analyzed using content and narrative analysis. Results: Preliminary analysis revealed four themes with screening implications. 1) Symptoms of depression were difficult to distinguish from perinatal experiences. 2) Emotional symptoms overshadowed physical, cognitive, and somatic symptoms in the perinatal period. 3) Symptoms were attributed to personal and social stressors over biological or psychological risk factors. 4) Caring for the fetus/infant placed additional stress on already strained personal and social resources, and distinguished perinatal depression from depression at other times. Conclusions: Perinatal depression is a valid construct among diverse women with low socioeconomic status. Screening measures must be evaluated for their ability to distinguish depression symptoms from perinatal experiences and stress. Measures must also assess the individual's social context to effectively screen for perinatal depression across increasingly diverse communities.