| Social determinants of health (SDH) have a demonstrable impact on maternal health
throughout pregnancy and postpartum, with systematic reviews indicating that such factors
(including racial-ethnic group, income, educational attainment, employment status, and social
support) are determinants of maternal antenatal depressive symptoms. Research further suggests
potentially higher prevalence rates and severity of depressive symptoms among maternal
antepartum and postpartum participants residing in “rural” areas as compared to those in the
general population. Similarly, those residing in health professional shortage areas (HPSAs) may
have worse health outcomes than those in the general population. However, there is a dearth of
literature regarding the impact of residence in an HPSA on mental health or maternal mental
health during pregnancy.
This study sought to determine the impact of SDH, including racial-ethnic group, income,
educational attainment, employment status, social support, and area of residence, on the severity
of maternal antenatal depressive symptoms, and to clarify the potential interactive impact of
residing in a HPSA for primary care (pcHPSA) or HPSA for mental health (mhHPSA), on the
relationship between SDH and maternal antenatal depressive symptoms.
Findings indicate a significant, protective relationship between level of social support and
antenatal depressive symptoms. Statistically significant increases in depression symptoms were
demonstrated for individuals endorsing a Spanish/Hispanic/Latino ethnic background and/or
Black or African American, Hispanic/Latino, or Asian origin as compared to those who
identified as Non-Hispanic and White in the context of pcHPSA status, and when residing
outside of a mhHPSA. No significant differences in depression symptoms by racial-ethnic group
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was demonstrated for those residing within a mhHPSA. An association between increased hours
typically worked and increased maternal antenatal depression symptoms was demonstrated in the
context of mhHPSA status. A significant interactive effect of mhHPSA status on the
relationships between racial-ethnic group and maternal antenatal depressive symptoms, and
difficulty paying expenses and depressive symptoms was also found. Results, strengths,
limitations, implications, and future directions are discussed in detail.
Key Words: HPSA, SDH, mental health, pregnancy, prenatal, partum, women |