Maternal Access for Depression in Rural Environments (MADRE)
Purpose
The long-term goal is to improve the health of rural families. Using The Theory of Unpleasant Symptoms, the purpose of this descriptive, cross-sectional research was to describe the prevalence of PPD in rural birthing people and explain the extent to which non-modifiable and modifiable biological, psychological, and social/situational factors explain PPD among rural birthing people.
Background and significance
As many as 25% of birthing people experience postpartum depression (PPD) within the first year after childbirth making this one of the most common postpartum disorders. PPD is prevalent, incapacitating, and treatable. The first step is identifying those at risk. Rural birthing people are understudied, and may have unique predisposing characteristics as well as geographic challenges for optimal detection and treatment of PPD.
Theoretical/Conceptual framework
Theory of Unpleasant Symptoms.
Method
A convenience sample of 150 rural birthing people were invited to participate in an internet survey of factors related to PPD. Information on demographics as well as non-modifiable and modifiable biological, psychological, and social/situational factors was assessed using descriptive statistics and linear regression.
Results
Aim 1-describe the prevalence of PPD symptoms in rural birthing persons. This study identified that twenty-five (17.2%) birthing persons of the study sample met a total EPDS score of greater than 10, indicating possible PPD symptoms.
Aim 2-describe the extent to which non-modifiable modifiable biological, psychological, and social/situational factors explain PPD among rural birthing persons. A significant association was found between the CDRS, MFSI-SF and EPDS (F=20.56, Adjusted R^2= 0.26, p=<0.001) and between the ACE score and EPDS (F=12.4, Adjusted R^2=0.077, p=<0.001). The social/situational modifiable factor included social support as measured by the MSPSS. Results of multivariate linear regression analysis supported a significant association between the modifiable social/situational predictor of social support and PPD symptoms (F=11.92, Adjusted R^2=0.07, p=<0.001).
Conclusions
This study identified several important predictors of PPD symptoms in rural birthing persons, including resilience, fatigue, social support, and adverse childhood events. While modifiable biological factors such as feeding method were not significantly associated with PPD symptoms, the strong role of psychological and social factors suggests that interventions should focus on building resilience, reducing fatigue, and enhancing social support networks. Additionally, screening for ACEs and history of depression could help identify at-risk individuals earlier, allowing for more targeted interventions. These findings contribute to a growing body of literature on PPD symptoms in rural populations and underscore the need for tailored mental health interventions that address the unique challenges faced by this population.
Maternal Access for Depression in Rural Environments (MADRE)
