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Stressful Life Events, Postpartum Depressive Symptoms, and Partner and Social Support Among Pregnant People with Disabilities

Published:November 30, 2022DOI:https://doi.org/10.1016/j.whi.2022.10.006

      Abstract

      Introduction

      As an increasing number of people with disabilities become pregnant and give birth, understanding their vulnerabilities for poor mental health and life stress can help to improve their health and well-being. We examined whether people with disabilities are more likely to experience stressful life events 12 months before childbirth, postpartum depressive symptoms (PDS), and lack of postpartum partner and social support, and compared these associations by race/ethnicity.

      Methods

      Using the Massachusetts Pregnancy Risk Assessment Monitoring System 2016–2020 data (n = 6,483), we used univariate and multivariable logistic regression models to estimate the associations of disability with stressful life events, PDS, and postpartum partner and social support, and calculated risk ratio (RR), adjusted RR, and 95% confidence interval (CI). We also conducted stratified analyses by race/ethnicity.

      Results

      The prevalence of disability was 10.7% overall, and 8.8% among White non-Hispanic people, 14.3% among Black non-Hispanic people, 15.5% among Hispanic people, and 8.3% among Asian non-Hispanic people. Compared with people without disabilities, those with disabilities were more likely to report emotional stress (RR, 1.54; 95% CI, 1.36–1.74), partner-related stress (RR, 2.55; 95% CI, 2.23–2.91), financial stress (RR, 1.55; 95% CI, 1.44–1.68), traumatic stress (RR, 2.27; 95% CI, 1.85–2.79), and PDS (RR, 3.77; 95% CI, 3.13–4.53). People with disabilities were also more likely to lack a partner's emotional support (RR, 2.57; 95% CI, 2.21–2.97), financial support from the newborn's father (RR, 2.89; 95% CI, 2.39–3.51), and social support while feeling tired or frustrated (RR, 2.05; 95% CI, 1.68–2.52). These associations remained statistically significant after adjustment for maternal factors and newborn's birth year. Strong associations of disability with stressful life events (including emotional stress and partner-related stress), PDS, lacking partner's emotional support, and social support existed across racial/ethnic groups.

      Conclusions

      Pregnant people with disabilities may benefit from additional screening for stressful life events and depression during pregnancy and postpartum. Multidisciplinary efforts that combine mental health screening and treatment, peer support groups, increased health care provider training about caring for people with disabilities during pregnancy and better access to care for pregnant people with disabilities are needed to improve their health and support their desire to become parents.
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      Biography

      Xiaoli Chen, MD, PhD, MPH, is an Epidemiologist of the Division of MCH Research and Analysis at the Massachusetts Department of Public Health. She has a track record of research accomplishments as evidenced by > 60 papers published in peer-reviewed journals with >5,000 citations.

      Biography

      As the Massachusetts Pregnancy Risk Assessment Monitoring System (PRAMS) Director, Emily Lu, MPH, brought over 15 years of experience in PRAMS implementation and MCH research. Emily Lu has published manuscripts on disability, infertility therapies, preterm birth, oral health, and safe sleep.

      Biography

      Sarah L. Stone, PhD, MPH, is a maternal and child health epidemiologist and serves as the Director of the Office of Data Translation, in the Division of Maternal and Child Health Research and Analysis at the Massachusetts Department of Public Health.

      Biography

      Oanh Bui, MHA, MA, manages Culturally Linguistically Appropriate Services initiatives at the Massachusetts Department of Public Health. Oanh has lived experience as a single immigrant mother of a child with complex disability and has been a cultural broker for the Vietnamese community.

      Biography

      Kimberley Warsett, BA, MSW, is a Program Coordinator in the Health and Disability Program at the Massachusetts Department of Public Health. She has worked extensively in the disability field and holds degrees from Stanford University and Boston University.

      Biography

      Hafsatou Diop, MD, MH, is the Director of the Division of MCH Research and Analysis at the Massachusetts Department of Public Health. She is an MCH content expert and has co-authored 70 manuscripts on infertility, autism, oral health, racism, opioid and COVID-19.