Maternal Mental Health Disparities and Patient Engagement in Research
Karen Tabb Dina, PhD
University of Illinois School of Social Work
Thursday, April 12
Abstract: Women’s mental health during the perinatal period is critically important. Currently there are no best practices for screening for depression and addressing mental health needs in public health clinics. Clinic staff are often responsible for performing depression screening, however, few studies examine staff perceptions on feasibility and acceptability of using perinatal screening for mood disorders in ethnically diverse public health clinics. We conducted focus group interviews with public health staff (n=25) to learn how a multidisciplinary clinical staff addresses mental health in their clinic. Most participants identified multiple barriers to universal depression screening in a public health clinic, but at the same time found value in the practice of screening low-income women for depression. The findings from the focus group study established the foundation for a university-community partnership to improve maternal health outcomes at the county level in Illinois. The partnership has grown into a local initiative and is now in the early stages of developing a patient centered outcomes research community.
Sponsored by the Iowa Institute of Public Health Research and Policy and the Iowa Perinatal Health Research Collaborative
Individuals with disabilities are encouraged to attend all University of Iowa-sponsored events. If you are a person with a disability who requires a reasonable accommodation in order to participate in this program, please contact the College of Public Health in advance at 319-384-1500.
A University of Iowa research paper on intimate partner violence during pregnancy and the risk for adverse infant outcomes has been awarded the David Liu Prize by the Royal Academy of Obstetricians and Gynaecologists.
The paper appeared in BJOG: An International Journal of Obstetrics and Gynaecology (BJOG) in 2016.
Researchers analyzed 50 studies into the effects of domestic violence by a partner or ex-partner on risk of preterm birth, low birth weight (less than 2500g) and small-for-gestational-age babies. The combined results evaluated more than 5 million women from 17 countries, 15,000 of whom had experienced domestic violence.
Overall, the results found that domestic violence doubled the risk of preterm birth and low birth weight. This risk further increased for women who experienced two or more types of domestic violence during their pregnancy.
The research team included Audrey Saftlas, professor of epidemiology; Brittney Donovan, doctoral student in epidemiology; Kelli Ryckman, associate professor of epidemiology; Cassie Spracklen, doctoral student in epidemiology; and Marin Schweitzer, assistant professor of internal medicine.
Mr. David T. Y. Liu, author of the classic text Labour Ward Manual and pioneer in chorion villus sampling, generously funds this prize to encourage research and publication in obstetrics and prenatal diagnosis.
The award recipient is chosen annually from papers in the field that have been published in BJOG over the previous 12 months. Contending articles are appraised on their validity, the likelihood of the findings being adopted into practice regionally and internationally, whether the paper is explained sufficiently for replication, and the quality of outcomes relevant for patients.
A recent study from the University of Iowa looked at ways in which men are involved in obstetric emergencies in Sub-Saharan Africa.
As men become more involved in childbirth in low- and middle-income countries such as Ghana, researchers believe it is important to identify the most effective ways to involve them during labor and delivery, especially during an obstetric emergency.
The study, led by Will Story, assistant professor of community and behavioral health at the University of Iowa College of Public Health, used data that was collected as part of the Maternal and Newborns Referral Project funded by the Bill and Melinda Gates Foundation and led by Dr. Kavita Singh at the University of North Carolina’s Gillings School of Global Public Health.
The research team conducted and evaluated qualitative interviews with 39 mothers and fathers in two districts in Northern and Central Ghana who had experienced obstetric emergencies as well as interviews with six health facility workers and eight focus group discussions with community members.
According to Story, the research showed that male involvement during obstetric emergencies operated across a spectrum of behaviors—from helpful to harmful.
“Although most men provided money and transportation to help their partner obtain care or helped them find a blood donor during the emergency, some men were either absent or acted as ‘gatekeepers’ and caused delays in care seeking,” he says.
“Similarly, we found a spectrum of male accommodation in health facilities during an obstetric emergency—from ignoring or disrespecting men to accommodating them by providing appropriate spaces [such as a waiting room].”
Story says that simply identifying ways in which men can be supportive during an obstetric emergency will not lead to better health outcomes unless health facilities make accommodations that allow men to fulfill their roles.
The study concludes that policies and programs should promote supportive behavior by men during obstetric emergencies while empowering women to make decisions that are best for their own health and the health of their child.
Co-authors include Clare Barrington and Kavita Singh from the Gillings School of Global Public Health, University of North Carolina; Corinne Fordham from Johns Hopkins Center for Communication Programs; Sodzi Sodzi-Tettey from the Institute for Health Care Improvement, Africa Region; and Pierre M. Barker from the Institute for Healthcare Improvement.
Researchers at the UI College of Public Health will use a “collaboratory” approach for two projects that tackle public health concerns. Funded by the Iowa Institute of Public Health Research and Policy (IIPHRP), the first project will investigate health risks from exposure to insecticides, and the second will work to improve health outcomes for low-birth-weight and premature children.
“A collaboratory is a creative group process designed to solve complex problems,” says Vickie Miene, interim director of the IIPHRP. “The process generates the opportunity for new organizational networks to form. This approach expands the scope, scale, and impact of public health research.”
The projects, which were selected through a competitive application process, provide an opportunity to gather collaborators from different backgrounds and disciplines around a topic to develop an innovative research proposal. A successful collaboratory stimulates an aspirational research proposal such as a large research service or center grant that bolsters and builds upon areas of research closely linked to the college’s three collective areas of excellence: rural health, comparative effectiveness research, and community engagement. The collaboratory leverages existing strengths within the college, while fostering new collaborations within and outside the University of Iowa.
Human Exposure and Health Risks from Neonicotinoid Insecticides
Bill Field, professor of occupational and environmental health, is the leader of the Collaboratory to Identify Human Exposure and Health Risks from Neonicotinoid Insecticides. Neonicotinoids are a relatively new class of insecticide, but have become the most widely used class of agricultural insecticides in the world.
Historically, neonicotinoid insecticides have been viewed as ideal replacements for more toxic compounds, such as organophosphates, due in part to their perceived limited potential to impact the environment and human health. Within the agricultural sector, they are preferred over other pesticides for several reasons, including their ability to be applied using a variety of methods; lower toxicity in birds, fish, and mammals; and high selectivity and potency for insects.
Few studies have been conducted to characterize human exposure to neonicotinoids or the insecticides’ potential health risks. The collaborative team will develop the infrastructure and preliminary data required to investigate the emerging potential risks of neonicotinoid exposure.
To the researchers’ knowledge, the collaborative is the first group in the U.S. to directly evaluate the potential human exposure of neonicotinoid insecticides. The study is also the first to assess neonicotinoid insecticide contamination in private wells used for drinking water, and the first to validate biomarkers necessary for future neonicotinoid-human health investigations.
Members of the team include: Wei Bao, MD, PhD; Susie Dai, PhD; Manuel Gadogbe, PhD; Michelle Hladik, PhD; Christopher Jones, PhD; Dana Kolpin, MS; Hans-Joachim Lehmler, PhD; Bob Libra, MS; Charles Lynch, MD, PhD; Keith Schilling, PhD; Darrin Thompson, MPH; John Vargo, PhD; and Peter Weyer, PhD.
The collaborative has also received letters of support from the Center for Health Effects of Environmental Contamination, Heartland Center for Occupational Health and Safety, Agricultural Health Study, Environmental Health Sciences Research Center, the Iowa Registry for Congenital and Inherited Disorders, Iowa Center for Agricultural Safety and Health, Iowa Department of Natural Resources, State Hygienic Laboratory at the University of Iowa, and U.S. Geological Survey.
Iowa Perinatal Health Research Collaborative
Kelli Ryckman, associate professor of epidemiology, is the leader of the Iowa Perinatal Health Research Collaborative (IPHRC). The central mission of the IPHRC is to develop a network of perinatal care providers and public health professionals working to improve the health outcomes of children born low birth weight (LBW) and/or preterm through innovative and multidisciplinary research initiatives.
Advances in neonatal intensive care have drastically reduced perinatal mortality related to LBW and/or preterm births. In infants born before 27 completed weeks of gestation, there is a 65% chance of survival and a 56% chance of survival without severe impairment, nationally. In Iowa, survival without severe impairment is even higher.
Follow-up of “high risk” infants is recommended by the American Academy of Pediatrics; however, standard guidelines are lacking on how long follow-up should occur and which infants qualify as “high risk.” Individuals identified for further follow-up widely varies based on the resource availability, and children who may benefit from resources or specialized programs are undoubtedly missed or excluded. This underscores the need for perinatal research collaboratives that bring together providers, public health care professionals, and families to identify outcomes and health care utilization gaps for children born LBW and/or preterm.
The project will focus on three intersecting thematic areas:
- The Database Development thematic area will establish a statewide database of children born LBW and/or preterm that provides a platform for outcomes research, quality improvement initiatives, and interventions.
- The Health Services and Outcomes thematic area will develop a hospital services and outcomes data source to better understand the health care needs and outcomes in this population of Iowa children.
- The Family and Community Engagement thematic area will engage families in research initiatives and provide and promote existing resources for families.
Team members include Mary Charlton, assistant professor of epidemiology; John Dagle, professor of pediatrics; and Lane Strathearn, professor of pediatrics and co-director of the University of Iowa Center for Excellence in Developmental Disabilities. In addition, graduate students Allison Momany and Nichole Nidey will contribute to this work.
To raise or not to raise the minimum wage? It’s a hotly debated question among policymakers and economists these days, because the overall economic impact of raising minimum wages isn’t yet well understood. But a new University of Iowa study suggests that decision-makers should be looking at broader impacts, for it finds evidence that increases in the minimum wage lead to improvements in infant health.
“Effects of the minimum wage on secondary outcomes such as health often go unconsidered in the debate, which is an oversight,” says George Wehby, CPH associate professor of health management and policy and lead author of the study.
A baby’s health depends critically on the mother’s health during pregnancy, and economists know that a higher income can improve maternal health in various ways, for example by enabling better diet, improving access to prenatal care, and/or reducing stress.
To investigate this issue in the context of minimum wage raises, Wehby and colleagues Dhaval Dave of Bentley University and Robert Kaestner of the University of Illinois at Chicago examined data on U.S. births during 1989-2012 to the millions of mothers aged 18-39 who had no college degree and were therefore most likely to be affected by minimum wage raises.
As the investigators reported in a National Bureau of Economic Research working paper in June 2016, state minimum wage raises during this period were followed by improvement in the birth weight and gestational age—basic measures of infant health— of babies born to these mothers in the affected states. Birth weight increased by about 11 grams on average for every $1 per hour increase in the minimum wage.
“That’s a meaningful and plausible effect,” says Wehby, “and it would translate into an increase of about 85 grams [3 ounces] for a raise in the current federal minimum wage from $7.25 to $15 per hour, as some have proposed.”
The researchers were able to account for differences in time trends between states, as well as changes in state welfare policies during the period, to minimize the effects of confounding factors and thereby isolate the effect of minimum wage raises on infant health. Highlighting two possible routes through which this effect could work, they linked minimum wage increases to greater use of prenatal care and less smoking by the pregnant mothers in their sample.
Wehby and colleagues are following up with studies of broader impacts of minimum wage increases on children’s well-being.
“It’s an active research area for us—we’re now looking at behavioral and learning outcomes throughout childhood,” Wehby says.
The full paper is available at http://www.nber.org/papers/w22373.
This story originally appeared in the Fall 2016 issue of InSight.