Community Violence and Postpartum Depression: Associations and Potential Intervention Strategies

Abstract

Postpartum Depression (PPD) is a debilitating perinatal mood disorder that many mothers across the United States suffer from silently. About one-eighth of all American women develop PPD the first year after giving birth. While maternal mental health has recently received increased attention in light of the COVID-19 pandemic, many legislators and perinatal mental health care providers have failed to account for how one’s residential environment may introduce stressors that increase their risk for the condition. Pregnant women living in communities with high violent crime rates are a segment of the population often forgotten among these stakeholders. There is a dearth of research into how exposure to this violence may impact the psychosocial status of these women.

Through this thesis, I utilize a mixed-methods approach to investigate whether exposure to community violence during pregnancy increases the likelihood of a woman developing PPD a year after giving birth. I first merged county-level restricted contract data with data from core maternal questionnaires included within the nationally representative Futures of Families and Child Wellbeing Study (FFCWS). To measure exposure to community violence, I employed county-level violent crime rate as a proxy. I then conducted multivariate logistic regressions, holding a wide range of variables related to demographic information and neighborhood characteristics constant to evaluate the impact of violence and overall crime on the probability a woman meets the criteria for PPD. I also conducted semi-structured interviews with key informants, including administrative staff at several maternal health nonprofits and victim services organizations, to gauge how these stakeholders work toward increasing access to perinatal mental health services for women living in at-risk communities. Interviews were analyzed using Framework Analysis.

Results from the quantitative analysis show that an increase in exposure to community violence during pregnancy is associated with an increase in the likelihood of being diagnosed with PPD. Specifically, compared to a woman living in the county with the lowest violent crime rate, a woman living in the county with the highest violent crime rate has an 86.7% and 23.1% increase in odds of being diagnosed with PPD on the liberal and conservative scales, respectively. Similarly, increased exposure to total crime is associated with a 60.5% and 12.7% increase in the probability of diagnosis considering the same scales. History of depression and intimate partner violence were identified as the variables most associated with increased risk of meeting the criteria for PPD diagnosis. All these findings were statistically significant.

The qualitative analysis provided key insights into how stakeholders use a trauma and community-informed lens to recognize women’s needs better for mental health services. Informants identified several barriers women in violent communities confront that prevent them from accessing perinatal mental health care and described how they address these barriers to increase engagement. Participants also highlighted policy priorities to support women navigating motherhood amid exposure to high rates of community violence.

This thesis concludes by introducing several strategies that draw upon existing policies and funding opportunities to increase the efficacy of crime prevention efforts, expand housing choices, and increase access to comprehensive perinatal mental health care services, along with noting research implications for the future.