Date of Award

January 2022

Document Type

Thesis

Degree Name

Master of Public Health (MPH)

Department

School of Public Health

First Advisor

Ashley Hagaman

Abstract

Objectives: This study seeks to document how both depression and discrimination during pregnancy may impact postpartum healthcare utilization (e.g. attendance of the 6-week postpartum appointment and maternal emergency room (ER) visits within 6 months after birth) among women in Detroit, MI and Nashville, TN. We also investigate how race may be associated in the relationship between depression during pregnancy and healthcare use. Methods: Descriptive, stratified, and logistic regression (univariate and multivariate) analyses were conducted using SAS 9.43. Data was drawn from the Expect with Me (EWM) study, a multisite prospective longitudinal matched-cohort that included 951 pregnant women from Detroit, MI and Nashville, TN. Results: Stratified analysis showed that there was no statistical difference (p-value > 0.05) between healthcare utilization and depression by race (Black, Other). In the full adjusted logistic regression model where the primary outcome was attendance of the 6-week postpartum appointment, neither of the primary exposures of interest (depression and discrimination) were statistically significant, but our race covariate was. In the full adjusted logistic regression model where the primary outcome was maternal ER visits, none of the primary exposures or covariates (age, race, and insurance status) were found to be statistically significant (p-value > 0.05). Conclusions: Although both of our fully adjusted logistic regression models did not yield statistically significant associations between the primary outcomes (attendance of the 6-week postpartum appointment and maternal ER visits) and covariates (age, race, and insurance status), future studies with larger sample sizes may yield different results. Larger samples may also be able to detect statistically significant differences (p-value > 0.05) between healthcare utilization and depression by race (Black, Other).

Comments

This thesis is restricted to Yale network users only. It will be made publicly available on 05/19/2024

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