Addressing Postpartum Depression in United States Rural Settings

This dissertation addresses postpartum depression (PPD) specifically within rural United States contexts. In Chapter 2, an integrative review revealed an elevated PPD prevalence among rural women populations compared to the U.S. average. No existing PPD screening tools were validated for clinical use in rural U.S. settings. Interventions addressing PPD in rural settings were scarce and mainly associated with feasibility research. Chapter 3 was a psychometric study with the aim to establish the psychometric properties of the Edinburgh Postnatal Depression Scale (EPDS) and assess its validity for clinical use within a rural American context. The EPDS was psychometrically sound, with construct validity, strong criterion-related validity, and acceptable reliability and internal consistency. This was the first study establishing validity of a PPD screening tool within a rural U.S. population. Chapter 4 presents findings from an open pilot feasibility study, offering a group-delivered intervention to women experiencing PPD in two rural counties in Indiana. The pilot group intervention was ultimately deemed not feasible due to low recruitment and retention rates of 9.6% and 40.0% respectively. However, the intervention was highly acceptable and satisfactory to both participants and facilitators. Finally, Chapter 5 presents findings from a post-intervention follow-up study with the aim of exploring the perspectives of healthcare providers involved in the aforementioned pilot intervention. The most common barriers reported to connecting rural women with care were cost concerns / insurance limitations, transportation access, and perceived lack of time. The most common facilitators reported in connecting rural women with non-pharmacological care were consistent depression screenings with explained results, recommendations from trusted medical providers, desire to minimize or avoid medications, and transportation assistance. Overall, this dissertation indicates the need to address the significant burden of PPD in rural America through the provision of more equitable mental health care.