Doctor of Philosophy (PhD)
First Advisor's Name
Dr. Mary Jo Trepka
First Advisor's Committee Title
Second Advisor's Name
Dr. Stefany Coxe
Second Advisor's Committee Title
Third Advisor's Name
Dr. Kristopher P. Fennie
Third Advisor's Committee Title
Fourth Advisor's Name
Dr. Purnima Madhivanan
Fourth Advisor's Committee Title
Postpartum depression, stressful life events, state-level socioeconomic status, latent class analysis, generalized linear mixed model, racial/ethnic disparities, provider communication on perinatal depression, PRAMS
Date of Defense
The purpose of this dissertation was to examine patterns of antenatal stressful life events (SLEs) experienced by women in the United States (U.S.) and their association with postpartum depression (PPD). It further explored the role of women's state-level socio-economic status (SES) on PPD; the racial/ethnic dispartites in SLE-PPD relationship; and the role of provider communication on perinatal depression.
Data from 2009–11 Pregnancy Risk Assessment Monitoring System (PRAMS) and SES indicators published by the Institute of Women’s Policy Research (IWPR) were used. Latent class analysis (LCA) was performed to identify unobserved class membership based on antenatal SLEs. Multilevel generalized linear mixed models examined whether state-level SES moderated the antenatal SLE-PPD relationship. Of 116,595 respondents to the PRAMS 2009-11, the sample size for our analyses ranged from 78% to 99%.
The majority (64%) of participants were in low-stress class. The illness/death related-stress class (13%) had a high prevalence of severe illness (77%) and death (63%) of a family member or someone very close to them, while those in the multiple-stress (22%) class endorsed most other SLEs. Eleven percent had PPD; women who experienced all types of stressors, had the highest odds (adjusted odds ratio [aOR]: 5.43; 95% confidence interval [CI]: 5.36, 5.51) of PPD. The odds of PPD decreased with increasing state-level social/economic autonomy index (aOR: 0.75; 95% CI: 0.64, 0.88), with significant cross-level interaction between stressors and state-level SES. Among non-Hispanic blacks and non-Hispanic whites, husband/partner not wanting the pregnancy (aOR: 1.47; 95% CI: 1.14, 1.90) and drug/drinking problems of someone close (aOR: 1.37; 95% CI: 1.21, 1.55) were respectively associated with PPD. Provider communication was protective.
That 1 out of every 5 and 1 out of every 8 women were in the high- and emotional-stress classes suggests that SLEs are common among pregnant women. Our results suggest that screening for antenatal SLEs might help identify women at risk for PPD. The finding that the odds of PPD decrease with increasing social/economic autonomy, could have policy implications and motivate efforts to improve these indices. This study also indicates the benefits of antenatal health care provider communication on perinatal depression.
Mukherjee, Soumyadeep, "Antenatal Stressful Life Events and Postpartum Depression in the United States: the Role of Women’s Socioeconomic Status at the State Level" (2016). FIU Electronic Theses and Dissertations. 2631.
Epidemiology Commons, Maternal and Child Health Commons, Medical Humanities Commons, Obstetrics and Gynecology Commons, Other Mental and Social Health Commons, Psychiatric and Mental Health Commons, Psychiatry Commons, Quantitative Psychology Commons, Women's Health Commons
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