Module 3 Assignment: Pinch Table Template


Research Problem (identify a gap in the literature): Postpartum depression is a major concern that can sometimes be overlooked. Finding new ways to reach out to patients should be considered and investigated. Low-income patients may not have access to transportation, or they may have other reasons for not coming into their doctor appointments. “Low income and minority women are at particularly high risk for unrecognized and untreated postpartum depression” (Kim, Geppert, Quan, Bracha, Lupo, & Cutt, 2012, p. 123). There should be further research and alternatives studied to help provide options and interventions for patients in need of further assistance.


Study Purpose

Sample (N=xx) and


Study Design type (describe in detail)

& Variables (List variables and label as Research, IV, DV)

Measurement methods of variables (tools, surveys or scales)

Major Study Findings / Results

(include some statistics and whether they are significant or not)


Study: Screening for Postpartum Depression Among Low-Income Mothers Using an Interactive Voice Response System

H. G. Kim was a part of the Department of Psychiatry, Hennepin Women’s Mental Health Program, Hennepin County Medical Center, Minneapolis,

J. Geppert, T. Quan D. B. Cutts- Department of Pediatrics, Hennepin County Medical Center, Minneapolis, MN, USA

Y. Bracha- Center for Urban Health, Hennepin County Medical Center, Minneapolis, MN, USA

V. Lupo-Department of Obstetrics/Gynecology, Hennepin County Medical Center, Minneapolis, MN, USA

“The purpose of this current study was to test the feasibility of using an automated phone screen for postpartum depression that low income mothers access remotely outside their clinic visits” (Kim, Geppert, Quan, Bracha, Lupo, & Cutt, 2012, p. 922).

Postpartum depression can affect 7-25% of new mothers within the first year after delivery of their baby (Kim et. al, 2012).

1,591 patients who recently delivered at Hennepin County Medical Center (HCMC) were approached.

1,013 (63.7%) signed consent to participate and completed the basic baseline demographic questionnaire. For initial sample, 70 mothers who were native-born Africans were not included in study due to lack of knowledge regarding their English literacy skills. 105 were also not included due to having private insurance. The final number of participants was 838, this included patients on Medical Assistance or who had no insurance. 324 study subjects used the automated phone screening system (Kim et. al., 2012).

The study was considered to be racially and ethnically diverse. -The study consisted of 26% African American, 51% Latina, 15% Caucasian, and 8% other.

-85% were >20 years old

-64% married

-50% had at least a high school diploma or GED

-38% were first time moms

-Most of the study participants were low-income: 74% were unemployed (Kim et. al., 2012).

-61 people out of 838 participated in the 3 month follow up survey.

The study design type is descriptive correlational. The dependent variables are: interactive voice response participation and

postpartum depression differentiated by an EPDS of >10 and >12.

No pilot studies were noted to be done.

-A data collection instrument was used to measure the variables.

The tool used was a Likert scale. Psychosocial

measurements used included self-report.

-The article states that trained research assistants were used to interview possible participants and to collect consents and a baseline demographic questionnaire. A survey about household food insecurity (HFI) was also completed in addition to a demographic survey.

-An interactive voice response system (IVR)was used by participants in their own home. Participants used the IVR to complete the Edinburgh Postnatal Depression Scale (EPDS). The EPDS consist of a 10-item self-rating scale to evaluate postpartum depression within the last 7 days. The article discusses that the researchers were taught to teach participants how to use the IVR system from the privacy of their homes in order to complete the EPDS. The scale was available for participants in Spanish and English. Study participants were required to use the IVR system about 7–10 days after delivery to complete the EPDS. Depending on the score of the screenings, participants listened to automated response messages that would provide them with information. If the question regarding self-harm was responded to as yes, then the study’s Psychiatrist would contact the patient.

-Three attempts were made by phone for their 3-month follow-up and then surveys were mailed.

-No physiological measurement tools were used.

-Descriptive statistics were used to describe the sample.

-Out of 838 participants in the study, only 324 (39%) called into the automated postpartum depression screening system. About 50% (N=162) used the Spanish-speaking phone line. Within the study, table 1 was used to describe those participants who called into the IVR and had at the least a high school education, were employed, and had food secure households. “After adjusting for maternal education in multivariate analyses, employment and food insecurity were not significant at the p <0.05 level. There was also no statistically significant difference between callers and non-callers in terms of race/ethnicity, marital status, parity, and selfreported history of depression, anxiety or self-harm” (Kim et. al., 2012, p. 923). There were no significant correlations between increased risk for postpartum depression in woman who were first time mothers, who were in a temporary living situation, had previous history of mental health disorder or a previous history of self-harm. This determination was made after adjustments were calculated to consider Hispanic and African American ethnicities. -The study was approved by the HCMC Institutional Review Board. -Participants were compensated with small gifts if they completed the initial interview, the automated phone screening survey for postpartum depression, and the 3-month follow-up survey. - A finding from the study discovered that there were high rates of participation in the depression screening but there were low rates of follow-up. Due to the low rate of follow-up calls after 3-months postpartum, it was discussed that a voicemail be added to the initial call for study subjects to leave a voicemail if they have any further questions or concerns. (Kim et. al., 2012). Multiple domains of stress predict postpartum depressive symptoms in low-income Mexican American women: the moderating effect of social support Shayna S. Coburn N. A. Gonzales L. J. Luecken K. A. Crni Shayna S. Coburn was a part of the Department of Psychology, Arizona State University, Tempe, AZ, USA & Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA “By including multiple distinct stressors within a single prospective model, this study aimed to clarify dimensions of stress that are most salient for low income Mexican American mothers during pregnancy and after the birth of a child” (Coburn, Gonzales, Luecken, & Crni, 2016, p. 1011). The study was aimed to evaluate the effects of prenatal stressors and social support on postpartum depressive symptoms in Mexican-American woman (Coburn, 2016). Informed consent was obtained from 337 participants. Two participants were unable to complete the interview. One became ineligible due to safety concerns. 12 were excluded due to being considered “Non- Mexican”. The larger study consisted of 322 study participants. The final study consisted of 269 Mexican American women from three county operated prenatal care clinics in Maricopa County, AZ. Participants ranged from ages 18–42. 83 % were Spanish speaking. Median income was reported as $10,000–$15,000. The study design type is descriptive correlational. Descriptive correlational designs examine the relationships that exist between the variables within a situation (Grove, Burns, & Gray, 2013). The study addresses the relationships between the study variables. -The research variables include Socio-demographic covariates, depressive symptoms, daily hassles, Culture-specific stressors, Family interpersonal stress, Partner interpersonal stress, and social support. Interviews were completed in the participants home using computer-assisted interviews in English or Spanish. Interviews read questions out loud and recorded participants answers. The interviews were conducted at (T1; 26–38week gestation; followed by a home visit at 6 weeks after delivery (T2). -Data collection instruments were used and included tools that measured the variables. These tools included Likert scales and questionnaires. It involved psychosocial measurements using self-report. Sociodemographic covariates- Consisted of collecting background information on participants. Depressive symptoms- Edinburgh Postpartum Depression Scale (EPDS): a 10-item Likert scale that had a max score of 30 Daily hassles: Were measured using the Daily Hassles measure which consist of a 25-item scale that addresses different everyday stressors that a mother may go through daily. Questions were rated on a 5-point scale ranging from 1 to 5. Culture-specific stressors: The Hispanic Stress Inventory (HSI) was used. This is a 7-subscale questionnaire aimed at capturing culture specific stressors that Hispanic individuals may face. It consists of 49-items with a maximum score of 23. The article reports this scale to have good construct validity, and high reliability in Hispanics. Family interpersonal stress: This was measures using three questions that discussed negativity and criticism that participant received from family members. They were asked to rate the questions on a scale of 1 out of 5 with a max score of 15. Partner interpersonal stress- This was measured using the Dyadic Adjustment Scale. This consisted of 7-items that discussed marital/partner relationship, relationship stress or dissatisfaction with the relationship. Maximum score of 20. Social support: Was measured using Medical Outcome Study which consisted of 17-items that asked about who people go to when they need help or support. Maximum score was 85. Descriptive statistics were used to describe the sample. Results indicated that “stress variables were positively associated with one another, positively associated with prenatal and 6-week depressive symptoms, and negatively associated with support. Culture-specific stress, however, was not significantly associated with social support” (Coburn, 2016). Compensation included $75 and small gifts (e.g., body lotion) for their participation at T1 and $50 and small gifts (e.g.,bibs) at T2. -Approval was obtained from all relevant Institutional Review Boards. Study Limitations included: 1): Partners of the participants were not interviewed. 2): Study was conducted in Arizona. During the time of the study Arizona was adapting to very big changes in illegal immigration laws. This may have causes some changes in attitudes of Mexican individuals which could have causes answers to be minimal due to potential fear of receiving additional social services (Coburn et. al., 2016). -The authors recommend that, “future studies should examine additional protective mechanisms, particularly cultural resources that may help to account for positive maternal adaptation and mental health” (Coburn et. al., 2016, p. 1017). A Problem-Solving Therapy Intervention for Low-Income, Pregnant Women at Risk for Postpartum Depression McClain Sampson, Yolanda Villarreal, and Allen Rubin All authors were a part of the Graduate College of Social Work, University of Houston, Houston, TX “The primary aim of this study was to assess whether a PST intervention adapted for low-income women at risk of PPD (1) appears to be a feasible way to engage and retain this target population in the treatment and research protocol and (2) shows promise regarding reducing depressive symptoms” (Sampson et. al., 2016, p. 237). Another aim to the study was to see if it was beneficial to add a Motivational Interview (MI) in addition to the Problem Solving Therapy (PST) sessions. The study was to determine if a Problem Solving Therapy (PST) was an effective treatment for depression. (Sampson et. al., 2016). Fourteen African-American women initially participated in the study. One participant dropped from the study after loss of pregnancy. Mean age was 24. 85% were not married. 61% were not first time mothers 46% reported that they had a high school degree 46% had a GED All participants were unemployed. Mean monthly income was $1,153. -In order to participate in study, participants had to score > 9 on Edinburgh Postnatal Depression Scale (EPDS) and met other eligible criteria such as: >18 years old, not currently receiving mental health treatment, and be at least 12 weeks pregnant.

-93% program retention rate.

The study design was Experimental Design- A pretest/posttest control group design (classic experimental design). The design type is distinguished by measuring an intervention applied to the study group at the beginning of the process and again at the end. (Grey, Grove, & Sutherland, 2017).

The independent variable is the intervention which is using Problem Solving Therapy (PST).

The dependent variable is Postpartum depression in low income women.

Data collection instruments were used and

included tools that measured the


These tools included Likert scales. It involved psychosocial

measurements using self-report. Edinburgh Postpartum Depression Scale (EPDS) and the PHQ-9, which measures the severity of depressive symptoms.

Trained caseworkers recruited participants by verbally administering the Edinburgh Postnatal Depression Scale (EPDS) during their enrollment into the Healthy start Program.

-Interventions included: Caseworkers did home-visits which included 5 total sessions. The first session consisted of a Motivational Interview (MI) and then four other sessions included Problem Solving Therapy (PST).

The intervention had a 93% retention rate. “Analysis revealed statistically significant improvements on measures of depression symptoms after intervention” (Sampson et. al., 2016, p. 236).

EDPS scores significant reduced from a mean of 13.36 at pretest to a mean of 7.69 at posttest.

PHQ-9 scores showed that there was a significant reduction in depression symptoms, p < .05, the mean was 10.85 at pretest and reduced to 5.23 at posttest. Data was provided after conclusion of the study that with only 4 PST sessions there was an improvement in symptoms that could be observed. Adding one Motivation Interview to the home-visits did not add to the improvement of depression symptoms. A pre-post pilot study was used for the research. - Funding for the study was provided by The University of Houston, Graduate College of Social Work-small grant mechanism and Postpartum Support International. Participants were compensated with $25 after they completed the initial intake and $25 after completion of all sessions. Caseworkers were compensated with a Kindle Fire after completion of at least 4 participants. A limitation to the study was that caseworkers declined to have the interviews recorded for researchers to be able to listen to sessions. Limited funding was provided to be able to hire outside caseworkers to be able to conduct the interviews. Another limitation in the study was a lack of the control group. The education levels of the caseworkers include that two of the caseworkers had an associate’s degree and one was certified as licensed professional counselor (Sampson et. al., 2016). -A graduate level research assistant did look over the caseworkers and provide help if needed. Feasibility and Perception of Using Text Messages as an Adjunct Therapy for Low-Income, Minority Mothers With Postpartum Depression Matthew A Broom, MD- SSM Cardinal Glennon Children's Medical Center Department of Pediatrics Amy S Ladley, PhD; Elizabeth A Rhyne, RN, CPNP Donna R Halloran, MD, MSPH “Among low-income, primarily racial, and ethnic minority mothers with postpartum depression, our aim was to evaluate (1) the feasibility of sending supportive text messages, and (2) the perception of receiving private, supportive text messages for postpartum depression.” (Broom, Ladley, Rhyne, & Halloran, 2015, p. 1). -All text messages included cognitive behavioral therapy (CBT). The aim of the text messages were to provide support and use principles of postnatal education. -Study was conducted in a single urban, academic pediatric clinic in St. Louis -58 mothers were enrolled 3 subjects were excluded due to not having text messaging service. 34 (63%) subjects had smart phones. 69% (40/58) were between the ages of 20-29 83% (48/58) were of non-Hispanic African-American race. The majority (38/47, 81%) had an annual income of 10 on Edinburgh Postnatal Depression Scale (EPDS)

This study used Quantitative and qualitative research.

The independent variables are feasibility and Perception of using text messages.

The dependent variable is low income, minority mothers with postpartum depression,

The data collection tools used were Likert scales such as Beck Depression Inventory-II (BDI-II) were used to evaluate depression.

“The mean EPDS was 13.57 +/- 3.14 (scores ≥10 indicative of risk for PPD) and the BDI-II was 24.24 +/- 9.73, with scores in the range of 16-25 indicative of moderate depression” (Broom et. al., 2015, p. 3).

-The perception of text messages were shown using a table that showed the Quantitative survey responses measured by using a Likert scale with a scale from 1 (strongly disagree) to 5 (strongly agree).

-Descriptive statistics were used to describe the evaluation.

-4158/4790 (86.81%) text messages were delivered to 54 mothers over 6-months.

-Text messages were delivered with a high rate of success- (86.8% of those sent)

-Text messaging was found to positively impact patients with outcomes liked to postpartum depression.

-They are an inexpensive way to communicate with low- income mothers who are unable to seek traditional treatment for postpartum depression. (Broom, 2015).

“Text messaging is feasible, well-accepted, and may serve as a simple, inexpensive adjunct therapy well-suited to cross socioeconomic boundaries and provide private support for at-risk mothers suffering from postpartum depression” (Broom et. al., 2015, p. 1).

-75% of participates shared text messages with others.

-Mothers reported feeling comfortable receiving text messages.

– The study was approved by the Saint Louis University Institutional Review Board.

-Total cost for text messaging was $777.60 ($14.40/ subject; 54 subjects).

-Cost per message was $0.15/message

-The cost of the study was less than anticipated.

Limitations: The study did not evaluate text messaging being an intervention for treatment of postpartum depression. Also, not all participants completed the exit survey.

-A limitation was that text message responses only allowed a yes or no response.

-Low-income mothers may not have continuous access to cellular services which can be barrier. Also, phone numbers changing frequently and not being updated.


Broom, M.A., Ladley, A. S., Rhyne, E. A., & Halloran, D. R. (2015). Feasibility and perception of using

text messages as an adjunct therapy for low-income, minority mothers with postpartum depression. JMIR Mental Health, 2(1), 1-9. doi: 10.2196/mental.4074

Coburn, S. S., Gonzales, N. A., Luecken, L. J., & Crni, K. A. (2016). Multiple domains of stress predict

postpartum depressive symptoms in low-income Mexican American women: the moderating effect of social support. Archives of Women’s Mental Health, 19(6),1009-1018. doi: 10.1007/s00737-016-0649-x

Gray, J., Grove, S., & Sutherland, S. (2017). Practice of nursing research appraisal, synthesis,

and generation of evidence, 8th Ed., St. Louis, MO: Elsevier.

Kim, H.G., Geppert, H., Quan, T., Bracha, Y., Lupo, V., Cutt, D. B. (2012). Screening for Postpartum

Depression Among Low-Income Mothers Using an Interactive Voice Response System, Maternal & Child Health Journal, 16, 921–928. doi: 10.1007/s10995-011-0817-6

Sampson, M., Villarreal, Y., & Rubin, A. (2016). A Problem-Solving Therapy Intervention for Low-

Income, Pregnant Women at Risk for Postpartum Depression. Research on Social Work Practice, 26(3), 236-242. Doi: 10.1177/1049731514551143