In her 2001 paper “Predictors of Postpartum Depression: An Update,” researcher Cheryl Tatano Beck presents the most common risk factors associated with postpartum depression in women. Postpartum depression occurs when women experience symptoms such as tearfulness, extreme mood changes, and loss of appetite for a lengthened period after giving birth. At the University of Connecticut in Storrs, Connecticut, nursing professor Beck updated a previous study of hers by analyzing literature about postpartum depression published in the 1990s. Beck found four predictors of postpartum depression that she had not included in her previous study. “Predictors of Postpartum Depression: An Update” presents risk factors that healthcare professionals can use to predict whether pregnant women are more likely to develop postpartum depression.

In 2004, Shu-Shya Heh, Lindsey Coombes, and Helen Bartlett studied the association between Chinese postpartum (post-childbirth) practices and postpartum depression in Taiwanese women. The researchers surveyed Taiwanese women about the social support they received after giving birth and then evaluated the depression rates in the same women. Heh and her colleagues focused on the month following childbirth, which according to traditional Chinese medicine, is an important period that warrants a set of specialized practices to aid the woman's recovery. Collectively called zuoyuezi (doing the month), the postpartum practices require the help of someone else, typically the woman's mother or mother-in-law, to complete. Heh and her colleagues found that generally, Taiwanese women with more social support displayed fewer postpartum depressive symptoms, and concluded that the practice of doing the month helped prevent postpartum depression in Taiwanese women.

In 2011, Sarah McMahon and colleagues published “The Impact of Emotional and Physical Violence During Pregnancy on Maternal and Child Health at One Year Post-partum,” hereafter, “The Impact,” in the journal, Child and Youth Services Review. While existing studies had indicated negative chronic effects resulting from intimate partner violence, or IPV, such as miscarriage and premature labor, there was little research specifically analyzing the separate and joint effects of psychological and physical abuse on pregnant women and fetuses. The authors reported that both physical and emotional IPV had negative impacts on the woman and child at one-year after birth, including worse overall health and increased likelihood of depression. In “The Impact,” the researchers analyzed the effects of partner abuse during pregnancy, distinguishing between the effects of emotional abuse and physical abuse on health outcomes for a pregnant woman and her offspring.

Homeless individuals encounter barriers such as lack of health insurance, increased cost of care and unavailability of resources. They have increased risk of comorbid physical disease and poor mental health. Depression is a prevalent mental health disorder in the US linked to increased risk of mortality. Literature suggests depression screening can identify high-risk individuals with using the patient health questionnaire (PHQ-9).

The objective of this project is to determine if screening identifies depression in the homeless and how it impacts healthcare access. Setting is a local organization in Phoenix offering shelter to homeless individuals. An evidence-based project was implemented over two months in 2019 using convenience sampling. Intervention included depression screening using the PHQ-9, referring to primary care and tracking appointment times. IRB approval obtained from Arizona State University, privacy discussed, and consent obtained prior to data collection. Participants were assigned a random number to protect privacy.

A chart audit tool was used to obtain sociodemographics and insurance status. Descriptive statistics used and analyzed using Intellectus. Sample size was (n = 18), age (M = 35) most were White-non-Hispanic, 44% had a high school diploma and 78% were insured. Mean score was 7.72, three were previously diagnosed and not referred. Three were referred with a turnaround appointment time of one, two and seven days respectively. No significant correlation found between age and depression severity. A significant correlation found between previous diagnosis and depression severity. Attention to PHQ-9 varied among providers and not always addressed. Future projects should focus on improving collaboration between this facility and providers, increasing screening and ensuring adequate follow up and treatment.