Disparities in healthcare utilization and depression among young mothers: The role of family functioning.

Shannon Whittaker, Isabel Martinez, Trace Kershaw
Author Information
  1. Shannon Whittaker: Department of Social and Behavioral Sciences, Yale University School of Public Health, New Haven, CT, USA. ORCID
  2. Isabel Martinez: Department of Social and Behavioral Sciences, Yale University School of Public Health, New Haven, CT, USA.
  3. Trace Kershaw: Department of Social and Behavioral Sciences, Yale University School of Public Health, New Haven, CT, USA.

Abstract

BACKGROUND: Extant research suggests that disparities in healthcare utilization and experiences of mental health disorders such as depression exist across sociodemographic groups. One understudied pathway that may have significant implications for these disparities is the role of family functioning. How families interact, communicate, and adapt may vary, but these relationships remain integral for vulnerable subsets of the population due to their seemingly protective properties. Yet, few studies have examined the relationship between family functioning and health.
OBJECTIVE: The aim of this study was to explore family functioning as a predictor for healthcare utilization and depression among young mothers and as a moderator of disparities for each of these outcomes.
DESIGN/METHODS: This analysis uses data from a prospective cohort study which was conducted with 296 pregnant young women recruited from obstetrics clinics in Connecticut between July 2007 and February 2011 and followed 1-year postpartum. Logistic regression models were used to assess family functioning, race/ethnicity, and immigrant status as predictors of healthcare utilization and depression. Family functioning was evaluated as a moderator for both outcomes.
RESULTS: Black and Latina mothers had decreased odds of using physical healthcare services (odds ratio = 0.13, p < 0.001; odds ratio = 0.31, p = 0.02). Family functioning was associated with decreased odds of using mental healthcare services (odds ratio = 0.97, p = 0.04) and had a protective effect against depression (odds ratio = 0.96, p = 0.003). Family functioning significantly moderated the relationship between immigrant status and physical healthcare utilization, Black race/ethnicity and physical healthcare utilization, and Other race/ethnicity and depression.
CONCLUSION: Family functioning is a significant factor associated with both healthcare utilization and depression among young mothers. It should be a strongly considered component within healthcare settings to mitigate risks among vulnerable populations.

Keywords

References

  1. J Adolesc Health. 2023 May;72(5S):S11-S17 [PMID: 37062578]
  2. Ann Fam Med. 2021 Jan-Feb;19(1):4-15 [PMID: 33431385]
  3. J Nerv Ment Dis. 2007 Mar;195(3):189-95 [PMID: 17468677]
  4. Am J Psychiatry. 1990 Sep;147(9):1128-37 [PMID: 2201221]
  5. Stigma Health. 2022 Aug;7(3):300-310 [PMID: 36776352]
  6. Glob Health Action. 2022 Dec 31;15(1):2067397 [PMID: 35762835]
  7. J Gen Intern Med. 2007 Nov;22 Suppl 2:289-93 [PMID: 17957413]
  8. J Fam Pract. 2000 Feb;49(2):147-52 [PMID: 10718692]
  9. Gen Hosp Psychiatry. 2004 Jul-Aug;26(4):289-95 [PMID: 15234824]
  10. Afr J Prim Health Care Fam Med. 2020 May 28;12(1):e1-e9 [PMID: 32501029]
  11. Hosp Prog. 1984 May;65(5):12-4, 31 [PMID: 10266499]
  12. Psychiatr Serv. 2008 Nov;59(11):1292-8 [PMID: 18971405]
  13. J Pain. 2010 Nov;11(11):1027-38 [PMID: 21055709]
  14. Soc Sci Med. 2018 Nov;216:88-96 [PMID: 30273777]
  15. Am J Community Psychol. 2013 Dec;52(3-4):288-301 [PMID: 24091562]
  16. J Community Health Nurs. 1992;9(3):161-9 [PMID: 1512620]
  17. Lancet Psychiatry. 2017 Feb;4(2):146-158 [PMID: 27856392]
  18. Psychosom Med. 2001 Sep-Oct;63(5):830-4 [PMID: 11573032]
  19. Socius. 2017 Jan;3: [PMID: 28845455]
  20. Matern Child Health J. 2018 Oct;22(10):1400-1406 [PMID: 29557522]
  21. J Marital Fam Ther. 2009 Oct;35(4):432-45 [PMID: 19785700]
  22. Am J Public Health. 2019 Oct;109(10):1342-1345 [PMID: 31415204]
  23. J Child Fam Stud. 2014 Feb;23(2):255-262 [PMID: 24653641]
  24. Hisp Health Care Int. 2016 Mar;14(1):10-6 [PMID: 27257186]
  25. J Affect Disord. 2008 May;108(1-2):147-57 [PMID: 18067974]
  26. J Gen Intern Med. 2003 Feb;18(2):146-52 [PMID: 12542590]
  27. Pediatrics. 2014 Jan;133(1):114-22 [PMID: 24298010]
  28. Arch Psychiatr Nurs. 2003 Oct;17(5):197-204 [PMID: 14608549]
  29. J Marital Fam Ther. 2012 Jan;38(1):265-80 [PMID: 22283390]
  30. Soc Work Health Care. 1997;24(3-4):85-97 [PMID: 9127906]
  31. Arch Intern Med. 2004 May 10;164(9):1010-4 [PMID: 15136311]
  32. JAMA. 2021 Aug 17;326(7):649-659 [PMID: 34402829]
  33. Public Health Rev. 2016 Dec 03;37:28 [PMID: 29450069]
  34. J Pediatr Psychol. 2008 Oct;33(9):1046-61; discussion 1062-4 [PMID: 17905801]
  35. Soc Psychiatry Psychiatr Epidemiol. 2008 Dec;43(12):983-98 [PMID: 18575787]
  36. J Law Med Ethics. 2020 Sep;48(3):506-517 [PMID: 33021163]
  37. J Clin Psychol Med Settings. 2015 Dec;22(4):265-78 [PMID: 26370202]
  38. Behav Med. 2019 Apr-Jun;45(2):86-101 [PMID: 31343961]
  39. J Psychosom Res. 2006 Nov;61(5):619-27 [PMID: 17084139]
  40. J Family Reprod Health. 2017 Sep;11(3):165-173 [PMID: 30018654]
  41. Public Health Rep. 1986 May-Jun;101(3):253-65 [PMID: 3086917]
  42. Psychol Med. 2009 Jul;39(7):1117-27 [PMID: 19000338]
  43. J Racial Ethn Health Disparities. 2016 Oct 19;: [PMID: 27761728]
  44. J Urban Health. 2016 Jun;93(3):456-67 [PMID: 27193595]
  45. Neuropsychiatr Dis Treat. 2019 Feb 22;15:603-609 [PMID: 30863081]
  46. Am J Public Health. 2007 Jan;97(1):76-83 [PMID: 17138911]
  47. Issues Ment Health Nurs. 2003 Apr-May;24(3):237-56 [PMID: 12623684]
  48. J Abnorm Psychol. 1991 Nov;100(4):594-9 [PMID: 1757673]
  49. Health Aff (Millwood). 2020 Mar;39(3):387-394 [PMID: 32119612]
  50. Br J Psychiatry. 1987 Jun;150:782-6 [PMID: 3651732]
  51. Indian J Psychiatry. 2020 Jan;62(Suppl 2):S192-S200 [PMID: 32055062]
  52. Curr Epidemiol Rep. 2017 Jun;4(2):145-155 [PMID: 29805955]
  53. AIDS Behav. 2012 Aug;16(6):1522-31 [PMID: 21983692]
  54. Am J Geriatr Psychiatry. 2012 Jun;20(6):533-42 [PMID: 21992942]
  55. Health Psychol. 2016 Sep;35(9):987-95 [PMID: 27175576]
  56. J Affect Disord. 2012 Jan;136(1-2):155-162 [PMID: 21864914]
  57. J Pediatr Adolesc Gynecol. 2010 Feb;23(1):16-22 [PMID: 19679498]

Grants

  1. F31 MD017129/NIMHD NIH HHS
  2. R01 MH075685/NIMH NIH HHS
  3. T32 MH020031/NIMH NIH HHS

MeSH Term

Female
Humans
Pregnancy
Depression
Ethnicity
Mothers
Patient Acceptance of Health Care
Prospective Studies
Healthcare Disparities

Word Cloud

Created with Highcharts 10.0.0healthcarefunctioningutilizationdepressionfamilyoddsyoungdisparitiesamongmothersFamilyratio = 0healthrace/ethnicityphysicalp = 0mentalmaysignificantrolevulnerableprotectiverelationshipstudymoderatoroutcomesimmigrantstatusBlackdecreasedusingservicesassociatedBACKGROUND:ExtantresearchsuggestsexperiencesdisordersexistacrosssociodemographicgroupsOneunderstudiedpathwayimplicationsfamiliesinteractcommunicateadaptvaryrelationshipsremainintegralsubsetspopulationdueseeminglypropertiesYetstudiesexaminedOBJECTIVE:aimexplorepredictorDESIGN/METHODS:analysisusesdataprospectivecohortconducted296pregnantwomenrecruitedobstetricsclinicsConnecticutJuly2007February2011followed1-yearpostpartumLogisticregressionmodelsusedassesspredictorsevaluatedRESULTS:Latina13p < 000131029704effect96003significantlymoderatedCONCLUSION:factorstronglyconsideredcomponentwithinsettingsmitigateriskspopulationsDisparitiesmothers:

Similar Articles

Cited By