Direct and indirect predictors of postpartum depression symptoms among indigenous Bedouin mothers in Israel.

Postpartum depression (PPD) is a common and complex phenomenon with negative outcomes for children, women and their families. This study set out to identify both direct and indirect predictors of PPD symptoms among indigenous Bedouin mothers in Israel. The study included 305 women, 18 to 45 years of age, who were interviewed while pregnant and again, 2 to 4 months postpartum. Interviews were conducted in Arabic and included the Edinburgh Postnatal Depression Scale, administered at both points of measurement. Using path analyses, we identified four significant, direct predictors of PPD symptoms. The strongest was depressive symptoms when pregnant, followed by low relative income, low hemoglobin, and number of prior miscarriages. The latter was significantly associated with consanguinity, meaning that women married to a first cousin experienced more miscarriages which, in turn, increased PPD risk. Low relative income was the only variable that had both a direct and indirect effect upon PPD symptoms (via symptoms of depression when pregnant and hemoglobin). Education and polygamy also emerged as indirect predictors of PPD via depressive symptoms reported during pregnancy. Results suggest a high rate of PPD in this perinatal sample of indigenous women. Our findings underscore the need for tailored interventions to reduce PPD, especially for low-income Bedouin women, faced with many barriers and insufficient access to healthcare services.

A Non-Randomized Controlled Trial for Reducing Postpartum Depression in Low-Income Minority Women at Community-Based Women's Health Clinics.

OBJECTIVE: To analyze an intervention that delivered tailored clinic staff training on postpartum depression (PPD) followed by awareness raising and social support aimed at lowering PPD among low-income Bedouin women in southern Israel. METHODS: We conducted a non-randomized controlled trial at two women's health clinics. The study included 332 of the 384 eligible women recruited at baseline (intervention = 169, control = 163), who completed two face-to-face interviews, one at 26-38 weeks of pregnancy (Time 1) and one 2-4 months postpartum (Time 2). PPD was measured by the Edinburgh Postnatal Depression Scale (EPDS) and dichotomized using a ≥ 10 score cutoff. We calculated EPDS change (rate difference of dichotomous EPDS from Time 1 to Time 2) (no change, positive change, or negative change), and compared EPDS changes in a control clinic vs. an intervention clinic. RESULTS: The intervention group showed a greater decrease in dichotomous EPDS ≥ 10 between times 1 and 2 (38.5% to 17.2%) than the control group (31.9% to 29.4%, PV = 0.008). Multinomial logistic regression showed that high PPD awareness significantly contributed to positive EPDS change in the intervention group (PV = 0.003) and high social support significantly protected against negative EPDS change in both groups, intervention (PV = 0.001) and control (PV = 0.003). CONCLUSIONS: In low-income women, an intervention focusing on increasing PPD awareness and social support following staff training was associated with reduced EPDS and positive EPDS change following the intervention. Similar interventions should be implemented in women's clinics during pregnancy. CLINICAL TRIAL REGISTRY: ClinicalTrials.gov NCT02862444.

Temporal Stability of Responses to the Edinburgh Postpartum Depression Scale by Bedouin Mothers in Southern Israel.

The detection and treatment of mental illness during pregnancy and postpartum are essential for the well-being of both mother and child. For this study, we set out to estimate the prevalence of perinatal depression among Bedouin mothers in southern Israel and determine if the latent structure of responses to the Edinburgh Postpartum Depression Scale (EPDS)-including depression, anxiety, and anhedonia-previously reported also applies to this population. A total of 332 women completed the EPDS during pregnancy (26-38 weeks) and again 2-4 months postpartum. Confirmatory factor analyses were performed to determine if first-order factors were correlated, or instead measure a second- or higher-order latent construct. We next performed temporal invariance analyses to compare the latent structure of EPDS responses over time. When pregnant, 35% of women provided EPDS responses suggestive of elevated depressive symptomology; this decreased to 23% postpartum. At both points, each EPDS factor significantly measures a higher-order, latent construct. The EPDS appears to measure three factors, labeled sadness, anxiety, and anhedonia. This latent structure appears stable (i.e., during pregnancy and postpartum). Further research is needed to validate EPDS responses versus structured clinical interviews. The construct validity of EPDS factors should be examined across other at-risk groups and over time.

COVID-19 Vaccination Among the Arab Bedouin Population: Lessons Learned From a Minority Population.

Objectives: We investigated the causes of low COVID-19 vaccination rates among a minority population and highlighted interventions for increasing the vaccination rate. Methods: We reviewed the experience during the mass vaccination campaign period among the Arab Bedouin (AB) in Israel, attempting to determine important causes of low vaccination rates and gathered information from real-life experience and through direct contact with the population during the campaign. Results: Causes for low vaccination rates in the AB are related to the health system infrastructure, crisis management strategies, and population characteristics. Long-standing socioeconomic inequalities, limited resources, and language and culture barriers present special challenges to the task of COVID-19 vaccination campaigns. Key interventions for increasing vaccination rates among minority populations include raising awareness, improving vaccination access, and directly targeting risk-groups. To maximize the effectiveness of these interventions they should be culturally adapted and executed according to the needs of each individual target community. Conclusion: Culturally adapted awareness campaigns, interventions, and improved access to vaccines can be accomplished by cooperation between relevant governing and community bodies to increase COVID-19 vaccination rates among minorities.

Direct and indirect determinants of prenatal depression among Arab-Bedouin women in Israel: The role of stressful life events and social support.

OBJECTIVE: Prenatal depression (PND) negatively affects the health and well-being of both mother and child. The aim of this study was to identify the direct and indirect determinants of prenatal depression symptoms (PNDS) among Arab-Bedouin women in southern Israel. DESIGN: Data collection was conducted in two women's health centers from October 2017 to February 2018. SETTING: Participants were recruited during visits to women's health centers in southern Israel. PARTICIPANTS: We recruited 376 Arab-Bedouin women as part of a larger study of perinatal health and well-being. We recruited 376 Arab-Bedouin women as part of a larger study of perinatal health and well-being. All women were 18+ years of age and 26-38 weeks of gestational age. MEASUREMENTS: PNDS were measured by an Arabic version of the Edinburgh Postnatal Depression Scale. We computed path analyses to identify direct and indirect determinants of PND and estimated the contribution of stressful life events and social support. RESULTS: Positive direct associations emerged between stressful life events, history of depression and gestational age, and PNDS; direct inverse associations were found between social support, PND awareness, and education, and PNDS. History of depression was the single strongest direct predictor of PNDS yet when considering combined direct and indirect effects, the contribution of stressful life events is greater. Stressful life events (via history of depression and PND awareness) and education (via PND awareness) had both direct and indirect effects on PNDS. Age of the mother indirectly affects PNDS via education and PND awareness. Polygamy emerged as neither a direct nor indirect predictor of PNDS. CONCLUSIONS: PNDS in the underserved and understudied Bedouin women has serval direct and indirect predictors. Interventions aiming at reducing stress and increasing social support, via PND awareness might be successful in reducing PND and possibly future postpartum depression.