(408) Impact of Health-Related Social Needs on Postpartum Anxiety in an Underserved Urban Community

Thursday, January 30, 2025

4:00 PM – 6:00 PM

Submitting Author and Presenting Author(s)

Andrea Rizkallah, MD

Resident
UT Southwestern
Dallas, TX, United States

Coauthor(s)

Ashlyn K. Lafferty, MD, MPH

Resident
University of Texas Southwestern Medical Center
Dallas, Texas, United States
RM

Robert B. Martin, MD

Assistant Professor
University of Texas Southwestern Medical Center
Dallas, Texas, United States
Elaine L. Duryea, MD

Associate Professor
University of Texas Southwestern Medical Center
Dallas, Texas, United States
KW

Kristie R. Wilburn-Wren, MD

Assistant Professor
University of Texas Southwestern Medical Center
Dallas, Texas, United States
DM

Donald D. McIntire, PhD

University of Texas Southwestern Medical Center
Dallas, Texas, United States
Catherine Y. Spong, MD

Professor and Chair
University of Texas Southwestern Medical Center
Dallas, Texas, United States
David B. Nelson, MD (he/him/his)

Associate Professor and Division Chief
University of Texas Southwestern Medical Center
Dallas, Texas, United States

Objective: The aim of this study was to determine the association of health-related social needs (HRSNs) with postpartum anxiety for individuals living in underserved communities. We hypothesized that individuals with greater social needs would have increased rates of anxiety after birth.

Study Design: This was a prospective observational study of patients delivered from 1 Oct 2020 through 31 Dec 2022 with subsequent 1-year follow-up postpartum. Participants living in underserved areas identified through a community-health needs assessment were enrolled in a dedicated, multidisciplinary postpartum care program. HRSNs were assessed upon enrollment using a standardized assessment modeled from the HealthyPeople2030 framework, and medical services were provided for 12 months. Patients were screened for anxiety using Generalized Anxiety Disorder-7 (GAD-7), at 1, 3, 6, and 9 months with positive scores ≥ 10 prompting mental health referral. Cochran-Armitage trend test was used to examine the association between number of HRSN and GAD-7 and the number of visits completed in relation to the type of HRSN.

Results: Of 1647 enrolled, 64.5% (N=1063) reported at least one HRSN with 28% (N=468), 16% (N=257), and 21% (N=338) of individuals reporting one, two, or more than two HRSN, respectively. The most prevalent HRSNs were poor WiFi (23.6%), access to childcare (21%), and missed electric or gas bill (15.3%). There was a significant association between increasing number of reported HRSN and screening positive for anxiety using GAD-7 instrument (P < 0.001, Figure). Individually, a reported need for transportation to medical appointments (N=158) and access to childcare (N=364) were significantly associated with fewer number of follow-up visits (both P < 0.01).

Conclusion: Among patients living in an underserved urban community, increasing number of HRSN was significantly associated with higher GAD scores, and specific HRSNs were associated with lower rates of postpartum follow-up. Addressing HRSN provides the opportunity to impact maternal wellbeing and postpartum follow-up.