Dissertations, Theses, and Capstone Projects

Date of Degree

9-2026

Document Type

Doctoral Dissertation

Degree Name

Doctor of Philosophy

Program

Social Welfare

Advisor

Alexis Kuerbis

Committee Members

Barbra Teater

Rufina Lee

Subject Categories

Maternal and Child Health | Public Health | Social and Behavioral Sciences | Social Work

Keywords

Perinatal mental health, New York City, depression identification, depression treatment, PRAMS

Abstract

Perinatal depression represents a significant public health concern, yet many women who experience depression symptoms during the perinatal period (either during pregnancy and/or after birth) do not receive treatment. Initiatives, such as ThriveNYC, were designed to address these gaps by screening and treating perinatal women for maternal depression, integrating screening into routine perinatal care and strengthening pathways to treatment. Using representative survey data collected between 2016 and 2021 via the Center for Disease Control and Prevention’s Pregnancy Risk Assessment Monitoring System (PRAMS), this study examined trends in perinatal depression inquiries (a proxy for “screening”) and postpartum diagnosis, as well as treatment initiation, among women in New York City. Binary logistic regression was used to examine predictors of treatment initiation among women diagnosed with postpartum depression. Results indicated that prenatal inquiries about depression and diagnosis rates for postpartum depression remained relatively stable over time, while postpartum depression inquires rose steadily. Postpartum treatment initiation remained uneven over time and across groups. Women with a pre-pregnancy mental health visit were significantly more likely to initiate treatment, as were women who explicitly asked for depression help during the postpartum period. In other words, those who had vulnerable mental health situations were the most likely to initiate treatment. In a post-hoc analysis removing postpartum help-seeking from the regression, due to its conceptual similarity to the outcome variable of initiating treatment, country of birth (foreign-born) and household income (lower income) both reduced the likelihood of initiating postpartum treatment. These findings, taken together, suggest that individual level factors often drive postpartum depression treatment initiation; while such pathways may facilitate care for some women, they may also leave others without access to needed services. They also suggest that screening or identification alone may be insufficient to prompt engagement with care. Policies and practices that move beyond screening alone and incorporate proactive engagement may be necessary to ensure more equitable access to postpartum mental health care.

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