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Health Promotion: Maternal Mental Health During the First Postpartum Year

Ana Hernandez

Florida National University

Health Promotion & Role Development in Advanced Nursing Practice

Nora Hernandez-Pupo

July 24, 2026

Maternal Mental Health During the First Postpartum Year

Poor mental health in mothers is widespread and often undiagnosed in the first year after giving birth. Wang et al. (2021) conducted a review of 565 studies in 80 countries and estimated that the prevalence of postpartum depression was 17.22% worldwide. In the United States, Khadka et al. (2024) found a significant increase in the prevalence of postpartum depression from 9.4% in 2010 to 19.0% in 2021, with high prevalence among non-Hispanic Black patients (22.0%). Robbins et al. (2023) identified 7.2% of mothers as having depressive symptoms at 9-10 months postpartum, with 57.4% of mothers screening negative prior to this stage. The proposed program will provide postpartum women in Miami-Dade County with repeated bilingual screening, psychoeducation, and warm referral. Measurable outcomes will include 20% decrease in elevated Edinburgh Postnatal Depression Scale scores and 80% completion of behavioral health referrals within 12 months.

Vulnerable Population

The target population is postpartum women in Miami-Dade County who are publicly insured, immigrants, or who are at risk for housing instability within the first year postpartum. The most important risk factor is being economically disadvantaged. Using data from the Pregnancy Risk Assessment Monitoring System, O'Connor and Su (2023) determined that 54% of mothers reporting symptoms of depression in the postpartum period were at or below the federal poverty guideline, and that psychosocial stress during pregnancy, such as intimate partner violence, more than triples the likelihood of symptoms of depression. Similar patterns were reported by Mitchell et al. (2023), with rates of 38.9% for women who experience intimate partner violence internationally.

Structural and clinical factors compound this risk. Robbins et al. (2023) linked postpartum Medicaid coverage, prior depression, and postpartum anxiety with postpartum symptoms at 9 to 10 months, when the majority of women are no longer receiving obstetric care. Khadka et al. (2024) reported the highest percentage change in diagnosis for Hispanic and non-Hispanic Black patients, the two largest patient groups in Miami-Dade County. There is also the burden of housing insecurity, as Curzon et al. (2025) found that 15.3% of 182 sheltered moms in Miami were clinically depressed. Even when screening takes place, follow-through is limited as a result of language barriers, fear related to immigration, and disjointed referral systems.

Review of Literature: Evidence-Based Interventions

Curzon et al. (2025) completed a feasibility and pilot study of Child-Parent Psychotherapy with 182 mothers with infants seven months or younger living in a women's shelter in Miami. Following treatment for 16 weeks based on relationships, the rate of clinically elevated symptoms was reduced from 15.3% to 6.7% among mothers, parenting stress was reduced, and treatment satisfaction was 94%. Fidelity was high, but only 53.8% completed the full intervention. The study illustrates that a nonclinical community environment is a viable option for dyadic, trauma-informed care to be provided to highly vulnerable local mothers.

Rafat et al. (2025) performed a randomized controlled trial with 108 non-depressed women using a social messaging app (SMS) that provided virtual education with Pender's health promotion model (HPM) over six weeks. The intervention group demonstrated significantly reduced EPDS, PHQ-9 scores, and increased health-promoting lifestyle scores, with fewer cases of postpartum depression as compared to controls. The trial has demonstrated that low-cost, technology-based prevention is possible without an in-person referral, and is relevant for mothers with transportation and childcare challenges.

Evaluation of Strengths and Weaknesses of the Sources

Across these sources, the prevalence literature is the strongest methodologically. All three studies, by Wang et al. (2021), Mitchell et al. (2023), and Khadka et al. (2024), have high precision and generalizability as they pool several hundred studies and several hundred thousand women. Their regular identification of poverty, violence exposure, and low social support as risks would lend confidence that these risks occur across settings, and are not merely a reflection of one sample. Their main limitation is that they use heterogeneous screening instruments and diagnostic codes, instead of structured interviews, and that prevalence estimates differ greatly between regions and cutoffs.

The intervention literature is more actionable, but weaker in design. Curzon et al. (2025) have strong ecological validity and employ a locally matched sample, but do not include a control group, which means that causal inferences are limited. Randomization and objective measures were utilized in Rafat et al. (2025); however, a small, culturally different, and non-depressed sample was utilized, and therefore, the effects might not be applicable to mothers in Miami who are experiencing symptoms. In particular, the studies point towards a common mechanism; structured relational or educational support provided in the place mothers are. Both are complemented by Robbins et al. (2023), who demonstrated that single-point screening misses late-onset cases, which neither of the intervention studies addressed.

Theoretical Framework

This model guiding the proposal is Pender's Health Promotion Model. The model is based on the individual difference factors and experience factors, behavior-specific cognitions such as perceived benefits, perceived barriers, self-efficacy, and interpersonal and situational factors that impact commitment to a plan of action. This structure is also suitable for postpartum mental health because beliefs of needing postpartum screening and treatment do not rely heavily on knowledge but rather on perceived barriers such as stigma, cost, language, lack of child care, etc., and interpersonal factors such as partners, family, and trusted community staff.

The model also helps to direct the design of concrete programs. Bilingual education is based on the concept that perceived benefits are addressed through the linkage between maternal mood and infant development. Addressing perceived barriers through screening in shelters, during pediatric visits, and with food assistance can help reduce barriers. Skills-based sessions develop self-efficacy, and peer and partner involvement mobilizes interpersonal influence. That same model was used by Rafat et al. (2025) and led to an empirically valid decrease in depression symptoms. APNs can work at all levels of the construct, such as assessment, counselling, coordination of referrals, and advocacy for continued postpartum care.

References

Curzon, M. M., Graziano, P. A., Arcia, E., Cox, S. K., Ayala, M., Carnero, N. A., & O’Mara, N. (2024). Initial promise of child-parent psychotherapy in reducing stress and postpartum depression among mothers experiencing homelessness: A feasibility and pilot study. Archives of Women’s Mental Health. https://doi.org/10.1007/s00737-024-01492-8

Khadka, N., Fassett, M. J., Oyelese, Y., Mensah, N. A., Chiu, V. Y., Yeh, M., Peltier, M. R., & Getahun, D. (2024). Trends in Postpartum depression by Race, ethnicity, and prepregnancy body mass index. JAMA Network Open, 7(11), e2446486. https://doi.org/10.1001/jamanetworkopen.2024.46486

Mitchell, A. R., Gordon, H., Lindquist, A., Walker, S. P., Homer, C. S. E., Middleton, A., Cluver, C. A., Tong, S., & Hastie, R. (2023). Prevalence of Perinatal depression in Low- and Middle-Income countries. JAMA Psychiatry, 80(5). https://doi.org/10.1001/jamapsychiatry.2023.0069

O’Connor, S., & L. Joseph Su. (2023). Postpartum depressive symptoms: An analysis of Social determinants using the pregnancy risk assessment monitoring system. Women’s Health Reports, 4(1), 584–593. https://doi.org/10.1089/whr.2023.0050

Rafat, N., Bakouei, F., Delavar, M. A., & Nikbakht, H.-A. (2025). Preventing postpartum depression in pregnant women using an app-based health-promoting behaviors program (pender’s health promotion model): A randomized controlled trial. BMC Psychology, 13(1). https://doi.org/10.1186/s40359-025-02547-w

Robbins, C. L. (2023). Timing of Postpartum depressive symptoms. Preventing Chronic Disease, 20(20). https://doi.org/10.5888/pcd20.230107

Wang, Z., Liu, J., Shuai, H., Cai, Z., Fu, X., Liu, Y., Xiao, X., Zhang, W., Krabbendam, E., Liu, S., Liu, Z., Li, Z., & Yang, B. X. (2021). Mapping global prevalence of depression among postpartum women. Translational Psychiatry, 11(1), 1–13. https://doi.org/10.1038/s41398-021-01663-6

2

Health Promotion: Maternal Mental Health During the First Postpartum Year

Ana Hernandez

Florida National University

Health Promotion & Role Development in Advanced Nursing Practice

Nora Hernandez-Pupo

July 24, 2026

Maternal Mental Health During the First Postpartum Year

Poor mental health in mothers is widespread and often undiagnosed in the first year after giving birth. Wang et al. (2021) conducted a review of 565 studies in 80 countries and estimated that the prevalence of postpartum depression was 17.22% worldwide. In the United States, Khadka et al. (2024) found a significant increase in the prevalence of postpartum depression from 9.4% in 2010 to 19.0% in 2021, with high prevalence among non-Hispanic Black patients (22.0%). Robbins et al. (2023) identified 7.2% of mothers as having depressive symptoms at 9-10 months postpartum, with 57.4% of mothers screening negative prior to this stage. The proposed program will provide postpartum women in Miami-Dade County with repeated bilingual screening, psychoeducation, and warm referral. Measurable outcomes will include 20% decrease in elevated Edinburgh Postnatal Depression Scale scores and 80% completion of behavioral health referrals within 12 months.

Vulnerable Population

The target population is postpartum women in Miami-Dade County who are publicly insured, immigrants, or who are at risk for housing instability within the first year postpartum. The most important risk factor is being economically disadvantaged. Using data from the Pregnancy Risk Assessment Monitoring System, O'Connor and Su (2023) determined that 54% of mothers reporting symptoms of depression in the postpartum period were at or below the federal poverty guideline, and that psychosocial stress during pregnancy, such as intimate partner violence, more than triples the likelihood of symptoms of depression. Similar patterns were reported by Mitchell et al. (2023), with rates of 38.9% for women who experience intimate partner violence internationally.

Structural and clinical factors compound this risk. Robbins et al. (2023) linked postpartum Medicaid coverage, prior depression, and postpartum anxiety with postpartum symptoms at 9 to 10 months, when the majority of women are no longer receiving obstetric care. Khadka et al. (2024) reported the highest percentage change in diagnosis for Hispanic and non-Hispanic Black patients, the two largest patient groups in Miami-Dade County. There is also the burden of housing insecurity, as Curzon et al. (2025) found that 15.3% of 182 sheltered moms in Miami were clinically depressed. Even when screening takes place, follow-through is limited as a result of language barriers, fear related to immigration, and disjointed referral systems.

Review of Literature: Evidence-Based Interventions

Curzon et al. (2025) completed a feasibility and pilot study of Child-Parent Psychotherapy with 182 mothers with infants seven months or younger living in a women's shelter in Miami. Following treatment for 16 weeks based on relationships, the rate of clinically elevated symptoms was reduced from 15.3% to 6.7% among mothers, parenting stress was reduced, and treatment satisfaction was 94%. Fidelity was high, but only 53.8% completed the full intervention. The study illustrates that a nonclinical community environment is a viable option for dyadic, trauma-informed care to be provided to highly vulnerable local mothers.

Rafat et al. (2025) performed a randomized controlled trial with 108 non-depressed women using a social messaging app (SMS) that provided virtual education with Pender's health promotion model (HPM) over six weeks. The intervention group demonstrated significantly reduced EPDS, PHQ-9 scores, and increased health-promoting lifestyle scores, with fewer cases of postpartum depression as compared to controls. The trial has demonstrated that low-cost, technology-based prevention is possible without an in-person referral, and is relevant for mothers with transportation and childcare challenges.

Evaluation of Strengths and Weaknesses of the Sources

Across these sources, the prevalence literature is the strongest methodologically. All three studies, by Wang et al. (2021), Mitchell et al. (2023), and Khadka et al. (2024), have high precision and generalizability as they pool several hundred studies and several hundred thousand women. Their regular identification of poverty, violence exposure, and low social support as risks would lend confidence that these risks occur across settings, and are not merely a reflection of one sample. Their main limitation is that they use heterogeneous screening instruments and diagnostic codes, instead of structured interviews, and that prevalence estimates differ greatly between regions and cutoffs.

The intervention literature is more actionable, but weaker in design. Curzon et al. (2025) have strong ecological validity and employ a locally matched sample, but do not include a control group, which means that causal inferences are limited. Randomization and objective measures were utilized in Rafat et al. (2025); however, a small, culturally different, and non-depressed sample was utilized, and therefore, the effects might not be applicable to mothers in Miami who are experiencing symptoms. In particular, the studies point towards a common mechanism; structured relational or educational support provided in the place mothers are. Both are complemented by Robbins et al. (2023), who demonstrated that single-point screening misses late-onset cases, which neither of the intervention studies addressed.

Theoretical Framework

This model guiding the proposal is Pender's Health Promotion Model. The model is based on the individual difference factors and experience factors, behavior-specific cognitions such as perceived benefits, perceived barriers, self-efficacy, and interpersonal and situational factors that impact commitment to a plan of action. This structure is also suitable for postpartum mental health because beliefs of needing postpartum screening and treatment do not rely heavily on knowledge but rather on perceived barriers such as stigma, cost, language, lack of child care, etc., and interpersonal factors such as partners, family, and trusted community staff.

The model also helps to direct the design of concrete programs. Bilingual education is based on the concept that perceived benefits are addressed through the linkage between maternal mood and infant development. Addressing perceived barriers through screening in shelters, during pediatric visits, and with food assistance can help reduce barriers. Skills-based sessions develop self-efficacy, and peer and partner involvement mobilizes interpersonal influence. That same model was used by Rafat et al. (2025) and led to an empirically valid decrease in depression symptoms. APNs can work at all levels of the construct, such as assessment, counselling, coordination of referrals, and advocacy for continued postpartum care.

References

Curzon, M. M., Graziano, P. A., Arcia, E., Cox, S. K., Ayala, M., Carnero, N. A., & O’Mara, N. (2024). Initial promise of child-parent psychotherapy in reducing stress and postpartum depression among mothers experiencing homelessness: A feasibility and pilot study. Archives of Women’s Mental Health. https://doi.org/10.1007/s00737-024-01492-8

Khadka, N., Fassett, M. J., Oyelese, Y., Mensah, N. A., Chiu, V. Y., Yeh, M., Peltier, M. R., & Getahun, D. (2024). Trends in Postpartum depression by Race, ethnicity, and prepregnancy body mass index. JAMA Network Open, 7(11), e2446486. https://doi.org/10.1001/jamanetworkopen.2024.46486

Mitchell, A. R., Gordon, H., Lindquist, A., Walker, S. P., Homer, C. S. E., Middleton, A., Cluver, C. A., Tong, S., & Hastie, R. (2023). Prevalence of Perinatal depression in Low- and Middle-Income countries. JAMA Psychiatry, 80(5). https://doi.org/10.1001/jamapsychiatry.2023.0069

O’Connor, S., & L. Joseph Su. (2023). Postpartum depressive symptoms: An analysis of Social determinants using the pregnancy risk assessment monitoring system. Women’s Health Reports, 4(1), 584–593. https://doi.org/10.1089/whr.2023.0050

Rafat, N., Bakouei, F., Delavar, M. A., & Nikbakht, H.-A. (2025). Preventing postpartum depression in pregnant women using an app-based health-promoting behaviors program (pender’s health promotion model): A randomized controlled trial. BMC Psychology, 13(1). https://doi.org/10.1186/s40359-025-02547-w

Robbins, C. L. (2023). Timing of Postpartum depressive symptoms. Preventing Chronic Disease, 20(20). https://doi.org/10.5888/pcd20.230107

Wang, Z., Liu, J., Shuai, H., Cai, Z., Fu, X., Liu, Y., Xiao, X., Zhang, W., Krabbendam, E., Liu, S., Liu, Z., Li, Z., & Yang, B. X. (2021). Mapping global prevalence of depression among postpartum women. Translational Psychiatry, 11(1), 1–13. https://doi.org/10.1038/s41398-021-01663-6