Postpartum depressive symptom severity among child-bearing Veterans: Examining contributions of environmental indices

Veterans are at increased risk of experiencing postpartum depression yet are understudied. Environmental factors like rurality and resource richness are associated with various health outcomes, although environmental relations to mental health outcomes, such as postpartum depression (PPD), have not been explored thoroughly. The current study aimed to examine the relation between living environment utilizing two indices (Area Deprivation Index and Rural Urban Commuting Area) and postpartum depressive symptom severity in postpartum Veterans. The study sample included postpartum Veterans that were recruited for an online CBT intervention. We utilized screening data from this recruitment effort. Depressive symptom severity was measured via the Patient Health Questionnaire-9. Individual Veteran-level administrative data included age, race, ethnicity, and residential address. Linear regression was used to determine whether resource richness and rurality were associated with depressive symptom severity when adjusting for race. Black Veterans had greater depressive symptom severity than White Veterans (β = 0.12, t = 3.39, p < .001). Rural-dwelling Veterans had lower depressive symptom severity than non-rural dwelling Veterans. Resource richness was not significantly associated with depressive symptom severity. There was not a significant interaction between race and rurality. The results of this study indicate that Black postpartum Veterans enrolled in VA care experienced greater depressive symptom severity. Additionally, rural-dwelling postpartum Veterans reported lower depressive symptom severity. Many postpartum Veterans in this sample were experiencing high symptom burden. Screenings for depressive symptom severity in the postpartum period should be provided to all childbearing individuals, but among Veterans, this may be particularly important.