| Introduction: Perinatal mental health problems are associated with adverse consequences for women, their children, and their families as a whole, constituting a significant public health problem. The aims of this dissertation were: (1) to examine associations between elevated symptoms of prenatal depression and anxiety in the first trimester of pregnancy and subsequent alcohol use in the third trimester of pregnancy, (2) to investigate associations between elevated symptoms of prenatal depression and anxiety and offspring emotional and behavioral problems in mid to late childhood, and (3) to explore perceptions of mental health services among low-income, perinatal African American women.;Methods: Both quantitative and qualitative data were used. Quantitative, population- based data from the Avon Longitudinal Study of Parents and Children were used to address Aims 1 and 2. Maternal mental health, alcohol use, and other psychosocial and sociodemographic variables were measured longitudinally, beginning in pregnancy and continuing at regular intervals through late childhood. Data on offspring emotional and behavioral problems were collected at ages 10 and l I. In-depth, qualitative data collected as part of a study assessing the feasibility of embedding a preventive intervention for perinatal depression into a home visitation model were used to address Aim 3.;Findings: Elevated symptoms of both depression and anxiety were associated with third- trimester binge drinking. In terms of offspring emotional and behavioral problems, elevated symptoms of prenatal depression were associated with increases in mother- and teacher-reported total difficulties and elevated symptoms of prenatal anxiety predicted an increase in total difficulties according to mothers, but not teachers. Four themes were identified from the qualitative data: perceptions of mental health care providers, concerns about confidentiality, beliefs about the effectiveness of psychotherapy, and perceptions of psychotropic medication. Overall, study participants expressed negative views of mental health care providers and treatment options.;Conclusion: Findings from this dissertation point to a need for increased attention to mental health during pregnancy, including consideration of both prenatal depression and anxiety, in clinical and research contexts. The results also have implications for overcoming barriers to mental health service use among low-income, perinatal African- American women, including the use of strategies to prevent mental health problems. |
