Nationally, approximately 700 women die each year from complications related to pregnancy and childbirth with perinatal depression being the most common postpartum complication (CDC). Within Los Angeles County, one in five women experience perinatal depression, and often those who are identified as having depression have difficulty finding appropriate care due to various social and economic factors, including material poverty, housing instability, and lack of social support (CDPH). Addressing social drivers (determinants) of health (SDOH) – defined as non-medical factors that affect health outcomes – can improve overall care and perinatal mental health outcomes.
A recent study in LA county, Social Determinants Among Pregnant Clients With Perinatal Depression, Anxiety, Or Serious Mental Illness (Health Affairs, April 2024), takes a close look at the linkages between SDOH and clients experiencing perinatal anxiety and depression. Co-author Dr. Bridgette Blebu, shared some of the study findings and implications for providing perinatal mental health care.
In LA County, we found that women with depression, anxiety, or a serious mental illness were more likely to experience multiple social determinants compared to those who did not have mental health issues during pregnancy. We also found that some social needs tended to “travel together” such as housing instability, low social support, intimate partner violence, or having a history of substance use.
While our findings are similar to other studies demonstrating the co-occurrence of social determinants is related to poor maternal mental health, they may offer some nuances for targeted partnerships between health care systems and community agencies or among community agencies. The care provided in LA County is centered on holistic assessments of social determinants as they unfold in the context of each woman’s life, and the hope is that with continued contact among care team members, including perinatal social workers, care coordinators, psychiatrists, and obstetric providers, clients will feel supported with resources and activated in their pregnancy.
The study found that the impacts of adverse SDOH on PMAD and serious mental illness (SMI) call for screening of social determinants in addition to mental health outcomes during the perinatal period. In addition, I think the findings also point to the fact that the task of addressing adverse social determinants in pregnancy within the health care setting alone may not be sustainable. But growing partnerships with and capacity in community support programs like St. John’s Community Health is critically important.
I would add that as a psychiatrist, it’s almost impossible for me to effectively address some mental health symptoms if the underlying stressors caused by SDOH aren’t resolved. How can an antidepressant truly make someone feel better if they and their infant are unhoused? Working hand in hand with a multidisciplinary team that wraps each new parent in the care they need allows my role to become much more impactful.”
– Social Determinants Among Pregnant Clients With Perinatal Depression, Anxiety, Or Serious Mental Illness (Health Affairs, 2024)
St. John’s Community Health is one of several LA County community health centers participating in Los Angeles County Maternal Mental Health Access (LAMMHA), a five-year program funded by The California Health Care Foundation (CHCF) to support Los Angeles County community health centers to identify and treat perinatal mood and anxiety disorders (PMAD) and reduce the risk of suicide. Through the program St. John’s has been working to implement the evidence-based collaborative care model (CoCM), a specific type of integrated care to treat common mental health conditions in medical settings like primary care. In addition to providing CoCM support to their patients, St. John’s partners with over 40 community organizations to offer additional SDOH services and support.
The most prevalent SDOH among St. John’s perinatal patients include racism in health care, access to quality health care, material poverty, unemployment, lack of housing, nutrition and food insecurity. offers several programs to address patients’ SDOH needs. The goal of the Committed to Black Wellness and Health Program (CBWH) is to promote health equity, improve Black maternal and infant health outcomes, empower Black mothers to thrive, and ensure accountability within medical institutions for instances of racial discrimination and bias.
St. John’s also shared with us the overall impact of addressing SDOH in perinatal mental health care and how these elements support overall wellbeing of birthing parents and families at St. John’s.
The intersection of SDOH and perinatal mental health care has yielded significant positive changes and outcomes. By addressing the social, economic, and environmental factors that influence mental health during pregnancy and postpartum, there has been a marked improvement in various aspects including improved mental health assessments, better birth outcomes, and effective resource allocation. In addition, in the Empowerment through Education program, pregnant individuals receive education about their rights, their health, and their baby’s health within the context of SDOH. This empowerment enables them to advocate for themselves, make informed decisions about their health care, and access the resources necessary to support their well-being and that of their child.
Achieving 100% positive feedback and witnessing continued attendance of mothers even after completing the program is a remarkable achievement and a testament to the effectiveness and impact of the services provided.”
– St. John’s staff member
By employing a multi-faceted approach that includes frontline staff engagement, behavioral health integration, community partnerships, and accessible information dissemination through QR codes, St. John’s ensures that patients are supported in addressing their perinatal and SDOH needs effectively.
Caring for myself during pregnancy was a journey made easier thanks to St. John’s Community Health and The CBWH Program. From the moment I walked through their doors, I felt supported and understood. CBWH provided me with culturally responsive care and resources tailored to my needs. The accessibility of their programs, coupled with the warm and welcoming environment, empowered me to prioritize my health and well-being. CBWH not only helped me navigate the complexities of pregnancy but also connected me with vital community resources for housing and support. I’m grateful for their dedication to serving diverse populations and making a positive difference in the lives of mothers like me.”
– St. John’s patient
For additional resources on addressing SDOH in perinatal mental health care, please see the LAMMHA resource page.
LAMMHA is a five-year program funded by The California Health Care Foundation (CHCF) to support Los Angeles County community health centers in the identification and treatment of common perinatal mental disorders in primary care. For more information and/or to apply for an upcoming LAMMHA cohort, please visit the CCALAC LAMMHA program page and our previous blog posts on the LAMMHA program and the LAMMHA ECHO series. For more information and resources around maternal mental health in California, please visit the California Department of Public Health – Maternal Mental Health page.
*LAMMHA program partners: Community Clinic Association of Los Angeles County (CCALAC), Elevation Health Partners (EHP), Maternal Mental Health Now (MMHN), Concert Health, University of Pennsylvania (UPenn), University of California, Los Angeles (UCLA) and the Department of Psychiatry and Behavioral Sciences at the University of Washington.
Co-authors:
Bridgette Blebu, PhD MPH
Faculty Investigator
The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center
Cassia Brockway, MPH
Practice Transformation Consultant, Elevation Health Partners
Melinda Vredevoogd, MS
Assistant Director for Research & Evaluation
Division Population Health, Department of Psychiatry & Behavioral Sciences, University of Washington School of Medicine
Heather Alexander
Program Director, St. John’s Community Health