Postpartum Depression: Racial/Ethnic Minorities Face Higher Prevalence, Less Care

Pregnant women who aren’t White are more likely to experience symptoms of postpartum depression and less likely to receive mental healthcare for those symptoms, say the results of several single-state, cross-sectional studies.

The authors of a new study published in Health Affairs aimed to build on these findings using longitudinal data to investigate the relationship between race and ethnicity and postpartum depressive symptoms, perinatal mood and anxiety disorder (PMAD), and the care patients received.¹ Six of the seven authors of the new study are from the University of North Carolina at Chapel Hill; the seventh is affiliated with Columbia University in New York City.

The research team obtained data from the 2020 Postpartum Assessment of Health Survey (PAHS), which includes data on women who were 12 to 14 months postpartum from the health departments of Kansas, Michigan, New Jersey, New York City, Pennsylvania, Utah, and Virginia. The PAHS was administered to participants in the 2020 Centers for Disease Control and Prevention’s Pregnancy Risk Assessment Monitoring Survey (PRAMS). “After weighting, the distribution of age, marital status, race, ethnicity, education, insurance at birth, and parity in the PAHS sample was within 1 percentage point of the distribution within the PRAMS sample,” the authors noted.¹

Characteristics of the study cohort

The current study included 4542 participants on the 2020 PRAMS recontact list who replied to the study solicitation and had PAHS data on early postpartum (2 to 6 months) depressive symptoms.¹ Early depressive symptoms were self-reported using a modified version of the Patient Health Questionnaire-2 (PHQ-2).

The study population’s race and ethnic distribution was as follows:

• Non-Hispanic White (54.1%)
• Hispanic (17.8%)
• Non-Hispanic Black (13.7%)
• Non-Hispanic individuals, including those of Asian, Native Hawaiian, Pacific Islander, Southwest Asian, Middle Eastern, and North African descent (9.5%)
• Multiple racial and ethnic identities (4.6%)
• American Indian or Alaska Native (0.3%)

The main outcome measure of the study was to test whether there are variations in the prevalence and care of postpartum depressive symptoms among different races and ethnicities.

Certain groups are less likely to get the care they need

What did the research team find? For one, participants with multiple racial and ethnic identities had the highest weighted prevalence (17.8%) of early postpartum depressive symptoms, followed by non-Hispanic Blacks (16.0%). Next came non-Hispanic individuals as described earlier (13.8%), non-Hispanic Whites (10.9%), and Hispanics (9.1%). More than half of the participants (59.6%) with early postpartum depressive symptoms had a depression, anxiety, or mood disorder diagnosis, and a quarter (25.4%) had a specific diagnosis of PMAD. About half of the women (52.8%) who reported any of these diagnoses got some form of mental healthcare in the year postpartum.

The group of non-Hispanic individuals (30.4%) and the Hispanic cohort (34.2%) were significantly less likely to receive a postpartum depression diagnosis than non-Hispanic Whites (74.0%). And compared to non-Hispanic White participants, Hispanics, Blacks, and the group of women of non-Hispanic ethnicities were significantly less likely to receive mental healthcare (67.4%, 37.2%, 37.1%, and 19.7%, respectively).

And the main take-aways are…

“Our results, in concert with the existing literature, indicate that racial and ethnic inequities along the postpartum mental healthcare continuum may be the most present at the care stage,” the authors wrote.¹ Going forward, they added, “future research must investigate the mechanisms that drive these inequities to inform the development and evaluation of interventions at the systems, healthcare, and provider levels to reduce mental health disparities.”¹

There is plenty, however, that can be done now to reduce these inequities, the authors insist.

“Policies that require and reimburse universal mental health screening at postpartum visits, ensure connection to care, reduce gaps in postpartum insurance coverage, and require clinician training in culturally responsive resources could improve equity of postpartum depression diagnoses and care in the U.S.,” the research team concluded.1

Published: June 28, 2024