Peripartum depression (PPD) has a major impact, affecting approximately 13% of all women (Liu et al., 2013). Individuals are disproportionately impacted at different rates based on various demographics, including race. Racially minoritized women are at increased risk of PPD development, as it is one of the most common (19% prevalence rate) forms of postpartum maternal mental health conditions for this community (Lange et al., 2021). Notably, compared to White women, African American and Hispanic women have significantly higher rates of PPD due to sociodemographic risk variables, including stress levels, social support, and stigma (Liu et al., 2013). Thus, this literature review will examine studies related to racial and ethnic disparities among PPD patients and how race affects diagnosis rates, treatment access, and health outcomes.
The reviewed literature reveals connections between race and PPD. Lange et al. (2021) is a meta-analysis that considers the racial and ethnic disparities among women with PPD. Specifically, there are racial disparities for early initiation and adequate delivery of prenatal care, care that significantly improves pregnancy related outcomes including the effects of PPD (Lange et al., 2021). Notably, Lange et al. (2021) found that Black and Hispanic women are less likely to access early prenatal care than White women. For example, the study revealed that in 2019, 10% of Black women and 8% of Hispanic women received late or no prenatal care compared to only 4% of White women in the United States (Lange et al., 2021). This means that minority women are receiving less essential prenatal care and are at higher risk of developing harmful pregnancy outcomes including PPD. Future research must examine the impacts of delayed prenatal care based on race and ethnicity to develop interventions making this care more accessible and equitable.
Similarly, Gopalan et al. (2022) is a literature review analyzing the impact of PPD risks among vulnerable communities. The review highlights data showing health inequalities within racial and ethnic minority communities based upon historical and continuous marginalization by the health care system, with multiple studies revealing higher PPD rates among marginalized women (Gopalan et al., 2022). Thus, Gopalan et al. (2022) found that minority women are more likely to suffer from PPD and are less likely to receive treatment and services. For example, a noted cross-sectional study including 2,539 Californian women found that Black women have higher rates of prenatal depressive symptoms and significantly lower use of postpartum counseling services and medications than White women (Gopalan et al., 2022). There are clear barriers to diagnosis and treatment of PPD. Gopalan et al. (2022) found some specific barriers in PPD care, including limited amounts of perinatal mental health practitioners and language and cultural differences between patients and doctors that prevent sufficient care (Gopalan et al., 2022). This confirms the notion that minority women are receiving much less care designed to prevent negative pregnancy-related outcomes. Therefore, future research must examine the implications of the barriers to treatment among minority communities and offer solutions, perhaps requiring translators in health facilities and increasing access to prenatal care.
As well, Howell et al. (2005) conducted a cross-sectional study using a survey of 655 White, African American, and Hispanic mothers (between two and six weeks postpartum) that inquired about various pregnancy-related factors. These factors included demographics, physical symptoms, daily function, infant behaviors, social support, infant managing skills, and access and trust in the medical system (Howell et al., 2005). Like the other studies examined above, Howell et al.’s (2005) results reveal that African American (43.9%) and Hispanic (46.8%) women reported more early PPD symptoms than White (31.3%) women. They also found that 2 physical and social factors – history of depression, daily function, social support, access, and trust – influence PPD rates, rates that are elevated among African American (2.16) and Hispanic (1.89) women (Howell et al., 2005). Therefore, Howell et al.’s (2005) study confirms that African American and Hispanic women are at higher risk of early PPD symptoms than White women. Future research must analyze this elevated risk and offer support and interventions to reduce PPD.
Kozhimannil et al. (2011) came to similar conclusions as the other analyzed studies in their assessment of racial and ethnic differences in PPD-related care utilization. The study used a retrospective cohort model and collected data from New Jersey’s Medicaid program, looking at 29,601 women who delivered babies from July 2004 to October 2007 (Kozhimannil et al. 2011). Specifically, Kozhimannil et al. (2011) analyzed racial and ethnic differences in PPD-care based on patients initiation of antidepressant medication and follow-up (refill or second visit) or continued outpatient mental health visits (minimum three visits or three prescription refills) within six months postpartum. Kozhimannil et al.’s (2011) results revealed that 9% of White women initiated postpartum mental health care but only 4% of Black women and 5% of Latinas did the same. Therefore, the initiation of treatment postpartum is significantly lower for minority women (Kozhimannil et al. 2011). They also found that minority women were less likely to receive follow-up treatment and continued care (Kozhimannil et al. 2011). Given these disparities in PPD health care based on race and ethnicity, additional clinical and policy research is needed to reduce these gaps and promote more equitable care (Kozhimannil et al. 2011).
Pao et al. (2019) is among the largest, most comprehensive research projects on PPD case status and its connection to social support. Pao et al. (2019) conducted research using a cross-sectional cohort with 1,517 women at six weeks postpartum (ages 17 to 45) from four 3 outpatient clinics in North Carolina from September 2012 to June 2017. The study found that a lack of social support leads to higher PPD risks while more social support leads to a stronger protection against PPD risk (Pao et al., 2019). Pao et al. (2019) confirmed that minority women are at higher risk of PPD development and, thereby, likely have less social support compared to White Women (Pao et al., 2019). The authors also found that the severity of PPD symptoms is connected to the amount of social support and that multidimensional social support systems can be protective for racial and ethnic minority women (Pao et al., 2019). Future research is needed to better understand how to implement culturally sensitive and aware interventions to increase social support among minorities and, ultimately, reduce PPD rates (Pao et al., 2019).
There are clear public health consequences reflected within these literature findings. For instance, the literature reveals that prenatal care is less accessible for minority communities, causing increased risk for PPD development (Lange et al., 2021). It also demonstrates barriers to care including appointment availability and wait time disparities between minority women and White women, reducing access to adequate care for minority women and putting them at higher risk of stress and social demographics that increase the risk of PPD development (Lange et al., 2021). The literature also reveals that past experiences of racism and discrimination contribute to decreased use and desire for the healthcare system among minority women. For example, Lange et al., (2021) found that Black and Hispanic individuals have three-times higher odds of experiencing discrimination due to race, language, or culture during care. Likewise, Gopalan et al. (2022) notes that the social determinants of health including lack of access to affordable healthcare and community-wide mistrust in government contribute to high PPD rates among minority women. Therefore, collectively the literature suggests that race/ethnicity and discrimination play a role in PPD development and access to necessary health services.
Thus, PPD disproportionately impacts minority women and more research is needed on its direct impact. Thereafter, better public health policies, solutions, and interventions can be designed to support minority women and ensure they receive proper PPD treatment
References
Gopalan, P., Spada, M. L., Shenai, N., Brockman, I., Keil, M., Livingston, S., Moses-Kolko, E., Nichols, N., O’Toole, K., Quinn, B., & Glance, J. B. (2022). Postpartum
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Howell, E. A., Mora, P. A., Horowitz, C. R., & Leventhal, H. (2005). Racial and ethnic
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Kozhimannil, K. B., Trinacty, C. M., Busch, A. B., Huskamp, H. A., & Adams, A. S. (2011).
Racial and ethnic disparities in postpartum depression care among low-income women. Psychiatric Services, 62(6), 619-625.
Lange, E. M., & Toledo, P. (2021). Peripartum racial/ethnic disparities. International
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