Experiences of racism and perinatal depression: Findings from the pregnancy risk assessment monitoring system, 2018

Abstract

Aim:To estimate the association between feeling upset by experiences of racism and self-reported depression during pregnancy among non-Hispanic Black women using a large population-based sample from the United States. Design:We conducted a secondary analysis of nationally representative crosssectional survey data with retrospective measures. Methods: Analysis of Phase 8 (2018) data from the Pregnancy Risk AssessmentMonitoring System survey included 7328 non-Hispanic Black respondents with a recent live birth from 11 states and New York City. Multivariable logistic regression models were used to estimate the association between self-report of feeling upset due to experience of racism during the year prior to delivery and self-reported depression during pregnancy, controlling for potential confounders. Results:The prevalence of feeling upset due to experiences of racism was 11.4% and the prevalence of depression during pregnancy was 11.4%. Respondents who reported feeling upset due to the experience of racism had over two-fold higher odds (OR 2.37, 95% CI 1.67, 3.37) of experiencing depression during pregnancy compared to respondents who did not report feeling upset due to the experience of racism, adjusted for maternal age, educational attainment, marital status, pre-pregnancy insurance type, region, and pre-pregnancy depression. Conclusion:Respondents who felt upset due to the experience of racism in the year prior to delivery experienced significantly higher odds of depression during pregnancy, and thus are at an increased risk for adverse maternal outcomes. Impact: Stress from racism and racial discrimination during the perinatal period may contribute to maternal morbidity, including perinatal depression, among Black women. No Patient or Public Contribution: The data in this study were collected by the Centers for Disease Control and Prevention for the Pregnancy Risk Assessment Monitoring System. To our knowledge, the conduct of the study did not include patient or public contribution. Neither did the analysis, interpretation, nor manuscript preparation include patient or public contribution because we did not have funding to support the study or their involvement.| 1983 BOWER et al.

Screening and Diagnosis of Mental Health Conditions During Pregnancy and Postpartum

“…Populations marginalized by racism and socioeconomic disadvantage experience significant health inequities in the prevalence, screening, treatment, and outcomes related to perinatal mental health conditions (7,102). Analysis of PRAMS (Pregnancy Risk Assessment Monitoring System) phase 8 2018 data, including 7,328 non-Hispanic Black respondents with live births from 11 states and New York City and controlling for potential confounders, showed that respondents who felt upset due to experiences of racism in the year before delivery had twofold higher odds of depression compared with those who did not (odds ratio 2.37, 95% CI 1.67-3.37) (21).…”

“…Without an intervention in place, less than a quarter of individuals with detected depression in outpatient perinatal care settings will have any treatment, as defined by an initial mental health visit, never mind symptom resolution (20). In addition, although depression is more common, screening or treatment rates are lower for populations experiencing or marginalized by racism and socioeconomic inequities (21)(22)(23).…”