Study Shows Inequities in Postpartum Mental Health Care Access Across Racial, Ethnic Groups

Results from a study published in Health Affairs show racial and ethnic inequities in the management of postpartum depressive symptoms among new mothers, with marginalized communities significantly less likely to access vital mental health support, despite no discernible differences in diagnosis rates.

The ability to identify the presence of racial and ethnic inequities within postpartum mental health care could indicate a gap in care for certain patients who are in need of referrals and overall access to care, the team of researchers noted. Their study aimed to expand on previous cross-sectional and single-state data documenting potential disparities of this nature.

A pregnany woman with postpartum depression | Image Credit: ryanking999 - stock.adobe.com

The study, utilizing data from the 2020 Postpartum Assessment of Health Survey (PAHS), was conducted as a collaborative effort between Columbia University and 7 participating health departments across various US jurisdictions. This survey was conducted 12 to 14 months postpartum among respondents of the 2020 Pregnancy Risk Assessment Monitoring Survey (PRAMS) administered by the CDC. PRAMS, an ongoing annual survey, identifies individuals from 2 to 6 months postpartum through a stratified random sample of live births from state and city birth certificates.

To create a longitudinal dataset covering preconception through to 1 year after birth, data from birth certificates were linked to PRAMS (early postpartum) and PAHS (late postpartum). The PAHS sample comprised 4598 individuals who were 12 to 14 months postpartum and resided in one of the 7 participating jurisdictions at the time of delivery.

Various measures were employed to assess postpartum mental health. Early postpartum depressive symptoms were determined using a modified version of the Patient Health Questionnaire-2 from PRAMS data. Those indicating "always" or "often/almost always" to either question were considered to have early postpartum depressive symptoms. Perinatal mood and anxiety disorder (PMAD) diagnosis was self-reported during late postpartum on the PAHS survey, with timing options of before, during, or after pregnancy. Receipt of mental health care in the first year postpartum was also self-reported on PAHS.

The analysis involved weighting the data to account for sampling, coverage, and nonresponse biases, ensuring that estimates were representative of all people with a live birth in 2020. Weighted percentages of sociodemographic variables were calculated, along with the prevalence of early postpartum depressive symptoms and the proportion reporting PMAD diagnosis and postpartum mental health care, stratified by racial and ethnic categories.

The study identified disparities in postpartum mental health care access and diagnosis among different racial and ethnic groups. Although the proportion reporting a PMAD diagnosis was lower among certain racial groups compared with White respondents, the proportion receiving mental health care was significantly lower among respondents identifying as Asian, Native Hawaiian, Pacific Islander, Southwest Asian, Middle Eastern, or North African; Hispanic; or Black compared with White respondents.

“It must be noted that any observed racial and ethnic disparities in postpartum depressive symptoms and care do not stem from biological differences,” the study stated. “Rather, interpersonal and structural racism experienced by groups that have been historically marginalized increases stress, weathering, and allostatic load, which can increase depressive symptoms, a process that has been demonstrated in the perinatal period.”

Among patients reporting depressive symptoms, only 25.4% disclosed receiving a diagnosis of PMAD, while 52.8% reported obtaining some form of postpartum mental health care. Notably, there were no significant differences observed in diagnosis rates across different racial and ethnic groups. However, disparities were identified in the receipt of mental health care. Respondents identifying as Asian; Native Hawaiian or Pacific Islander; Southwest Asian, Middle Eastern, or North African; Hispanic; and non-Hispanic Black were significantly less likely than non-Hispanic White respondents to access mental health care, highlighting systemic inequities in managing postpartum depressive symptoms.

The authors acknowledged several limitations of the study, including reliance on self-reported measures, small sample sizes in certain racial and ethnic groups, and potential lack of generalizability beyond the included jurisdictions and the timeframe of 2020-2021, during the COVID-19 pandemic.

According to the study, future research examining the influencing mechanisms of these inequities is necessary to inform the development and evaluation of interventions at the systems, health care, and provider levels to reduce mental health disparities.

“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 US,” the authors wrote.

Reference

Haight SC, Daw JR, Martin CL, et al. Racial and ethnic inequities in postpartum depressive symptoms, diagnosis, and care in 7 US jurisdictions. Health Affairs. Published online April 1, 2024. https://www.healthaffairs.org/doi/full/10.1377/hlthaff.2023.01434