Experiences of racism double odds of depression during pregnancy
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Feeling upset due to experiencing racism in the year prior to delivery was associated with greater odds of depression during pregnancy, according to findings published in the Journal of Advanced Nursing.
“Wherever there are health inequities, racism should be interrogated as a root cause,” Kelly M. Bower, PhD, MSN/MPH, RN, associate director of the Johns Hopkins Urban Health Institute, told Healio. “In the case of perinatal mental health disorders, they are among the most common complications during and after pregnancy, and Black women are more likely to experience a maternal mental health condition and less likely to receive care.”
Bower and colleagues conducted a cross-sectional analysis of 2018 data from the CDC’s Pregnancy Risk Assessment Monitoring System (PRAMS), which uses birth certificates to identify and contact mothers who recently had a live birth to complete a survey.
The researchers focused on feelings of anger, sadness or frustration due to experiences of racism in the year before delivery and depression as self-reported in the PRAMS survey. Only non-Hispanic Black participants were included for analyses.
In total, there were 7,328 non-Hispanic Black women, of whom 11.4% reported feeling upset by experiences of racism. These feelings were more commonly reported by participants with depression vs. no depression during pregnancy (28.5% vs. 9.1%).
Feeling upset by experiences of racism was associated with 16 years or more vs. fewer years of education (P = .0001), prepregnancy depression vs. no prepregnancy depression (P < .0001) and living in the Midwest and West vs. the Northeast or the South (P < .0001).
Depression during pregnancy was reported by 11.4% of participants.
Fully adjusted analyses revealed that women had twice the odds of depression during pregnancy if they reported feeling upset by experiences of racism (adjusted OR = 2.31; 95% CI, 1.63-3.28). Odds of depression during pregnancy were also higher with Medicaid prepregnancy insurance coverage (aOR = 1.37; 95% CI, 1.01-1.87) and prepregnancy depression (aOR = 25.68; 95% CI, 19.08-34.56).
Depression during pregnancy was more common with inadequate (aOR = 1.76; 95% CI, 1.16-2.67) or adequate plus (aOR = 1.64; 95% CI, 1.15-2.32) vs. adequate prenatal care, where inadequate care was defined as starting care later than the fourth month of pregnancy or attending fewer than 50% of recommended visits, adequate care was defined as attending 80% to 109% of recommended visits, and adequate plus care was defined as attending at least 110% of recommended visits.
The odds of depression during pregnancy were lower for married women (aOR = 0.62; 95% CI, 0.41-0.92) and residence in the Northeast vs. the Midwest or West (aOR = 0.68; 95% CI, 0.49-0.94).
“Nurses can stand up against racism in all its forms,” Bower said. “Nurses can also advocate for policy changes to ensure perinatal mental health services are accessible and culturally appropriate for Black women. Future research is needed to test the association between racism and perinatal depression using more sophisticated measures of each.”