Prenatal depression ‘presents differently across cultures,’ warranting tailored care

Key takeaways:

• Prenatal depression burden and symptom severity varies widely by race and ethnicity.
• Nativity and acculturation may contribute to disparities between Hispanic and Asian women.

Risk for moderate to severe depressive symptoms during pregnancy varied widely across 20 different racial and ethnic groups, suggesting women from different cultural backgrounds view and report depression symptoms differently, data show.

“Our study found differences among racial and ethnic subgroups in several aspects of prenatal depression, including the likelihood of receiving a diagnosis and reporting symptoms when screened in prenatal care,” Kendria Kelly-Taylor, PhD, a research fellow with Kaiser Permanente Northern California Division of Research, told Healio. “We found most of the [racial] groups were less likely to have a diagnosis of prenatal care and more likely to report moderate-to-severe depressive symptoms when screened. Previous research provides some possible reasons for these findings, which include differences in how patients in various racial and ethnic subgroups experience symptoms, view their symptoms, and their comfort in discussing them with a clinician or having a diagnosis in their medical record.”

For the population-based study, researchers analyzed data from 258,452 women with a singleton birth between 2013 and 2019 who had at least one prenatal care visit and self-reported their race and ethnicity, using data from Kaiser Permanente Northern California (mean age, 31 years). Researchers identified 20 race and ethnic groups for analysis and assessed scores from Patient Health Questionnaire-9 surveys completed during pregnancy. Undiagnosed depression was defined as a score of 10 or higher without evidence of a depression diagnosis. Researchers estimated the relative risk for prenatal depression diagnoses, self-reported symptoms of moderate to severe depression and undiagnosed depression by race and ethnicity.

The findings were published in a research letter in JAMA Network Open.

Within the cohort, 15.5% had a prenatal depression diagnosis, with 10.9% exhibiting moderate to severe depressive symptoms.

The prevalence of prenatal depression diagnoses ranged from 4.7% among Hmong Chinese women to 26.7% among Puerto Rican women, whereas depressive symptoms ranged from 7.5% among Japanese women to 17.3% among Black women.

Compared with white women, Puerto Rican (adjusted RR = 1.28; 95% CI, 1.17-1.39) and Black (aRR = 1.03; 95% CI, 1.01-1.07) had higher risk for a prenatal depression diagnosis.

Asian and Pacific Islander women had a lower risk for prenatal depression diagnosis compared with white women, particularly Vietnamese women (adjusted RR = 0.25; 95% CI, 0.24-0.3), Mexican women (aRR = 0.75; 95% CI, 0.73-0.77) and Central and South American women (aRR = 0.82; 95% CI, 0.78-0.87).

Researchers also found that the risk for moderate to severe depressive symptoms was greater among all racial groups compared with white women, with increased risk ranging from 9% among Chinese women (aRR = 1.09; 95% CI, 1.03-1.16) to 108% for Black women (aRR = 2.08; 95% CI, 1.99-2.17). With the exception of women who identified as American Indian or Alaska Native, the risk for undiagnosed depression was higher across all racial groups with moderate to severe symptoms compared with white women, according to the researchers.

“The differences we found suggest that pregnant patients may vary in their comfort discussing mood in pregnancy, and how they view and report physical and emotional symptoms,” Kelly-Taylor told Healio. “Other studies have shown that depression can present differently across cultures, and this can be tied to many things such as stigma regarding mental health conditions. This is a reminder of the importance of culturally relevant care, especially regarding pregnancy and mental health conditions. Although awareness has increased over the years, this study serves as a reminder that there is still much work to be done.”

Kelly-Taylor said epidemiologic and qualitative studies are needed to better understand how cultural differences affect prenatal depression. Researchers also cautioned that the findings may not apply to uninsured pregnant women.

“Prenatal depression is treatable, so research to explore and identify modifiable factors that can reduce gaps in diagnosis is critical to improving the well-being of mothers and their children.”

For more information:

Kendria Kelly-Taylor, PhD, can be reached at kendria.d.kelly-taylor@kp.org; X (Twitter): @kendriakt_phd; Bluesky: @kpdor.bsky.social.