Racial/Ethnic Disparities in Severe Postpartum Depression

Importance: A recent report shows upward trends of maternal hospitalizations for depression. Given the expanding non-white population and two major national obstetric priorities in the United States to improve maternal mental health and reduce disparities in maternal care, there is a pressing need to examine whether racial/ethnic disparities exist in severe postpartum depression.
Objective: To determine whether the risk of hospital based care for postpartum depression differs according to maternal race and ethnicity.
Design: A retrospective cohort study
Setting: Analysis was based on the linked data containing hospital discharge and birth certificate data from the Office of Statewide Health Planning and Development (OSHPPD) in California.
Participants: Primiparous mothers aged 15-50 years who delivered in California hospitals between 2008 and 2012.
Exposure: Race and ethnicity
Main Outcomes and Measures: Hospital encounters for postpartum depression in the first 9 months after delivery
Results: Our cohort comprises 984,167 first-time mothers. The overall cumulative incidences over the first 9 months after delivery for a principal diagnosis and a principal or secondary diagnosis of depression are 15.9 and 53.6 per 10,000 deliveries respectively. Non-Hispanic black women had the highest incidence of postpartum admission for depression and non-Hispanic Asian women had the lowest incidence. When compared to the non-Hispanic white, the risk was 2-fold higher in black women while Asian and Hispanic women had a lower risk by 20-60%. In our sensitivity analyses, similar findings were observed after excluding women with antepartum depression, or under different scenarios where women underwent postpartum hospitalization or assessment only in the emergency room. Mediation analyses revealed maternal education and insurance status may contribute to the differences up to 80%.
Conclusions and Relevance: Non-Hispanic black women may be one of the most susceptible groups that warrant more attention to monitoring and/or treating the depressive symptoms at the community setting. Further research is needed to determine causative factors for these disparities and identify ways to improve mental health care and support for African-American women after delivery.