A Kaiser Permanente analysis finds that the association varies by race and ethnicity
Mothers who live in neighborhoods with greater economic disadvantage are more likely to experience postpartum depression, according to Kaiser Permanente analysis published in JAMA Network Open.
The increased risk varied by race or ethnicity and suggested that neighborhood disadvantage may contribute to disparities in postpartum depression between white and black individuals.
“Postpartum depression is a common complication of childbirth and carries serious health risks for both mother and child,” said the lead author Ticara Onyewuenyi, MD, MPH, gynecologist at The Permanente Medical Group. “Our findings show that the risk of postpartum depression is increased for individuals living in high and moderate disadvantaged neighborhoods. As clinicians, it is important to identify those who contribute to this type of disparity, so that we are aware of them when caring for patients in the clinic.”
The study looked at 122,995 Kaiser Permanente Northern California patients who gave birth between 2012 and 2017; 12.5% of them had a diagnosis of postpartum depression (depression during the first year after childbirth). The researchers define neighborhood disadvantage using an index that takes into account several factors of neighborhood socioeconomic status such as educational and employment status, poverty, and housing quality.
Previous studies have established a link between neighborhood disadvantage and depression in the general population, but evidence has been lacking as to whether this extends to a vulnerable group of people, postpartum women. This is the first study to examine the association between 3 factors: neighborhood disadvantage, race and ethnicity, and depression.
The study found that people with postpartum depression were more likely to live in economically disadvantaged areas (28% vs. 21%).
Black women had a 30% higher risk of postpartum depression compared to whites, while Asians had a 52% lower risk and Hispanic mothers had an 8% lower risk.
The researchers then added a third layer to their analysis: considering how race or ethnicity might affect postpartum depression and neighborhood deprivation. And they discovered differences between people of different origins.
Among blacks, as neighborhood disadvantage increased, the risk of postpartum depression increased (in a dose-dependent manner); Blacks living in the most disadvantaged areas had a 60% higher risk of depression compared to blacks in the least disadvantaged areas.
The study found that neighborhood disadvantage was associated with postpartum depression among whites and Asians to a lesser extent, but found no association for Hispanic patients.
This study was part of the senior author’s project Lyndsay AvalosPhD, MPH, Research Scientist with Kaiser Permanente Research Department Edit, research on mental health before, during and after pregnancy. This paper found differences in prevalence of mental health diagnoses and start of treatment by race and ethnicity, and Avalos said it is important to more specifically explore the reasons for these differences.
Potential interventions
Researchers found that blacks were more likely to live in disadvantaged environments. The reasons for the link between higher rates of postpartum depression among black people are likely “multifactorial and complex,” the authors said.
“Systemic factors and discriminatory practices such as tenure and housing discrimination, unequal access to education, employment discrimination, disproportionate incarceration rates, and health disparities add enormous burdens to the normal stressors of life,” they wrote. “Lifestyle factors such as food intake patterns, sleep status, exercise and physical activity can significantly influence postpartum depression.”
These findings highlight the importance of reviewing the electronic health record to learn more about the patient we are examining.
— Ticara Onyewuenyi, MD, MPH
The authors proposed targeted collaboration with community organizations to provide psychosocial interventions delivered by trained community peers to assist Black new mothers. They also recommended wider use of depression screening for pregnant women and culturally appropriate interventions.
“At the provider level, these findings highlight the importance of reviewing the electronic health record to learn more about the patient we are seeing,” Onyewuenyi said. “We can take a moment to see where they live and what that might tell us about the challenges they face as we address their mental health.”
The strength of the study, Avalos said, was that it covered the time period shortly after Kaiser Permanente Northern California began screening all pregnant and postpartum patients for depression, providing both an opportunity to accurately identify and support patients, along with data for researchers. study mental health during and after pregnancy.
The study was funded by a Kaiser Permanente Community Health grant and the National Institutes of Health.
Additional co-authors were Kelli Peterman, MPH, Charles P. Quesenberry, PhD, Nerissa Nance, MPH, Ann-Marie Surmava, MBA, from the Research Department; Eve Zaritsky, MD, and Bria L. Pettway, MD, of The Permanente Medical Group; and Miranda L. Ritterman Weintraub, PhD, MPH, Kaiser Permanente Northern California Graduate Medical Education.
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About the Kaiser Permanente Research Department
The Kaiser Permanente Division of Research conducts, publishes and disseminates epidemiologic and health services research to improve the health and medical care of Kaiser Permanente members and society at large. It seeks to understand the determinants of disease and well-being and to improve the quality and cost-effectiveness of health care. Currently, DOR’s more than 600 employees work on more than 450 epidemiological and health research projects. For more information, visit divisionofresearch.kaiserpermanente.org or follow us @KPDOR.
