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PPD affects races similarly, inequities lie in mental healthcare

Postpartum depression (PPD) is depression lasting more than two weeks postpartum, and is characterised by feelings of hopelessness, anger, guilt, self-harm, or withdrawal.

In the US in 2018, approximately 13.2% of postpartum people experienced PPD.

PPD is part of a larger mental health condition known as perinatal or postpartum mood and anxiety disorder (PMAD), which encompasses feelings of depression or anxiety before or after birth.

Though PPD and PMAD are common conditions, the CDC reported that in 2018, only 79.3% of pregnant people were asked about it during prenatal care visits and 87.4% were asked during a postpartum visit.

A recent publication in Health Affairs identifies disparities in the postpartum mental healthcare spectrum, from self-reported symptoms to treatment.  

The authors, Haight and colleagues from the University of North Carolina at Chapel Hill, explore these inequities from a racial and social perspective.

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The study used data from the Postpartum Assessment of Health Survey, a survey given approximately 12-14 months postpartum.

It contained data from 4,542 participants.

The first level of the study was self-reported symptoms of early PPD.

This was identified by responses of ‘always’ or ‘almost always’ in the survey.

The weighted prevalence of early PPD among all participants was 11.8%. People identifying as multiple races/ethnicities reported the highest rate of symptoms (17.8%), followed by Black (16.0%), Asian/Native Hawaiian Pacific Islander/Southwest Asian, Middle Eastern, or North African (NHPI/SWMENA) (13.8%), White (10.9%), and Hispanic (9.1%) participants.

Notably, the rate of early PPD symptoms was not significantly different between races.

Similarly, the proportion of study participants with PMAD diagnoses from their provider was not significantly different between racial categories.

Among all participants, 25.4% received a diagnosis, and White participants were most likely to be diagnosed (28.4%), followed by Black participants (22.4%) and Asian/NHPI/SWMENA participants (16.1%).

This does not appear to affect receipt of care and suggests the necessity of self-reporting symptoms versus formal diagnoses in postpartum care.

The disparity lay in postpartum mental healthcare.

The authors found that 52.8% of participants received mental healthcare in the first year postpartum, more than those who received a PMAD diagnosis.

Additionally, the proportion of participants who received mental healthcare significantly differed between racial categories.

White postpartum people are most likely to receive care (67.4%), a significantly higher proportion than Hispanic (37.2%), Black (37.1%), and Asian/NHPI/SWMENA (19.7%) postpartum people.

The authors attribute this disparity to social stressors, as the participants gave birth and were postpartum in 2020-21, during the Covid–19 pandemic.

White postpartum people are less likely to develop PPD and more likely to receive postpartum mental healthcare than postpartum people of other races.

Part of this disparity may be due to intersectionality between race and socioeconomic status or social support.

Early PPD symptoms were reported to be more likely in previously married people (divorced, widowed, separated), first pregnancies, people without college degrees, people on public health insurance, and people living in rural areas.

The distribution of postpartum depression by race in this study represents an important subsect of race and mental illness in the US.

Leading data and analytics company GlobalData explored major depressive disorder (MDD) by race and ethnicity in the US and found that in 2024, 62.7% of MDD 12-month total prevalent cases are in White adults, 18.53% are in Hispanic adults, 12.4% are in Black adults, 4.27% are in Asian/Pacific Islander adults, and 2.03% are in Native American adults.

Further exploration into the gap between awareness, diagnosis, and treatment may serve to bring equity to mental healthcare in the racial/ethnic arena.