Mental Health
Differences in Prenatal Depression by Maternal Race and Ethnicity: A Retrospective Cohort Study Kendria Kelly-Taylor* Kendria Kelly-Taylor Sara Aghaee Joshua Nugent Ayesha Sujan Nina Oberman Ai Kubo Elaine Kurtovich Charles P. Quesenberry Jr Kathryn Ridout Mibhali Bhalala Lyndsay Avalos
Existing studies suggest that Black and Hispanic persons experience significantly higher rates of prenatal depression compared to White persons, yet little is known how these rates differ among subgroups of Hispanic (e.g., Mexican) and Asian (e.g., Korean) populations. The study examined racial and ethnic subgroup differences in prenatal depression diagnosis and severity among a large cohort of pregnant persons universally screened for depression. A retrospective cohort of pregnant persons receiving prenatal care at Kaiser Permanente Northern California from 2013 to 2019 (n=258,452) were analyzed. Twenty racial and ethnic groups were obtained from birth records, and depression diagnosis, severity (measured using the Patient Health Questionairre-9 [PHQ-9]), and covariates (maternal age, parity, education, neighborhood deprivation, delivery year) were captured via electronic health records. We calculated age-adjusted prevalence rates and used modified Poisson regression models to estimate adjusted relative risks. Puerto Rican persons had the highest prevalence of prenatal depression (25.3%), followed by Native American (23.5%) and Black (20.9%) persons, while Hmong persons had the lowest prevalence (4.3%). Severe depression (PHQ-9 15+) was highest among Black persons (7.5%) and lowest among Asian Indian (2.9%) persons. Puerto Rican, Black, and Native American persons had higher risks of prenatal depression compared to White persons in unadjusted models (RR:1.34, 95%CI: 1.22-1.48; RR:1.08, 95%CI: 1.04-1.11, RR:1.17, 95%CI: 0.98-1.40, respectively). In the adjusted models, the associations were attenuated (aRR:1.05, 95%CI: 1.03-1.07; aRR:1.00, 95%CI: 0.99-1.01; aRR:1.03, 95%CI: 1.00-1.06, respectively). Substantial variation in the prevalence and risk of depression diagnosis and severity were observed. The findings suggest differences in maternal characteristics and socioeconomic factors may partially explain racial and ethnic disparities in prenatal depression.