Mental Health
Associations between Maternal Nativity and Prenatal Depression by Racial and Ethnic Subgroups 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
US born persons present more adverse perinatal outcomes compared to non-US born, yet less is known how maternal nativity (US born vs. non-US born) is associated with prenatal depression among racial and ethnic subgroups (e.g., Mexican, Hmong). This study examined differences in prenatal depression diagnosis and severity by maternal nativity among a large cohort of pregnant persons universally screened for depression. A retrospective cohort study of pregnant persons receiving prenatal care at Kaiser Permanente Northern California from 2013 to 2019 (n=258,452) was conducted. Twenty racial and ethnic groups, and nativity were obtained from birth records, and depression diagnosis, severity (measured using Patient Health Questionairre-9 [PHQ-9]), and covariates (maternal age, parity, delivery year, education, and neighborhood deprivation) were captured via electronic health records. We calculated age-adjusted prevalence rates and used modified Poisson regression models to estimate adjusted relative risks. Among race/ethnic subgroups, non-US-born persons had lower prevalence of prenatal depression compared to US-born persons (PRrange:3.9-20.3%; PRrange:4.8-25.4%, respectively). Adjusted models documented equivalent or lower risk among non-US born persons. In contrast, the prevalence of severe depression (PHQ-9 score: 15+) varied. Non-US born persons (vs. US born) had higher rates among Chinese (3.2% vs. 1.9%) and Hmong (4.6% vs. 3.2%) persons, yet lower rates among Black (3.9% vs. 8.1%) and Puerto Rican (1.9% vs. 6.8%) persons, for example. Adjusted models for severe depression showed non-US born Japanese, Chinese, and Vietnamese persons had significantly higher risk compared to US born (aRR:3.45, 95%CI:1.16-10.27; aRR:2.31, 95%CI:1.71-3.14; aRR:1.90, 95%CI:1.24-2.90, respectively). Future research should continue to explore the relationship between nativity, prenatal depression and severity among racial and ethnic groups and investigate mechanisms for these associations.