Mental Health
Racial and Rurality Disparities in Screening for Postpartum Depression in North Dakota (2017-2021) Andrew Williams* Andrew Williams Asma Ul Husna Juliana Antwi Kilyn Parisien Rylee Bergeron
Background: Postpartum Depression (PPD) is one of the most prevalent maternal health conditions affecting women after their childbirth, and a key contributor to maternal mortality. Undiagnosed PPD can lead to increased risk of substance use, suicidality, and poor maternal-infant bonding.. This study examined the intersection between race and rurality in regard to PPD screening in North Dakota (ND).
Methods: Data (weighted n=39,477) from the 2017-2021 ND Pregnancy Risk Assessment Monitoring System (PRAMS) were analyzed. Maternal race (White, American Indian, Other) and PPD screening were self-reported. County-level rurality was based on the 2013 National Center for Health Statistics Urban-Rural Classification Scheme for Counties. Logistic regression estimated odds ratios (OR) with 95% confidence intervals (CI) for the odds of PPD screening among AI and Other women, compared to White women. Models were fit overall and by rurality, adjusted for maternal sociodemographic and health factors.
Results: Overall, 95% of women were screened for PPD, yet screening differed by race/ethnicity: 89% of AI women, 90% of Other race women, and 95% of White women (p<.05). In regression analyses, overall, AI women had 56% lower odds (OR:0.44, 95%CI0.27,0.71) of being screened for PPD compared to White women. We observed no differences for PPD screening among Other race women. The odds of PPD screening by race differed by rurality. Among rural women, AI women had 63% lower odds (OR:0.37, 95%CI:0.19,0.73) and Other race women had 67% lower odds (0.33, 95%CI:0.12,0.87) of PPD screening compared to White women. We observed no differences in PPD screening among urban women.
Discussion: This study shows significant disparity in postpartum depression screening in AI women and Other race women compared to White women. This disparity is more pronounced in rural settings of ND and may reflect the lack of access to postpartum healthcare in rural areas, and social stigma around mental health support.