Health Disparities
Nativity-Based Disparities in Postpartum Mental Health Diagnoses in a Hospital-Based Birth Cohort Shashi Sarnaik* Shashi Sarnaik Sarnaik Sarnaik Johns Hopkins Bloomberg School of Public Health
Background: Postpartum mental health conditions are a leading cause of maternal morbidity, and their identification varies across populations. Immigrant mothers face unique challenges that influence whether these conditions are diagnosed, yet disparities in clinically documented postpartum mental health conditions remain poorly characterized. This study examined nativity-based differences among a hospital-based birth cohort in Boston.
Methods: Participants were 2,442 mothers in the Boston Birth Cohort. Nativity was defined as U.S.-born versus foreign-born. Postpartum mental health conditions were assessed via health records and defined as new diagnoses of stress or adjustment disorders, depression, anxiety, or other related disorders within one year postpartum. Differences in prevalence by nativity were assessed descriptively, while associations between nativity and postpartum mental health diagnoses were evaluated using logistic regression adjusted for sociodemographic, obstetric, and pregnancy-related clinical covariates.
Results: 20.9% of participants received a mental health diagnosis. Foreign-born mothers had a lower prevalence of diagnosis than U.S.-born mothers (13.0% vs. 33.8%). Foreign-born status was associated with lower odds of postpartum mental health diagnosis relative to U.S.-born status (aOR = 0.37, 95% CI: 0.29–0.47), with differences consistent across categories of mental health disorder.
Conclusions: Foreign-born mothers were less likely than U.S.-born mothers to receive a clinically documented postpartum mental health diagnosis. While this pattern may reflect lower mental health risk, existing evidence of disparities in screening, diagnosis, and mental health stigma suggests that structural and health-system factors may play a role in shaping nativity-based inequities in postpartum mental health. Findings underscore the need to distinguish true mental health risk from inequities in care access and utilization among postpartum immigrant populations.