Women’s Health
Disparities in Prenatal Depression Treatment Engagement by Nativity, Race, and Ethnicity Kendria Kelly-Taylor* Kendria Kelly-Taylor Kelly-Taylor Kelly-Taylor Kelly-Taylor Kelly-Taylor Kelly-Taylor Kelly-Taylor Kelly-Taylor Kelly-Taylor KPNC Division of Research
Depression severity may play a key role in understanding racial, ethnic, and nativity related disparities in prenatal depression treatment. This study examines differences in treatment initiation and type by maternal nativity (US-born vs. non-US-born) among a diverse cohort of pregnant individuals universally screened for depression. We conducted a retrospective cross-sectional analysis (2013-2019) of Kaiser Permanente Northern California members who were newly diagnosed with depression between the first day of LMP to the day before a live birth (n=27,044). Race and ethnicity, and nativity were obtained from birth records. Treatment initiation (any vs. none), type (antidepressant medication vs. psychotherapy), and covariates (e.g., maternal age, Medicaid, anxiety, parity, substance use, depression severity via Patient Health Questionarrie-9) were extracted from electronic health records. Modified Poisson regression models (one with depression severity included and one without) estimated the adjusted relative risk (aRR); analysis was stratified by race/ethnicity. In the models excluding depression severity, US-born Hispanic and White individuals were significantly less likely to initiate treatment than their non–US-born counterparts (aRR:0.78;95%CI:0.67-0.92, aRR:0.81;95%CI:0.71-0.91, respectively). These associations attenuated and became non- significant after adjusting for depression severity. No significant differences were observed between US-born and non–US-born Black or Asian individuals. Treatment type did not significantly differ by nativity across racial and ethnic groups. Findings suggest depression severity may mediate the relationship between maternal nativity and treatment initiation; further analysis is warranted. In addition, examining this relationship across race, ethnicity, and nativity incorporates an intersectional lens to better understand disparities in perinatal treatment engagement.