Skip to main content

Advertisement

Log in

Rates and Predictors of Postpartum Depression by Race and Ethnicity: Results from the 2004 to 2007 New York City PRAMS Survey (Pregnancy Risk Assessment Monitoring System)

Maternal and Child Health Journal Aims and scope Submit manuscript

Abstract

The objective of this study was to examine racial/ethnic disparities in the diagnosis of postpartum depression (PPD) by: (1) identifying predictors that account for prevalence rate differences across groups, and (2) comparing the strength of predictors across groups. 3,732 White, African American, Hispanic, and Asian/Pacific Islander women from the New York City area completed the Pregnancy Risk Assessment Monitoring System from 2004 to 2007, a population-based survey that assessed sociodemographic risk factors, maternal stressors, psycho-education provided regarding depression, and prenatal and postpartum depression diagnoses. Sociodemographic and maternal stressors accounted for increased rates in PPD among Blacks and Hispanics compared to Whites, whereas Asian/Pacific Islander women were still 3.2 times more likely to receive a diagnosis after controlling for these variables. Asian/Pacific Islanders were more likely to receive a diagnosis after their providers talked to them about depressed mood, but were less likely than other groups to have had this conversation. Prenatal depression diagnoses increased the likelihood for PPD diagnoses for women across groups. Gestational diabetes decreased the likelihood for a PPD diagnosis for African Americans; a trend was observed in the association between having given birth to a female infant and increased rates of PPD diagnosis for Asian/Pacific Islanders and Whites. The risk factors that account for prevalence rate differences in postpartum diagnoses depend on the race/ethnic groups being compared. Prenatal depression is confirmed to be a major predictor for postpartum depression diagnosis for all groups studied; however, the associations between other postpartum depression risk factors and diagnosis vary by race/ethnic group.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. O’Hara, M. W., & Swain, A. M. (1996). Rates and risk of postpartum depression-A meta-analysis. International Review of Psychiatry, 8, 37–54.

    Article  Google Scholar 

  2. Gavin, N. I., Gaynes, B. N., Lohr, K. N., Meltzer-Brody, S., Gartlehner, G., & Swinson, T. (2005). Perinatal depression: A systematic review of prevalence and incidence. Obstetrics and Gynecology, 106, 1071–1083.

    Article  PubMed  Google Scholar 

  3. Leigh, B., & Milgrom, J. (2008). Risk factors for antenatal depression, postnatal depression and parenting stress. BMC Psychiatry, 8, 24.

    Article  PubMed  Google Scholar 

  4. O’Hara, M. W. (2009). Postpartum depression: What we know. Journal of Clinical Psychology, 65, 1258–1269.

    Article  PubMed  Google Scholar 

  5. Robertson, E., Grace, S., Wallington, T., & Stewart, D. E. (2004). Antenatal risk factors for postpartum depression: A synthesis of recent literature. General Hospital Psychiatry, 26, 289–295.

    Article  PubMed  Google Scholar 

  6. Kleinman, A. (2004). Culture and depression. New England Journal of Medicine, 351, 951–953.

    Article  PubMed  CAS  Google Scholar 

  7. Chentsova-Dutton, Y. E., & Tsai, J. L. (2007). Cultural factors influence the expression of psychopathology. In S. O. Lilienfeld & W. T. O’Donohue (Eds.), The great ideas of clinical science: 17 principles that every mental health professional should understand (pp. 375–396). New York: Routledge/Taylor & Francis Group.

    Google Scholar 

  8. United States. Agency for Healthcare Research and Quality. (2005). Perinatal depression: Prevalence, screening accuracy, and screening outcomes. In B. N. Gaynes, N. Gavin, S. Meltzer-Brody, K. N. Lohr, T. Swinson, G. Gartlehner, S. Brody, W. Miller Evidence Report/Technology Assessment No. 119. Contract No. 290-02-0016.

  9. Howell, E. A., Mora, P. A., Horowitz, C. R., & Levanthal, H. (2005). Racial and ethnic differences in factors associated with early postpartum depressive symptoms. Obstetrics and Gynecology, 105, 1442–1450.

    Article  PubMed  Google Scholar 

  10. Wei, G., Greaver, L. B., Marson, S. M., Herndon, C. H., Rogers, J., & Robeson Healthcare Corporation. (2008). Postpartum depression: racial differences and ethnic disparities in a tri-racial and bi-ethnic population. Maternal and Child Health Journal, 12, 699–707.

    Article  PubMed  Google Scholar 

  11. Yonkers, K. A., Ramin, S. M., Rush, J., Navarrete, M. A., Carmody, T., March, D., et al. (2001). Onset and persistence of postpartum depression in an inner-city maternal health clinic system. American Journal of Psychiatry, 158, 1856–1863.

    Article  PubMed  CAS  Google Scholar 

  12. Beeghly, M., Olson, K. L., Weinberg, M. K., Pierre, S. C., Downey, N., & Tronick, E. Z. (2003). Prevalence, stability, and socio-demographic correlates of depressive symptoms in black mothers during the first 18 months postpartum. Maternal and Child Health Journal, 7, 157–168.

    Article  PubMed  Google Scholar 

  13. Hobfoll, S. E., Ritter, C., Lavin, J., Hulsizer, M. R., & Cameron, R. P. (1995). Depression prevalence and incidence among inner-city pregnant and postpartum women. Journal of Consulting and Clinical Psychology, 63, 445–453.

    Article  PubMed  CAS  Google Scholar 

  14. Rich-Edwards, J. W., Kleinman, K., Abrams, A., Harlow, B. L., McLaughlin, T. J., Joffe, H., et al. (2006). Sociodemographic predictors of antenatal and postpartum depressive symptoms among women in a medical group practice. Journal of Epidemiology and Community Health, 60, 221–227.

    Article  PubMed  Google Scholar 

  15. Huang, Z. J., Wong, F. Y., Ronzio, C. R., & Yu, S. M. (2007). Depressive symptomatology and mental health help-seeking patterns of U.S.- and foreign-born mothers. Maternal and Child Health Journal, 11, 257–267.

    Article  PubMed  Google Scholar 

  16. Hsu, L. K. G., Wan, Y. M., Chang, H., Summergrad, P., Tsang, B. Y. P., & Chen, H. (2008). Stigma of depression is more severe in Chinese Americans than Caucasian Americans. Psychiatry: Interpersonal and Biological Processes, 71, 210–218.

    Article  Google Scholar 

  17. U.S. Census Bureau. (2010). National population projections. Washington, DC.

  18. United States. Census Bureau, Population Division. (2008). Projections of the population by sex, race and Hispanic origin for the United States: 2010 to 2050.

  19. Centers for Disease Control and Prevention. (2003). Deaths: Leading causes for 2001. National Vital Statistics Reports, vol. 52.

  20. United States. Public Health Service, National Center for Health Statistics. (2003). Health, United States, 2003.

  21. Duldulao, A. A., Takeuchi, D. T., & Hong, S. (2009). Correlates of suicidal behaviors among Asian Americans. Archives of Suicide Research, 13, 277–290.

    Article  PubMed  Google Scholar 

  22. Hayes, D., Ta, V., Hurwitz, E., Mitchell-Box, K., & Fuddy, L. (2010). Disparities in self-reported postpartum depression among Asian, Hawaiian, and Pacific Islander Women in Hawaii: Pregnancy Risk assessment monitoring system (PRAMS), 2004–2007. Maternal and Child Health Journal, 14, 765–773.

    Article  PubMed  Google Scholar 

  23. New York City Department of Health and Mental Hygiene, Bureau of Maternal, Infant and Reproductive Hygiene. (2004). Number and percent of women diagnosed with postpartum depression by select sociodemographic characteristics: NYC PRAMS, 2004–2005.

  24. New York City Department of Health and Mental Hygiene, Bureau of Maternal, Infant and Reproductive Hygiene. (2006). Number and percent of women diagnosed with postpartum depression by select sociodemographic characteristics: NYC PRAMS, 2006.

  25. New York City Department of Health and Mental Hygiene, Bureau of Maternal, Infant and Reproductive Hygiene. (2007). Number and percent of women diagnosed with postpartum depression by select sociodemographic characteristics: NYC PRAMS, 2007.

  26. New York City Department of Health and Mental Hygiene, Bureau of Maternal, Infant and Reproductive Hygiene (2010). Number and percent of women diagnosed with postpartum depression.

  27. Segre, L. S., O’Hara, M. W., Arndt, S., & Stuart, S. (2007). The prevalence of postpartum depression: The relative significance of three social status indices. Social Psychiatry and Psychiatric Epidemiology, 42, 316–321.

    Article  PubMed  Google Scholar 

  28. Dennis, C. L., & Letourneau, N. (2007). Global and relationship-specific perceptions of support and the development of postpartum depressive symptomatology. Social Psychiatry and Psychiatric Epidemiology, 42, 389–395.

    Article  PubMed  Google Scholar 

  29. Bernazzani, O., Marks, M. N., Bifulco, A., Siddle, K., Asten, P., & Conroy, S. (2005). Assessing psychosocial risk in pregnant/postpartum women using the contextual assessment of maternity experience (CAME): Recent life adversity, social support and maternal feelings. Social Psychiatry and Psychiatric Epidemiology, 40, 497–508.

    Article  PubMed  Google Scholar 

  30. Boyce, P., & Hickey, A. (2005). Psychosocial risk factors to major depression after childbirth. Social Psychiatry and Psychiatric Epidemiology, 40, 605–612.

    Article  PubMed  Google Scholar 

  31. Wolf, A. W., De Andraca, I., & Lozoff, B. (2002). Maternal depression in three Latin American samples. Social Psychiatry and Psychiatric Epidemiology, 37, 169–176.

    Article  PubMed  Google Scholar 

  32. Noh, E. (2007). Asian American women and suicide: Problems of responsibility and healing. Women & Therapy, 30, 87–107.

    Google Scholar 

  33. Kumar, R. (1994). Postnatal mental illness: A transcultural perspective. Social Psychiatry and Psychiatric Epidemiology, 29, 250–264.

    Article  PubMed  CAS  Google Scholar 

  34. Morsbach, G., Sawaragi, I., Riddell, C., & Carswell, A. (1983). The occurrence of ‘maternity blues’ in Scottish and Japanese mothers. Journal of Reproductive and Infant Psychology, 1, 29–35.

    Article  Google Scholar 

  35. Xie, R. H., He, G., Liu, A., Bradwejn, J., Walker, M., & Wen, S. W. (2007). Fetal gender and postpartum depression in a cohort of Chinese women. Social Science and Medicine, 65, 680–684.

    Article  PubMed  Google Scholar 

  36. Xie, R. H., He, G., Koszycki, D., Walker, M., & Wen, S. W. (2009). Prenatal Social Support, Postnatal Social Support, and Postpartum Depression. Annals of Epidemiology, 19, 637–643.

    Article  PubMed  Google Scholar 

  37. Patel, V., Rodrigues, M., & DeSouza, N. (2002). Gender, poverty, and postnatal depression: A study of mothers in Goa, India. The American Journal of Psychiatry, 159, 43–47.

    Article  PubMed  Google Scholar 

  38. Chu, S. Y., Abe, K., Hall, L. R., Kim, S. Y., Njoroge, T., & Qin, C. (2009). Gestational diabetes mellitus: All Asians are not alike. Preventive Medicine, 49, 265–268.

    Article  PubMed  Google Scholar 

  39. Kozhimannil, K. B., Pereira, M. A., & Harlow, B. L. (2009). Association between diabetes and perinatal depression among low-income mothers. JAMA: Journal of the American Medical Association, 301, 842–847.

    Article  PubMed  CAS  Google Scholar 

  40. Pedula, K., Hillier, T., Schmidt, M., Mullen, J., Charles, M., & Pettitt, D. (2009). Ethnic differences in gestational oral glucose screening in a large US population. Ethnicity and Disease, 19, 414–419.

    PubMed  Google Scholar 

  41. Way, B. M., & Lieberman, M. D. (2010). Is there a genetic contribution to cultural differences? Collectivism, individualism and genetic markers of social sensitivity. Social Cognitive and Affective Neuroscience, 5, 203–211.

    Article  PubMed  Google Scholar 

  42. Wong, S. L. (2001). Depression level in inner-city Asian American adolescents: The contributions of cultural orientation and interpersonal relationships. Journal of Human Behavior in the Social Environment, 3, 49–64.

    Article  Google Scholar 

  43. Ryder, A. G., Yang, J., & Heini, S. (2002). Somatization versus psychologization of emotional distress: A paradigmatic example for cultural psychopathology. In W. J. Lonner, D. L. Dinnel, S. A. Hayes, & D. N. Sattler (eds) Online readings in psychology and culture, Unit 9. Center for Cross-Cultural Research, Western Washington University: Washington.

  44. Ryder, A. G., Yang, J., Zhu, X., Yao, S., Yi, J., Heine, S. J., et al. (2008). The cultural shaping of depression: Somatic symptoms in China, psychological symptoms in North America? Journal of Abnormal Psychology, 117, 300–313.

    Article  PubMed  Google Scholar 

  45. Cho, J., Holditch-Davis, D., & Miles, M. (2008). Effects of maternal depressive symptoms and infant gender on the interactions between mothers and their medically at-risk infants. Journal of Obstetric, Gynecologic, and Neonatal Nursing, 37, 58–70.

    Article  PubMed  Google Scholar 

  46. Beebe, B., Jaffe, J., Buck, K., Chen, H., Cohen, P., Feldstein, S., et al. (2008). Six-week postpartum maternal depressive symptoms and 4-month mother-infant self-and-interactive contingency. Infant Mental Health Journal, 29, 442–471.

    Article  Google Scholar 

  47. Shea, E., & Tronick, E. (1988). The Maternal Self-Report Inventory: A research and clinical instrument for assessing maternal self-esteem. In H. E. Fitzgerald, B. M. Lester, & M. W. Yogman (Eds.), Theory and research in behavioral pediatrics (Vol. 4, pp. 101–141). New York: Plenum Publishing Corporation.

    Google Scholar 

  48. Sussman, L. K., Robins, L. N., & Earls, F. (1987). Treatment-seeking for depression by Black and White Americans. Social Science and Medicine, 24, 187–196.

    Article  PubMed  CAS  Google Scholar 

  49. Wagner, J., Tsimikas, J., Abbott, G., de Groot, M., & Heapy, A. (2007). Racial and ethnic differences in diabetic patient-reported depression symptoms, diagnosis, and treatment. Diabetes Research and Clinical Practice, 75, 119–122.

    Article  PubMed  Google Scholar 

  50. Wagner, J. A., Perkins, D. W., Piette, J. D., Lipton, B., & Aikens, J. E. (2009). Racial differences in the discussion and treatment of depressive symptoms accompanying type 2 diabetes. Diabetes Research and Clinical Practice, 86, 111–116.

    Article  PubMed  Google Scholar 

  51. Tiwari, A., Rajan, M., Miller, D., Pogach, L., Olfson, M., & Sambamoorthi, U. (2008). Guideline-consistent antidepressant treatment patterns among veterans with diabetes and major depressive disorder. Psychiatric Services, 59, 1139–1147.

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

The authors would like to acknowledge the NYC Department of Health and Mental Hygiene Bureau of Maternal, Infant and Reproductive Health PRAMS Team, Bureau of Vital Statistics, and the CDC PRAMS Team, Program Services and Development Branch, Division of Reproductive Health. Support during the preparation of this manuscript was provided through a grant from the Sackler Foundation for Psychobiological Research and through the Stuart T. Hauser Clinical Research Training Fellowship (2T32MH016259-30).

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Cindy H. Liu.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Liu, C.H., Tronick, E. Rates and Predictors of Postpartum Depression by Race and Ethnicity: Results from the 2004 to 2007 New York City PRAMS Survey (Pregnancy Risk Assessment Monitoring System). Matern Child Health J 17, 1599–1610 (2013). https://doi.org/10.1007/s10995-012-1171-z

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10995-012-1171-z

Keywords

Navigation