Skip to main content

Advertisement

Log in

Perinatal Complications, Poor Hospital Treatment, and Positive Screen for Postpartum Depressive Symptoms Among Black Women

  • Published:
Journal of Racial and Ethnic Health Disparities Aims and scope Submit manuscript

Abstract

Though mandatory screening for depression during pregnancy and the postpartum period is recommended, postpartum depression is still underdiagnosed and overlooked among Black women. Understanding risk factors during pregnancy and delivery that may increase the risk for postpartum depression is important for Black women. Thus, the purpose of this study is to examine the relationship between perinatal complications (i.e., preterm birth, low birth weight, gestational diabetes, unplanned cesarean section, undesired pregnancy, depression during pregnancy), poor hospital treatment, and postpartum depressive symptoms (i.e., depressed mood, anhedonia, and positive screen on PHQ-2) among Black women. Using the Listening to Mothers III survey, we conducted logistic regression analyses in a nationally representative sample of 368 Black women to examine the relationship between perinatal complications, poor hospital treatment, and positive screen for postpartum depressive symptoms, measured by the Patient Health Questionnaire-2 (PHQ-2). We also examined these factors in predicting anhedonia and depressed mood. Poor hospital treatment was associated with a positive screen for postpartum depression, anhedonia, and depressed mood. Perinatal complications, when measured continuously, were associated with a positive screen for depression and depressed mood. Gestational diabetes and preterm birth were associated with depressed mood while depression during pregnancy was associated with anhedonia. Perinatal complications during pregnancy and delivery may increase the risk for postpartum depression among Black women. When screening for postpartum depression, it may also be important to inquire about poor hospital treatment and stressors emanating from these experiences.

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.

Similar content being viewed by others

References

  1. Earls MF, Committee on psychosocial aspects of Child and Family Health American Academy of Pediatrics,. Incorporating recognition and management of perinatal and postpartum depression into pediatric practice. Pediatrics. 2010;126(5):1032–9. https://doi.org/10.1542/peds.2010-2348.

    Article  PubMed  Google Scholar 

  2. Bauman BL, Ko JY, Cox S, D'Angelo DV, Warner L, Folger S, Tevendale HD, Coy KC, Harrison L, Barfield WD (2020) Vital signs: postpartum depressive symptoms and provider discussions about perinatal depression - United States, 2018. MMWR. Morbidity and Mortality Weekly Report 69(19):575–581. https://doi.org/10.15585/mmwr.mm6919a2

  3. Le Strat Y, Dubertret C, Le Foll B. Prevalence and correlates of major depressive episode in pregnant and postpartum women in the United States. J Affect Disord. 2011;135(1–3):128–38. https://doi.org/10.1016/j.jad.2011.07.004.

    Article  PubMed  Google Scholar 

  4. Beeghly M, Olson KL, Weinberg MK, Pierre SC, Downey N, Tronick EZ. Prevalence, stability, and socio-demographic correlates of depressive symptoms in Black mothers during the first 18 months postpartum. Matern Child Health J. 2003;7(3):157–68. https://doi.org/10.1023/a:1025132320321.

    Article  PubMed  Google Scholar 

  5. Melville JL, Gavin A, Guo Y, Fan MY, Katon WJ. Depressive disorders during pregnancy: prevalence and risk factors in a large urban sample. Obstet Gynecol. 2010;116(5):1064–70. https://doi.org/10.1097/AOG.0b013e3181f60b0a.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Rich-Edwards JW, Kleinman K, Abrams A, Harlow BL, McLaughlin TJ, Joffe H, Gillman MW. Sociodemographic predictors of antenatal and postpartum depressive symptoms among women in a medical group practice. J Epidemiol Community Health. 2006;60(3):221–7. https://doi.org/10.1136/jech.2005.039370.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Howell EA, Mora PA, Horowitz CR, Leventhal H. Racial and ethnic differences in factors associated with early postpartum depressive symptoms. Obstet Gynecol. 2005;105(6):1442–50. https://doi.org/10.1097/01.AOG.0000164050.34126.37.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Field T, Diego M, Hernandez-Reif M, Deeds O, Holder V, Schanberg S, Kuhn C. Depressed pregnant Black women have a greater incidence of prematurity and low birthweight outcomes. Infant Behav Dev. 2009;32(1):10–6. https://doi.org/10.1016/j.infbeh.2008.09.005.

    Article  PubMed  Google Scholar 

  9. NK Grote JA Bridge AR Gavin JL Melville S Iyengar WJ Katon 2010 A meta-analysis of depression during pregnancy and the risk of preterm birth low birth weight and intrauterine growth restriction Arch Gen Psychiatr 67 10 1012 1024 https://doi.org/10.1001/archgenpsychiatry.2010.111

  10. HF Coelho L Murray M Royal-Lawson PJ Cooper 2011 Antenatal anxiety disorder as a predictor of postnatal depression: a longitudinal study J Affect Disord 129 1 3 348 353 https://doi.org/10.1016/J.JAD.2010.08.002

  11. Vigod SN, Villegas L, Dennis CL, Ross LE (2010) Prevalence and risk factors for postpartum depression among women with preterm and low-birth-weight infants: a systematic review. BJOG: An International Journal of Obstetrics and Gynaecology 117(5):540–550. https://doi.org/10.1111/j.1471-0528.2009.02493.x

  12. Hinkle SN, Buck Louis GM, Rawal S, Zhu Y, Albert PS, Zhang C. A longitudinal study of depression and gestational diabetes in pregnancy and the postpartum period. Diabetologia. 2016;59(12):2594–602. https://doi.org/10.1007/s00125-016-4086-1.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  13. Kozhimannil KB, Pereira MA, Harlow BL. Association between diabetes and perinatal depression among low-income mothers. JAMA. 2009;301(8):842–7. https://doi.org/10.1001/jama.2009.201.

    Article  CAS  PubMed  Google Scholar 

  14. Abbasi S, Chuang CH, Dagher R, Zhu J, Kjerulff K. Unintended pregnancy and postpartum depression among first-time mothers. J Womens Health. 2013;22(5):412–6. https://doi.org/10.1089/jwh.2012.3926.

    Article  Google Scholar 

  15. Blom EA, Jansen PW, Verhulst FC, Hofman A, Raat H, Jaddoe VW, Coolman M, Steegers EA, Tiemeier H (2010) Perinatal complications increase the risk of postpartum depression. The Generation R Study. BJOG: an International Journal of Obstetrics and Gynaecology 117(11):1390–1398. https://doi.org/10.1111/j.1471-0528.2010.02660.x

  16. Mercier RJ, Garrett J, Thorp J, Siega-Riz AM (2013) Pregnancy intention and postpartum depression: secondary data analysis from a prospective cohort. BJOG: an international journal of obstetrics and gynaecology 120(9):1116–1122. https://doi.org/10.1111/1471-0528.12255

  17. Garfield L, Holditch-Davis D, Carter CS, McFarlin BL, Schwertz D, Seng JS, Giurgescu C, White-Traut R. Risk factors for postpartum depressive symptoms in low-income women with very low-birth-weight infants. Advances in Neonatal Care: Official journal of the National Association of Neonatal Nurses. 2015;15(1):E3–8. https://doi.org/10.1097/ANC.0000000000000131.

    Article  PubMed  Google Scholar 

  18. Nutor JJ, Slaughter-Acey JC, Giurgescu C, Misra DP (2018) Symptoms of depression and preterm birth among Black women. MCN. The American Journal of Maternal Child Nursing 43(5):252–258. https://doi.org/10.1097/NMC.0000000000000464

  19. Creanga AA, Syverson C, Seek K, Callaghan WM. Pregnancy-related mortality in the United States, 2011–2013. Obstet Gynecol. 2017;130(2):366–73.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Lu MC, Kotelchuck M, Hogan V, Jones L, Wright K, Halfon N. Closing the Black-White gap in birth outcomes: a life-course approach. Ethn Dis. 2010;20(1 Suppl 2):S2-76.

    PubMed  Google Scholar 

  21. Tucker MJ, Berg CJ, Callaghan WM, Hsia J. The Black-White disparity in pregnancy-related mortality from 5 conditions: differences in prevalence and case-fatality rates. Am J Public Health. 2007;97(2):247–51. https://doi.org/10.2105/AJPH.2005.072975.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Crear-Perry J, Correa-de-Araujo R, Lewis Johnson T, McLemore MR, Neilson E, Wallace M. Social and structural determinants of health inequities in maternal health. J Womens Health. 2021;30(2):230–5. https://doi.org/10.1089/jwh.2020.8882.

    Article  Google Scholar 

  23. O’Hara MW, McCabe JE. Postpartum depression: current status and future directions. Annu Rev Clin Psychol. 2013;9:379–407. https://doi.org/10.1146/annurev-clinpsy-050212-185612.

    Article  PubMed  Google Scholar 

  24. Zayas LH, Cunningham M, McKee MD, Jankowski KR. Depression and negative life events among pregnant African American and Hispanic women. Womens Health Issues. 2002;12(1):16–22. https://doi.org/10.1016/s1049-3867(01)00138-4.

    Article  PubMed  Google Scholar 

  25. Carrington CH (2006) Clinical depression in African American women: diagnoses, treatment, and research. Journal of Clinical Psychology 62(7):779–791. https://doi:https://doi.org/10.1002/jclp.20289.

  26. Lara-Cinisomo S, Griffin BA, Daugherty L. Disparities in detection and treatment history among mothers with major depression in Los Angeles. Womens Health Issues. 2009;19(4):232–42. https://doi.org/10.1016/j.whi.2009.03.007.

    Article  PubMed  PubMed Central  Google Scholar 

  27. Lara-Cinisomo S, Clark CT, Wood J. Increasing diagnosis and treatment of perinatal depression in Latinas and African American women: addressing stigma is not enough. Womens Health Issues. 2018;28(3):201–4. https://doi.org/10.1016/j.whi.2018.01.003.

    Article  PubMed  PubMed Central  Google Scholar 

  28. Gara MA, Minsky S, Silverstein SM, Miskimen T, Strakowski SM. A naturalistic study of racial disparities in diagnoses at an outpatient behavioral health clinic. Psychiatr Serv. 2018;70(2):130–4. https://doi.org/10.1176/appi.ps.201800223.

    Article  PubMed  Google Scholar 

  29. Olbert CM, Nagendra A, Buck B (2018) Meta-analysis of Black vs. White racial disparity in schizophrenia diagnosis in the United States: do structured assessments attenuate racial disparities? Journal of Abnormal Psychology 127(1):104–115. https://doi.org/10.1037/abn0000309

  30. Whaley AL. Cultural mistrust: an important psychological construct for diagnosis and treatment of African Americans. Prof Psychol Res Pract. 2001;32(6):555–62. https://doi.org/10.1037//0735-7028.32.6.555.

    Article  Google Scholar 

  31. Nelson, T, Shahid, NN, Cardemil, EV. Do I really need to go and see somebody? Black women's perceptions of help-seeking for depression. J Black Psychol. 2020;46(4):263–286. https://doi.org/10.1177/0095798420931644.

  32. Nelson, T, Ernst, SC, Tirado, C, Fisse, JL, Moreno, O. Psychological distress and attitudes toward seeking professional psychological services among Black women: The role of past mental health treatment. J Racial Ethn Health Disparities. 2022;9(2):527–537. https://doi.org/10.1007/s40615-021-00983-z.

  33. Nadeem E, Lange JM, Edge D, Fongwa M, Bellin T, Miranda J (2007) Does stigma keep poor young immigrant and U.S.-born Black and Latina women from seeking mental health care? Psychiatric Services 58(12):1547–1554. https://doi.org/10.1176/ps.2007.58.12.1547

  34. Mehra R, Boyd LM, Magriples U, Kershaw TS, Ickovics JR, Keene DE. Black pregnant women “get the most judgment”: a qualitative study of the experiences of Black women at the intersection of race, gender, and pregnancy. Womens Health Issues. 2020;30(6):484–92. https://doi.org/10.1016/j.whi.2020.08.001.

    Article  PubMed  PubMed Central  Google Scholar 

  35. Declercq ER, Sakala C, Corry MP, Applebaum S, Herrlich A. Major survey findings of listening to mothers (SM) III: New mothers speak out: report of national surveys of women’s childbearing experiences conducted October-December 2012 and January-April 2013. J Perinat Educ. 2014;23(1):17–24. https://doi.org/10.1891/1058-1243.23.1.17.

    Article  PubMed  PubMed Central  Google Scholar 

  36. Kroenke K, Spitzer RL, Williams JB. The patient health questionnaire-2: validity of a two-item depression screener. Med Care. 2003;4:1284–92.

    Article  Google Scholar 

  37. American Psychiatric Association (2013) Diagnostic and statistical manual of mental disorders (5th ed.). https://doi.org/10.1176/appi.books.9780890425596

  38. Garfield L, Watson-Singleton NN. Culturally responsive mindfulness interventions for perinatal African-American women: a call for action. West J Nurs Res. 2021;43(3):219–26. https://doi.org/10.1177/0193945920950336.

    Article  PubMed  Google Scholar 

  39. Canady RB, Bullen BL, Holzman C, Broman C, Tian Y. Discrimination and symptoms of depression in pregnancy among African American and White women. Womens Health Issues. 2008;18(4):292–300. https://doi.org/10.1016/j.whi.2008.04.003.

    Article  PubMed  PubMed Central  Google Scholar 

  40. Rosenthal L, Earnshaw VA, Lewis TT, Reid AE, Lewis JB, Stasko EC, Tobin JN, Ickovics JR. Changes in experiences with discrimination across pregnancy and postpartum: Age differences and consequences for mental health. Am J Public Health. 2015;105(4):686–93. https://doi.org/10.2105/AJPH.2014.301906.

    Article  PubMed  PubMed Central  Google Scholar 

  41. Vedam S, Stoll K, Taiwo TK, Rubashkin N, Cheyney M, Strauss N, McLemore M, Cadena M, Nethery E, Rushton E, Schummers L, Declercq E, GVtM-US steering council,. The giving voice to mothers study: inequity and mistreatment during pregnancy and childbirth in the United States. Reprod Health. 2019;16(1):77. https://doi.org/10.1186/s12978-019-0729-2.

    Article  PubMed  PubMed Central  Google Scholar 

  42. Giscombé CL, Lobel M. Explaining disproportionately high rates of adverse birth outcomes among African Americans: the impact of stress, racism, and related factors in pregnancy. Psychol Bull. 2005;131(5):662–83. https://doi.org/10.1037/0033-2909.131.5.662.

    Article  PubMed  PubMed Central  Google Scholar 

  43. Nelson T, Cardemil EV, Adeoye CT. Rethinking strength: Black women’s perceptions of the “Strong Black Woman” role. Psychol Women Q. 2016;40(4):551–563. https://doi.org/10.1177/0361684316646716.

  44. Nelson, T, Brown, MJ, Garcia-Rodriguez, I., Moreno, O. Gendered racism, anxiety, and depression. The mediating roles of gendered racialized stress and social isolation. Ethnicity and Health. 2021; Advanced online publication. https://doi.org/10.1080/13557858.2021.2002826.

  45. Nelson, T, Cardemil, EV, Overstreet, NM, Hunter, CD, Woods-Giscombé, CL. Association between superwoman schema, depression, and resilience: The mediating role of social isolation and gendered racial centrality. Cultural Diversity and Ethnic Minority Psychology. 2022. Advanced online publication. https://doi.org/10.1037/cdp0000533.

  46. Essed P (1991) Understanding everyday racism: an interdisciplinary theory. SAGE.

  47. Rosenthal L. Lobel M (2011) Explaining racial disparities in adverse birth outcomes: unique sources of stress for Black American women. Soc Sci Med. 1982;72(6):977–83. https://doi.org/10.1016/j.socscimed.2011.01.013.

    Article  Google Scholar 

  48. Thomas AJ, Witherspoon KM, Speight SL (2008) Gendered racism, psychological distress, and coping styles of African American women. Cultural Diversity & Ethnic Minority Psychology 14(4):307–14. https://doi:https://doi.org/10.1037/1099-9809.14.4.307.

  49. Watson NN, Hunter CD. “I had to be strong”: tensions in the strong Black woman schema. J Black Psychol. 2016;42(5):424–52. https://doi.org/10.1177/0095798415597093.

    Article  Google Scholar 

  50. Hoyert DL, Uddin S, Miniño AM. Evaluation of the pregnancy status checkbox on the identification of maternal deaths. National Vital Statistics Reports: from the Centers for Disease Control and Prevention, National Center for Health Statistics, National Vital Statistics System. 2020;69(1):1–25.

    PubMed  Google Scholar 

  51. Petersen EE, Davis NL, Goodman D, Cox S, Syverson C, Seed K, Shapiro-Mendoza C, Callaghan WM, Barfield W (2019) Racial/ethnic disparities in pregnancy-related deaths - United States, 2007–2016. MMWR. Morbidity and mortality weekly report 68(35):762–765. https://doi.org/10.15585/mmwr.mm6835a3

  52. Gjerdingen D, Crow S, McGovern P, Miner M, Center B. Postpartum depression screening at well-child visits: validity of a 2-question screen and the PHQ-9. Ann Fam Med. 2009;7(1):63–70. https://doi.org/10.1370/afm.933.

    Article  PubMed  PubMed Central  Google Scholar 

  53. Whooley MA, Avins AL, Miranda J, Browner WS (1997) Case-finding instruments for depression. Two questions are as good as many. Journal of General Internal Medicine 12(7):439–445. https://doi.org/10.1046/j.1525-1497.1997.00076.x

  54. Dubowitz H, Feigelman S, Lane W, Prescott L, Blackman K, Grube L, Meyer W, Tracy JK. Screening for depression in an urban pediatric primary care clinic. Pediatrics. 2007;119(3):435–43. https://doi.org/10.1542/peds.2006-2010.

    Article  PubMed  Google Scholar 

  55. O’Hara MW, Stuart S, Watson D, Dietz PM, Farr SL. D’Angelo D (2012) Brief scales to detect postpartum depression and anxiety symptoms. J Womens Health. 2002;21(12):1237–43. https://doi.org/10.1089/jwh.2012.3612.

    Article  Google Scholar 

  56. Olson AL, Dietrich AJ, Prazar G, Hurley J. Brief maternal depression screening at well-child visits. Pediatrics. 2006;118(1):207–16. https://doi.org/10.1542/peds.2005-2346.

    Article  PubMed  Google Scholar 

  57. Hoedjes M, Berks D, Vogel I, Franx A, Bangma M, Darlington AS, Visser W, Duvekot JJ, Habbema JD, Steegers EA. Raat H (2011) Postpartum depression after mild and severe preeclampsia. J Womens Health. 2002;20(10):1535–42. https://doi.org/10.1089/jwh.2010.2584.

    Article  Google Scholar 

  58. Fingar KR, Mabry-Hernandez I, Ngo-Metzger Q, Wolff T, Steiner CA, Elixhauser A (2017) delivery hospitalizations involving preeclampsia and eclampsia, 2005–2014: statistical brief #222. In Healthcare Cost and Utilization Project (HCUP) Statistical Briefs. Agency for Healthcare Research and Quality (US).

Download references

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Author information

Authors and Affiliations

Authors

Contributions

First author, conceptualization, formal analysis – secondary, writing; second author, formal analysis – primary, writing; third author, writing.

Corresponding author

Correspondence to Tamara Nelson.

Ethics declarations

Ethics Approval

The Institutional Review Board of Rutgers University declared this study to be exempt as this was a secondary data analysis.

Consent for Publication

All authors consented to the submission of this manuscript for publication.

Conflict of Interest

The authors declare no competing interests.

Submission Declaration

The work described has not been published previously and is not under consideration for publication elsewhere.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Nelson, T., Ernst, S.C. & Watson-Singleton, N.N. Perinatal Complications, Poor Hospital Treatment, and Positive Screen for Postpartum Depressive Symptoms Among Black Women. J. Racial and Ethnic Health Disparities 10, 1371–1378 (2023). https://doi.org/10.1007/s40615-022-01322-6

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s40615-022-01322-6

Keywords

Navigation