Objectives More than 10 % of pregnant women in the United States (U.S.) suffer from depression, which has far-reaching consequences on maternal and fetal well-being. There is conflicting evidence regarding the prevalence of antenatal depression among different race and ethnic groups. This systematic review aimed to summarize the existing literature concerning racial/ethnic disparities in the prevalence and correlates of antenatal depression in the U.S. Methods PubMed, CINAHL and PsycINFO databases were searched online for research studies published in English in peer-reviewed journals until March 2015, using a pre-designed search strategy. Eligibility was determined using pre-specified criteria; and quality was assessed. Results Forty-one (41) articles met the criteria; 13 were cross-sectional, and 21 were longitudinal studies. Overall, the prevalence of antenatal depression was 10–30 %; it was higher among non-Hispanic blacks (NHBs) and Hispanics, compared to non-Hispanic whites (NHWs). Few studies looked at the correlates of depression by race/ethnicity. Among employed women, higher depression scores were observed among NHBs, compared to NHWs; while there was no racial difference among unemployed women. Racial difference and race-employment interaction disappeared once discrimination was accounted for. In another study, higher parity, higher stress, and lower self-esteem were significant correlates of depression among NHBs, while less satisfaction with social support, and higher stress predicted higher depression scores among NHWs and Hispanics respectively. Conclusions The findings of our review suggest that not only is antenatal depression a major public health issue that needs to be addressed, but different racial/ethnic groups seem to differ in their vulnerability and risk factors.
This is a preview of subscription content, access via your institution.
Buy single article
Instant access to the full article PDF.
Price includes VAT (USA)
Tax calculation will be finalised during checkout.
World Health Organization. (2008). Improving maternal mental health. Accessed May 5, 2015. http://www.who.int/mental_health/prevention/suicide/Perinatal_depression_mmh_final.pdf.
Birndorf, C. A., Madden, A., Portera, L., & Leon, A. C. (2001). Psychiatric symptoms, functional impairment, and receptivity toward mental health treatment among obstetrical patients. The International Journal of Psychiatry in Medicine, 31(4), 355–365.
Payne, J. L. (2012). Depression: Is pregnancy protective? Journal of Women’s Health, 21(8), 809–810.
Marcus, S. M., Flynn, H. A., Blow, F. C., & Barry, K. L. (2003). Depressive symptoms among pregnant women screened in obstetrics settings. Journal of Women’s Health, 12(4), 373–380.
Dennis, C. L., & Dowswell, T. (2013). Interventions (other than pharmacological, psychosocial or psychological) for treating antenatal depression. Cochrane Database of Systematic Reviews, 31(7), CD006795. doi:10.1002/14651858.CD006795.pub3.
Bonari, L., Koren, G., Einarson, T. R., Jasper, J. D., Taddio, A., & Einarson, A. (2005). Use of antidepressants by pregnant women: Evaluation of perception of risk, efficacy of evidence based counseling and determinants of decision making. Archives of Women’s Mental Health, 8(4), 214–220.
Bennett, I., Marcus, S., Palmer, S., & Coyne, J. (2010). Pregnancy-related discontinuation of antidepressants and depression care visits among Medicaid recipients. Psychiatric Services, 61(4), 386–391.
Marcus, S., Barry, K., Flynn, H., & Blow, F. (1998). Improving detection, prevention and treatment of depression and substance abuse in childbearing women: Critical variables in pregnancy and pre-pregnancy planning. Ann Arbor: University of Michigan Clinical Ventures, Faculty Group Practice.
Blier, P. (2006). Pregnancy, depression, antidepressants and breast-feeding. Journal of Psychiatry and Neuroscience, 31(4), 226–228.
Kurki, T., Hiilesmaa, V., Raitasalo, R., Mattila, H., & Ylikorkala, O. (2000). Depression and anxiety in early pregnancy and risk for preeclampsia. Obstetrics and Gynecology, 95(4), 487–490.
Paarlberg, K. M., Vingerhoets, A., Passchier, J., Dekker, G. A., & Van Geijn, H. P. (1995). Psychosocial factors and pregnancy outcome: A review with emphasis on methodological issues. Journal of Psychosomatic Research, 39(5), 563–595.
Arck, P., Rose, M., Hertwig, K., Hagen, E., Hildebrandt, M., & Klapp, B. (2001). Stress and immune mediators in miscarriage. Human Reproduction, 16(7), 1505–1511.
Arck, P. C. (2001). Stress and pregnancy loss: Role of immune mediators, hormones and neurotransmitters. American Journal of Reproductive Immunology, 46(2), 117–123.
Sugiura-Ogasawara, M., Furukawa, T. A., Nakano, Y., Hori, S., Aoki, K., & Kitamura, T. (2002). Depression as a potential causal factor in subsequent miscarriage in recurrent spontaneous aborters. Human Reproduction, 17(10), 2580–2584.
Dayan, J., Creveuil, C., Marks, M. N., Conroy, S., Herlicoviez, M., Dreyfus, M., & Tordjman, S. (2006). Prenatal depression, prenatal anxiety, and spontaneous preterm birth: A prospective cohort study among women with early and regular care. Psychosomatic Medicine, 68(6), 938–946.
Zuckerman, B., Amaro, H., Bauchner, H., & Cabral, H. (1989). Depressive symptoms during pregnancy: Relationship to poor health behaviors. American Journal of Obstetrics and Gynecology, 160(5 Pt 1), 1107–1111.
Stocky, A., & Lynch, J. (2000). Acute psychiatric disturbance in pregnancy and the puerperium. Best Practice & Research Clinical Obstetrics & Gynaecology, 14(1), 73–87.
Andersson, L., Sundström-Poromaa, I., Wulff, M., Aström, M., & Bixo, M. (2006). Depression and anxiety during pregnancy and six months postpartum: A follow-up study. Acta Obstetricia et Gynecologica Scandinavica, 85(8), 937–944.
Ko, J. Y., Farr, S. L., Dietz, P. M., & Robbins, C. L. (2012). Depression and treatment among US pregnant and nonpregnant women of reproductive age, 2005–2009. Journal of Women’s Health, 21(8), 830–836.
Patel, V., Rodrigues, M., & DeSouza, N. (2002). Gender, poverty, and postnatal depression: A study of mothers in Goa, India. American Journal of Psychiatry, 159(1), 43–47.
Grigoriadis, S., Vonderporten, E., Mamisashvili, L., Tomlinson, G., Dennis, C., Koren, G., et al. (2013). The impact of maternal depression during pregnancy on perinatal outcomes: A systematic review and meta-analysis. The Journal of Clinical Psychiatry, 74(4), e321–e341.
Centers for Disease Control and Prevention. (2013). Depression surveillance data sources. Accessed May 5, 2015. http://www.cdc.gov/mentalhealth/data_stats/depression.htm.
Melville, J. L., Gavin, A., Guo, Y., Fan, M., & Katon, W. J. (2010). Depressive disorders during pregnancy: Prevalence and risk factors in a large urban sample. Obstetrics and Gynecology, 116(5), 1064–1070.
Canady, R. B., Bullen, B. L., Holzman, C., Broman, C., & Tian, Y. (2008). Discrimination and symptoms of depression in pregnancy among African American and White women. Women’s Health Issues, 18(4), 292–300.
Jesse, D. E., Walcott-McQuigg, J., Mariella, A., & Swanson, M. S. (2005). Risks and protective factors associated with symptoms of depression in low-Income African American and Caucasian women during pregnancy. Journal of Midwifery & Women’s Health, 50(5), 405–410.
Soubry, A., Murphy, S. K., Huang, Z., Murtha, A., Schildkraut, J. M., Jirtle, R. L., et al. (2011). The effects of depression and use of antidepressive medicines during pregnancy on the methylation status of the IGF2 imprinted control regions in the offspring. Clinical Epigenetics, 3(2), 1–10.
Lancaster, C. A., Gold, K. J., Flynn, H. A., Yoo, H., Marcus, S. M., & Davis, M. M. (2010). Risk factors for depressive symptoms during pregnancy: A systematic review. American Journal of Obstetrics and Gynecology, 202(1), 5–14.
Bennett, H. A., Einarson, A., Taddio, A., Koren, G., & Einarson, T. R. (2004). Prevalence of depression during pregnancy: Systematic review. Obstetrics and Gynecology, 103(4), 698–709.
Dole, N., Savitz, D. A., Siega-Riz, A. M., Hertz-Picciotto, I., McMahon, M. J., & Buekens, P. (2004). Psychosocial factors and preterm birth among African American and white women in central North Carolina. American Journal of Public Health, 94(8), 1358–1365.
Hogue, C. J., & Bremner, J. D. (2005). Stress model for research into preterm delivery among black women. American Journal of Obstetrics and Gynecology, 192(5 Suppl), S47–S55.
Moher, D., Liberati, A., Tetzlaff, J., & Altman, D. G. (2009). Preferred reporting items for systematic reviews and meta-analyses: The PRISMA statement. Annals of Internal Medicine, 151(4), 264–269.
Kaufman, J. S., & Cooper, R. S. (2001). Commentary: Considerations for use of racial/ethnic classification in etiologic research. American Journal of Epidemiology, 154(4), 291–298.
Goodman, A. H. (2000). Why genes don’t count (for racial differences in health). American Journal of Public Health, 90(11), 1699–1702.
Smedley, A., & Smedley, B. D. (2005). Race as biology is fiction, racism as a social problem is real: Anthropological and historical perspectives on the social construction of race. American Psychologist, 60(1), 16.
Kmet, L. M., Lee, R. C., & Cook, L. S. (2004). Standard quality assessment criteria for evaluating primary research papers from a variety of fields. Alberta Heritage Foundation for Medical Research (AHFMR). HTA Initiative #13.
Cameron, R. P., Grabill, C. M., Hobfoll, S. E., Crowther, J. H., Ritter, C., & Lavin, J. (1996). Weight, self-esteem, ethnicity, and depressive symptomatology during pregnancy among inner-city women. Health Psychology, 15(4), 293–297.
Blalock, J. A., Fouladi, R. T., Wetter, D. W., & Cinciripini, P. M. (2005). Depression in pregnant women seeking smoking cessation treatment. Addictive Behaviors, 30(6), 1195–1208.
Chapman, H. A., Hobfoll, S. E., & Ritter, C. (1997). Partners’ stress underestimations lead to women’s distress: A study of pregnant inner-city women. Journal of Personality and Social Psychology, 73(2), 418–425.
Cook, C. A., Flick, L. H., Homan, S. M., Campbell, C., McSweeney, M., & Gallagher, M. E. (2010). Psychiatric disorders and treatment in low-income pregnant women. Journal of Women’s Health, 19(7), 1251–1262.
Connelly, C. D., Hazen, A. L., Baker-Ericzén, M. J., Landsverk, J., & Horwitz, S. M. (2013). Is screening for depression in the perinatal period enough? The co-occurrence of depression, substance abuse, and intimate partner violence in culturally diverse pregnant women. Journal of Women’s Health, 22(10), 844–852.
Dornelas, E., Oncken, C., Greene, J., Sankey, H. Z., & Kranzler, H. R. (2013). Major depression and PTSD in pregnant smokers enrolled in nicotine gum treatment trial. The American Journal on Addictions, 22(1), 54–59.
Fellenzer, J. L., & Cibula, D. A. (2014). Intendedness of pregnancy and other predictive factors for symptoms of prenatal depression in a population-based study. Maternal and Child Health Journal, 18(10), 2426–2436.
Gavin, A. R., Melville, J. L., Rue, T., Guo, Y., Dina, K. T., & Katon, W. J. (2011). Racial differences in the prevalence of antenatal depression. General Hospital Psychiatry, 33(2), 87–93.
Haas, D. M., Weida, J., Smith, R., & Abernathy, M. P. (2010). A comparison of depression symptoms and histories in pregnant women. The Journal of Reproductive Medicine, 56(1–2), 39–43.
Hickey, C. A., Cliver, S. P., Goldenberg, R. L., McNeal, S. F., & Hoffman, H. J. (1995). Relationship of psychosocial status to low prenatal weight gain among nonobese black and white women delivering at term. Obstetrics and Gynecology, 86(2), 177–183.
Holzman, C., Eyster, J., Tiedje, L. B., Roman, L. A., Seagull, E., & Rahbar, M. H. (2006). A life course perspective on depressive symptoms in mid-pregnancy. Maternal and Child Health Journal, 10(2), 127–138.
Jesse, D. E., & Swanson, M. S. (2007). Risks and resources associated with antepartum risk for depression among rural southern women. Nursing Research, 56(6), 378–386.
Lancaster, C. A., Flynn, H. A., Johnson, T. R., Marcus, S. M., & Davis, M. M. (2010). Peripartum length of stay for women with depressive symptoms during pregnancy. Journal of Women’s Health, 19(1), 31–37.
Levine, M. D., Marcus, M. D., & Leon-Verdin, M. (2008). Similarities in affect, perceived stress, and weight concerns between Black and White women who quit smoking during pregnancy. Nicotine & Tobacco Research, 10(10), 1543–1548.
Li, D., Liu, L., & Odouli, R. (2009). Presence of depressive symptoms during early pregnancy and the risk of preterm delivery: A prospective cohort study. Human Reproduction, 24(1), 146–153.
Loprinzi, P. D., Fitzgerald, E. M., & Cardinal, B. J. (2012). Physical activity and depression symptoms among pregnant women from the National Health and Nutrition Examination Survey 2005–2006. Journal of Obstetric, Gynecologic, and Neonatal Nursing, 41(2), 227–235.
Maxson, P. J., Edwards, S. E., Ingram, A., & Miranda, M. L. (2012). Psychosocial differences between smokers and non-smokers during pregnancy. Addictive Behaviors, 37(2), 153–159.
Mora, P. A., Bennett, I. M., Elo, I. T., Mathew, L., Coyne, J. C., & Culhane, J. F. (2009). Distinct trajectories of perinatal depressive symptomatology: Evidence from growth mixture modeling. American Journal of Epidemiology, 169(1), 24–32.
Rich-Edwards, J. W., Kleinman, K., Abrams, A., Harlow, B. L., McLaughlin, T. J., Joffe, H., & Gillman, M. W. (2006). Sociodemographic predictors of antenatal and postpartum depressive symptoms among women in a medical group practice. Journal of Epidemiology and Community Health, 60(3), 221–227.
Ritter, C., Hobfoll, S. E., Lavin, J., Cameron, R. P., & Hulsizer, M. R. (2000). Stress, psychosocial resources, and depressive symptomatology during pregnancy in low-income, inner-city women. Health Psychology, 19(6), 576.
Mehta, U. J., Siega-Riz, A. M., & Herring, A. H. (2011). Effect of body image on pregnancy weight gain. Maternal and Child Health Journal, 15(3), 324–332.
Scholle, S. H., Haskett, R. F., Hanusa, B. H., Pincus, H. A., & Kupfer, D. J. (2003). Addressing depression in obstetrics/gynecology practice. General Hospital Psychiatry, 25(2), 83–90.
Setse, R., Grogan, R., Pham, L., Cooper, L. A., Strobino, D., Powe, N. R., & Nicholson, W. (2009). Longitudinal study of depressive symptoms and health-related quality of life during pregnancy and after delivery: The Health Status in Pregnancy (HIP) study. Maternal and Child Health Journal, 13(5), 577–587.
Shieh, C., & Wu, J. (2014). Depressive symptoms and obesity/weight gain factors among black and hispanic pregnant women. Journal of Community Health Nursing, 31(1), 8–19.
Sidebottom, A. C., Hellerstedt, W. L., Harrison, P. A., & Hennrikus, D. (2014). An examination of prenatal and postpartum depressive symptoms among women served by urban community health centers. Archives of Women’s Mental Health, 17(1), 27–40.
Sleath, B., West, S., Tudor, G., Perreira, K., King, V., & Morrissey, J. (2005). Ethnicity and prenatal depression: Women’s experiences and perspectives on communicating about their emotions and feelings during pregnancy. Patient Education and Counseling, 58(1), 35–40.
Smith, M. V., Shao, L., Howell, H., Lin, H., & Yonkers, K. A. (2011). Perinatal depression and birth outcomes in a Healthy Start project. Maternal and Child Health Journal, 15(3), 401–409.
Stewart, A. L., Dean, M. L., Gregorich, S. E., Brawarsky, P., & Haas, J. S. (2007). Race/ethnicity, socioeconomic status and the health of pregnant women. Journal of Health Psychology, 12(2), 285–300.
Straub, H., Adams, M., Kim, J. J., & Silver, R. K. (2012). Antenatal depressive symptoms increase the likelihood of preterm birth. American Journal of Obstetrics and Gynecology, 207(4), 329-e1.
Ward, K. D., Weg, M. W. V., Sell, M. A., Scarinci, I. C., & Read, M. C. (2006). Characteristics and correlates of quitting among black and white low-income pregnant smokers. American Journal of Health Behavior, 30(6), 651–662.
Westdahl, C., Milan, S., Magriples, U., Kershaw, T. S., Rising, S. S., & Ickovics, J. R. (2007). Social support and social conflict as predictors of prenatal depression. Obstetrics and Gynecology, 110(1), 134.
Zayas, L. H., Cunningham, M., McKee, M. D., & Jankowski, K. R. (2002). Depression and negative life events among pregnant African-American and Hispanic women. Women’s Health Issues, 12(1), 16–22.
Liu, C. H., & Tronick, E. (2013). 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, 17(9), 1599–1610.
Koleva, H., Stuart, S., O’Hara, M. W., & Bowman-Reif, J. (2011). Risk factors for depressive symptoms during pregnancy. Archives of Women’s Mental Health, 14(2), 99–105.
Liu, C. H., & Tronick, E. (2014). Prevalence and predictors of maternal postpartum depressed mood and anhedonia by race and ethnicity. Epidemiology and Psychiatric Sciences, 23(02), 201–209.
Segre, L. S., O’Hara, M. W., & Losch, M. E. (2006). Race/ethnicity and perinatal depressed mood. Journal of Reproductive and Infant Psychology, 24(02), 99–106.
Centers for Disease Control and Prevention. (2010). Current depression among adults—United States, 2006 and 2008. Morbidity and Mortality Weekly Report (MMWR), 59(38), 1229.
Beck, C. T. (2001). Predictors of postpartum depression: an update. Nursing Research, 50(5), 275–285.
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(4), 289–295.
Lorant, V., Deliège, D., Eaton, W., Robert, A., Philippot, P., & Ansseau, M. (2003). Socioeconomic inequalities in depression: A meta-analysis. American Journal of Epidemiology, 157(2), 98–112.
Kochhar, R., & Fry, R. (2014). Wealth inequality has widened along racial, ethnic lines since end of Great Recession. Washington, DC: Pew Research Center.
Ortega, A. N., Rosenheck, R., Alegria, M., & Desai, R. A. (2000). Acculturation and the lifetime risk of psychiatric and substance use disorders among Hispanics. The Journal of Nervous and Mental Disease, 188(11), 728–735.
Escobar, J. I. (1998). Immigration and mental health: Why are immigrants better off? Archives of General Psychiatry, 55(9), 781–782.
American College of Obstetricians and Gynecologists, & Committee on Obstetric Practice. (2015). Committee opinion no. 630: Screening for perinatal depression. Accessed May 5, 2015. http://www.acog.org/Resources-And-Publications/Committee-Opinions/Committee-on-Obstetric-Practice/Screening-for-Perinatal-Depression.
The authors would like to gratefully acknowledge the valuable inputs regarding search terms and databases from Barbara M. Sorondo, the Health Sciences Librarian at Florida International University.
There was no funding involved in the conduct and writing of this systematic review.
Study concept: Mukherjee, Trepka. Database search and data extraction: Mukherjee, Pierre-Victor, Bahelah, Avent. Quality assessment and compilation of the results: Mukherjee, Pierre-Victor, Bahelah, Avent. Interpretation of results and drafting of the manuscript: Mukherjee, Trepka. Critical revision of the manuscript: Trepka, Mukherjee, Pierre-Victor, Bahelah.
About this article
Cite this article
Mukherjee, S., Trepka, M.J., Pierre-Victor, D. et al. Racial/Ethnic Disparities in Antenatal Depression in the United States: A Systematic Review. Matern Child Health J 20, 1780–1797 (2016). https://doi.org/10.1007/s10995-016-1989-x
- Antenatal depression
- Racial/ethnic disparities
- Systematic review