Postpartum Depression: Racial Differences and Ethnic Disparities in a Tri-Racial and Bi-Ethnic Population

Guo Wei; Linda B. Greaver; Stephen M. Marson; Cynthia H. Herndon; James Rogers; Robeson Healthcare Corporation

Disclosures

Matern Child Health J. 2008;12(6):699-707. 

In This Article

Abstract and Introduction

Abstract

Objectives. This research investigated the differences and disparities of postpartum depression in a sample of African American, Hispanic, Native American, and White women.
Methods. A sample of 586 women were administered the Beck-Gable PDSS at 6-weeks postpartum. Factor analysis was applied to analyze the similarities among African American, Hispanic, Native American, and White participants. Confidence intervals of the rates of depression by group were estimated, followed by statistical tests to determine the differences among these rates. Risk assessment was performed with factor analysis and correlation methods.
Results. Hispanic women had a remarkably lower depression rate (2.5%) than other groups (P-values < 0.05). Significant differences for major depression were not found among African American, Native American, and White women; but Whites had higher minor depression (P-values < 0.05). Native American women had the highest rate of major depression (18.7%) and an average minor depression (10.5%). Although Whites had the second highest major depression (17.6%) and the highest minor depression (19.6%), their average full score (76.1) was noticeably lower than that of Native Americans (82.9) and slightly lower than that of African Americans (78.9; major and minor depression rates: 14.8% and 9.9%). The sample also demonstrated strong associations of depression with depression history and breastfeeding.
Conclusion. Statistically, postpartum depression can be ranked from high to low as Native Americans, Whites, African Americans and Hispanics (Hispanics have remarkably lower depression rates). This information is critically important to clinicians, researchers, agency administrators and social workers who work with these populations.

Introduction

Postpartum depression threatens the health of a new mother and her infant immediately after delivery.[1,2,3,4] After giving birth, most new mothers experience mood swings and mild depression. This condition usually peaks in a few days after delivery or may extend to the end of the second week. During the postpartum period, the body returns to a state of equilibrium as a response to changes in postpartum hormone levels. However, many women, particularly those with a history of depression, may not successfully return to the state of equilibrium, resulting in a lasting postpartum depression which usually peaks 3–6 months following delivery and requires clinical treatment.

Prevalence estimates for perinatal depression were not significantly different from that among similarly aged nonchildbearing women.[5,6,7] Gaynes et al.[7] concluded that the estimates for major depression alone range between 3.1% and 4.9% at different times during pregnancy and between 1.0% and 5.9% at different times during the first postpartum year; for major and minor depression together, range between 8.5% and 11.0% at different times during pregnancy and between 6.5% and 12.9% at different times during the first year postpartum.

Cox et al.,[3] however, found that in the first 5-weeks postpartum, the odds of a new episode of major depression are three times that of a comparison group, suggesting that after an event as psychologically and physiologically stressful as labor and delivery, the likelihood of depression is substantially higher.

The precise level of the prevalence and incidence of postpartum (and prenatal) depression is uncertain. Published estimates of the rate of major and minor depression in the postpartum period range widely, from 5% to more than 25%, depending on the assessment method, the timing of the assessment, and population characteristics.[8,9,10]

Postpartum depression in White and African American women has been studied in the general population by many researchers.[11,12,13] The absence of information on other populations was striking.[7] In particular, the depressive status of Native American and Hispanic women is essentially unknown; a direct comparison among African American, Hispanics, Native American, and White women remains a gap in the literature.

This research addressed such a gap by using data obtained from Robeson County, North Carolina. Table 1 summarizes the racial and ethnic distributions of the sample, along with comparisons to the racial and ethnic distributions of relevant populations (2000 US Census). Native American and Hispanic women were oversampled; White women were undersampled.

A previous study for the combined prevalence of postpartum depression for Robeson County was conducted in 2005 based on a smaller sample of 151 postpartum women.[14]

The goal of this research was to estimate the prevalence of postpartum depression for African American, Hispanic, Native American, and White women, and determine any presence of racial or ethnic differences and disparities.

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