Risk for postpartum depression and anxiety among Black mothers were associated with interpersonal/systemic racism coupled with negative experiences associated with the COVID-19 pandemic, according to study findings published in JAMA Psychiatry.
The study authors analyzed data from a longitudinal cohort study that followed 151 Black pregnant individuals from pregnancy through the early postpartum period during the COVID-19 pandemic. Participants received care from 1 of 2 urban hospitals in the University of Pennsylvania Health System in Philadelphia.
Two online REDCap surveys were completed. A pregnancy survey during a period of high community spread of COVID-19 (April to July 2020) and a postpartum survey was completed between August and March 2021. Additionally, participants were asked to answer 3 questions on COVID-19-related stressors, and interpersonal racism and mental health status were evaluated using standardized scales. Systemic racism was evaluated based on a number of variables including income, education, street address, and insurance type as well as a Philadelphia-based measure of structural racism–based redlining known as the Home Owners’ Loan Corporation (HOLC) grade.
Based on the answers to the surveys, the researchers divided the results into 4 categories that caused poor mental health outcomes: negative COVID-19 pandemic experiences, experience of systemic and interpersonal racism, syndemic (COVID-19 and racism) and postpartum depression, and syndemic and postpartum anxiety.
Negative COVID-19 Pandemic Experiences
Of the 151 participants 132, (87%) reported having at least 1 significant worry at the pregnancy assessment and 107 (71%) reported having 1 significant worry at the postpartum survey. “For pregnancy-related COVID-19 worries, 137 (91%) endorsed at least 1 significant worry. For delivery-related and postpartum-related pandemic worries, 121 (81%) endorsed at least a moderate concern for at least 1 item,” study authors reported.
Systemic and Interpersonal Racism
The highest risk for systemic racism (HOLC grade D) was found among 51 (33.8%) participants. Only 2 participants (1.3%) had the lowest risk grade (A), and the remainder were in grade B (n=26; 17.2%), and grade C (n=38; 25.2%). Thirty-four participants had missing HOLC grades.
On the interpersonal racism scales, the mean score was 11.2 (range 0 to 39) on the Everyday Discrimination Scale and 1.37 (range 0 to 6) on the Major Experiences of Discrimination Scale.
Syndemic and Postpartum Depression
Nearly 30% (n=44) of participants screened positive for postpartum depression. The likelihood of screening for postpartum depression was associated with negative COVID-19 experiences and higher scores on the interpersonal racism scales.
“Negative COVID-19 pandemic experiences were significantly associated with postpartum depression among participants who reported high levels of systemic racism, but not low systemic racism,” study authors reported. “Negative COVID-19 pandemic experiences were also associated with postpartum depression specifically among participants reporting high interpersonal racism, but not low interpersonal racism.”
Syndemic and Postpartum Anxiety
Twenty (13%) participants met screening criteria for postpartum anxiety. There was a significant association between postpartum anxiety and negative COVID-19 experiences as well as experiences of interpersonal racism.
In this study of Black mothers, racism was associated with negative postpartum mental health. “Long-standing structural inequities have been negatively associated with every aspect of Black individuals’ lives from neighborhood quality to nutrition, medical care, and related services. These findings underscore the importance of early detection of prenatal mood disorders and point to an urgent need for policy developments to mitigate downstream mental health effects of COVID-19,” the study authors concluded.
Njoroge WFM, White LK, Waller R, et al. Association of COVID-19 and endemic systemic racism with postpartum anxiety and depression among Black birthing individuals. JAMA Psychiatry. Published online April 13, 2022.doi:10.1001/jamapsychiatry.2022.0597