Mothers living in neighborhoods with greater economic disadvantage are more likely to experience depression after giving birth, according to a Kaiser Permanente analysis recently published in JAMA Network Open.

Black patients were more likely to suffer from postpartum depression and where they live influences their risk, the researchers said.

“Postpartum depression is a common complication of childbirth and carries serious health risks for the mother and child,” said lead author Ticara Onyewuenyi, MD, MPH, an ob-gyn resident physician with The Permanente Medical Group.

“Our findings demonstrate that the risk of postpartum depression is elevated for individuals living in neighborhoods with both high and moderate disadvantage,” she continued. “As a clinician, it’s important to identify contributors of this kind of disparity, so that we are aware of them when we’re caring for patients in the clinic.”

The study looked at 122,995 Kaiser Permanente Northern California patients who had given birth between 2012 and 2017. Of those, 12.5% of them had a diagnosis of postpartum depression, defined as depression during the first year after birth.

It’s important to identify contributors of this kind of disparity, so that we are aware of them when we’re caring for patients in the clinic –

Ticara Onyewuenyi, MD, MPH

Compared with white patients, Black individuals were more likely to have postpartum depression, while Asian and Hispanic patients were less likely.

The researchers applied an index that accounts for several neighborhood socioeconomic status factors, such as educational and employment status, poverty, and housing quality to define neighborhood disadvantage.

As neighborhood disadvantage increased, the risk of postpartum depression also increased among Black individuals. Asian and white patients living in disadvantaged neighborhoods also saw higher risk, but Hispanic patients did not.

“Our findings suggest addressing social factors will be important for improving postpartum mental health outcomes, particularly among Black and Asian populations,” said senior author Lyndsay Avalos, PhD, MPH, a researcher with the Kaiser Permanente Division of Research.

Potential interventions

The researchers found that Black individuals were more likely to live in neighborhoods of higher disadvantage. The authors said the reasons for a link between higher rates of postpartum depression among Black individuals was likely “multifactorial and complex.”

“Systemic factors and discriminatory practices such as redlining and housing discrimination, inequitable access to education, employment discrimination, disproportionate rates of incarceration, and health disparities add a tremendous burden onto the normal stressors of life,” they wrote. Eating regularly, getting enough sleep, and being physically active can affect postpartum depression, they said.

The authors suggested a few possible solutions. For instance, they suggested working with community organizations so that trained community peers can assist new Black mothers. They also recommended wider use of depression screening for pregnant patients and culturally appropriate interventions.

“On the provider level, these findings highlight the importance of looking in the electronic health record to learn more about the patients we are seeing,” Dr. Onyewuenyi said. “We can take a moment to see where they live and what could that tell us about the challenges they face as we address their mental health.”

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