Perceived Everyday Discrimination and Ethnic Disparities in Postpartum Depression: A Longitudinal Study of Asian...

Asians may face elevated risk for postpartum depression (PPD), though findings are mixed. Perceived discrimination, a known mediator of health outcomes, remains understudied in this group.

To examine (1) the likelihood of probable PPD using culturally informed Edinburgh Postnatal Depression Scale (EPDS) cut-offs among Asian and non-Hispanic White (NHW) participants and (2) whether perceived everyday discrimination mediated the association between ethnicity and probable PPD. A secondary aim compared postpartum mental health treatment-seeking between groups.

This secondary analysis used data from the Pregnancy during the Pandemic (PdP) study, a longitudinal study that followed Canadians throughout pregnancy and the postpartum (2020-2021). Asian (n = 170) and NHW (n = 170) participants were matched on demographics (N = 340). Online surveys assessed demographics (< 35 weeks' gestation), perceived discrimination (pregnancy to 9 months postpartum), depressive symptoms, and treatment-seeking (12 months postpartum). Data were analyzed using logistic regression and path analysis. Sensitivity analyses examined the impact of alternative EPDS threshold specifications.

Asian participants were more likely to meet criteria for probable PPD when using a culturally informed threshold (EPDS ≥ 9 vs. ≥ 13 for NHW). However, this difference was not observed under alternative or uniform threshold specifications. A significant indirect effect was identified, such that Asian participants reported higher perceived everyday discrimination, which was associated with increased likelihood of PPD symptoms. No group differences were observed in mental health treatment-seeking.

Observed differences in probable PPD between Asian and NHW participants were dependent on EPDS threshold specification, underscoring the sensitivity of prevalence estimates to cut-off selection. While culturally informed thresholds may improve detection, optimal EPDS cut-offs for Asian populations remain uncertain. These findings highlight the importance of culturally responsive screening approaches and the role of perceived discrimination in postpartum mental health.