Racial, ethnic, and nativity disparities in elevated symptoms and diagnosis of perinatal mood and anxiety disorders:...

This study evaluated racial, ethnic, and nativity disparities in diagnosis of perinatal mood and anxiety disorders (PMADs) for individuals with elevated symptoms in a state with universal screening of perinatal depression.

This was a cross-sectional analysis of linked New Jersey birth records and hospital discharge records between January 2016 and December 2019 (n = 338,537 births). Primary outcomes were a positive screen for elevated symptoms using the Edinburgh Postnatal Depression Scale (EPDS ≥ 10) and positive EPDS with a PMAD diagnosis on the delivery hospitalization discharge record. Logistic regression was used to estimate associations between racial, ethnic, and nativity groups and outcomes. We also examined associations between screening and diagnosis outcomes at delivery and postpartum use emergency department (ED) use.

Compared with White US-born, births to Asian/Pacific Islander foreign-born mothers had significantly higher odds of positive EPDS (adjusted OR 1.84, 95%CI 1.73-1.96), but lower odds of positive EPDS with PMAD diagnosis (AOR 0.36 95%CI 0.29-0.45). Similar differences were found for Black US-born, Black foreign-born, Hispanic US-born, and White foreign-born births. Compared to those with a negative screen, a positive screen without a diagnosis was associated with higher odds of a psychiatric ED visit in the first year postpartum (AOR 2.23, 95%CI 1.99-2.51).

This population-level study found that in a setting with universal screening of perinatal depression, there remain substantial racial and ethnic disparities in the pathway from screening to diagnosis. Further research is needed to understand the mechanisms behind these findings and identify policies to improve equity in perinatal mental health care.