Perinatal depression and anxiety among Latinas: Behavioral activation and contextual predictors

Spanish-speaking Latina mothers experience elevated rates of perinatal depression and anxiety (PDA) yet face substantial barriers to culturally responsive care. Behavioral Activation (BA) is a scalable intervention targeting activity engagement and environmental reward, but its relevance in community-based, non-treatment-seeking Latina populations remains unclear.

This cross-sectional study examined BA process variables, psychosocial stressors, and structural and demographic predictors of PDA in a community sample of Spanish-speaking pregnant and postpartum Latinas (N = 674) recruited nationally via digital platforms. Logistic regression and bootstrapped multivariate models were used to identify predictors of depression, anxiety, and co-occurring symptoms.

Nearly one-third of participants met criteria for depression (31.9%), 27% for anxiety, and 22% for co-occurring symptoms. In univariate models, higher activity engagement and environmental reward were associated with lower odds of PDA, whereas perceived stress, discrimination, unemployment, and lack of insurance were associated with increased risk. In multivariate analyses, activity level and perceived stress emerged as the only consistent independent predictors. Models including these variables demonstrated strong discriminative ability (AUCs = 0.87-0.91) with balanced sensitivity and specificity (0.79-0.83).

BA processes and perceived stress are robust, modifiable predictors of PDA among Spanish-speaking Latinas in community settings. These findings support scalable screening and intervention strategies targeting activity engagement and stress. Culturally grounded, peer-delivered BA interventions may help reduce disparities in perinatal mental health.