Perinatal depression is a significant public health issue that affects nearly 20% of pregnant and postpartum individuals in the United States. Perinatal depression has been linked to adverse obstetric outcomes, impaired infant bonding, and increased risk of suicide. A substantial body of evidence suggests that both pharmacologic and nonpharmacologic interventions effectively reduce depression symptoms and improve outcomes for individuals and families.1,2,3

Inequities in access to perinatal mental health care services among racial minorities have been well-documented. Despite evidence of higher rates of perinatal depression among Black and Hispanic individuals, non-Hispanic white (NHW) individuals are significantly more likely to receive treatment for perinatal mental health disorders than their Black and Hispanic counterparts. The specific factors contributing to these gaps in care are poorly understood. Previous research has suggested that barriers to treatment disproportionately affect Minoritized perinatal individuals and include community stigma, fear of discrimination or legal consequences, low social support, limited time and resources, lack of access to culturally-sensitive care, and implicit biases among healthcare providers.4 

A recent study from the University of Massachusetts Chan Medical School compares rates of treatment referral and participation among racial minority and NHW perinatal individuals and sheds new light on where breakdowns in the pathway to mental healthcare occur. 

Researchers initially conducted a cluster randomized controlled trial (RCT) to compare the efficacy of two interventions, MCPAP for Moms and PRISM, in addressing perinatal depression treatment gaps across 10 ambulatory obstetric settings. A secondary analysis of the data compared rates of treatment referral and participation among Minoritized (Black, Asian, Hispanic/Latina, Pacific Islander, Native American, Multiracial, and white Hispanic/Latina) and NHW perinatal individuals. 

The sample included 149 NHW and 157 Minoritized perinatal individuals who screened positive for depression symptoms using the Edinburgh Postnatal Depression Scale (EPDS ?10). The analysis focused on rates of treatment referral (i.e., offered medications or referred to mental health clinicians), initiation (i.e., attended ?1 mental health visit or reported prescribed antidepressant), and sustainment (i.e., attended >1 mental health visit per study month or prescribed antidepressant medication at time of study interviews). Participants were interviewed over five study windows (4 weeks up to 25 weeks of gestation; 25-40 weeks of gestation; 0-12 weeks postpartum; 5-7 months postpartum; and 11-13 months postpartum).  

• 54% of all participants were referred for treatment, 47% initiated, and 24% sustained treatment.
• Minoritized individuals were significantly less likely than NHW individuals to be referred to treatment (46% vs. 62%), initiate treatment (41% vs. 54%), and sustain treatment (18% vs. 30%).
• Minoritized individuals who screened positive for depression were about half as likely to be referred for treatment (aOR = 0.48; 95% CI = 0.27–0.88) than NHW individuals. 
• However, among those who received referrals, there were no statistically significant differences in rates of treatment initiation or sustainment by race/ethnicity, after accounting for income, insurance, age, and education.

Next Steps

This study provides valuable insight into the inequities in perinatal mental healthcare. This study suggests that the most significant barriers to mental healthcare for Minoritized individuals may occur at the provider referral level, rather than at the stages of treatment participation or compliance. 

This study found that Minoritized perinatal individuals who screened positive for depression symptoms were less than half as likely to be referred to mental health treatment as NHW individuals. However, among Minoritized individuals who were referred to treatment, they were statistically as likely to initiate and sustain treatment as their NHW counterparts. 

While further research is needed to better qualify the specific barriers to referral for Minoritized individuals, implicit bias among healthcare providers must be considered as a contributing factor. These findings align with existing literature highlighting the systemic and structural barriers that Minoritized perinatal individuals face in accessing mental health care.5   

This study reveals the need for targeted interventions to ensure equitable and consistent referral processes among healthcare providers. Standardization of referral processes once an individual screens positively for depression symptoms may reduce racial disparities in referral rates.  

Ginger Gramson, BS

References

Boama-Nyarko E, Flahive J, Zimmermann M, Allison JJ, Person S, Moore Simas TA, Byatt N. Examining racial/ethnic inequities in treatment participation among perinatal individuals with depression. Gen Hosp Psychiatry. 2024 May-Jun; 88:23-29.