Disparities in prenatal depression highlight need to disaggregate race data

Disparities in prenatal depression highlight need to disaggregate race data | Image Credit: © DAZOKA.com - © DAZOKA.com - stock.adobe.com.

Introduction

Disaggregating race and ethnicity data is vital for understanding prenatal depression diagnoses (PDDs) burden and symptom severity, according to a recent study published in JAMA Network Open.¹

Adverse outcomes linked to prenatal depression include preterm birth and postpartum depression. Racial and ethnic minorities are disproportionately impacted by this condition, with increased odds of more severe symptoms but reduced odds of seeking treatment.²

“Prior research has often aggregated racial and ethnic groups, potentially masking important within-group differences and cultural nuances,” wrote investigators.¹ The population-based cross-sectional study was conducted to address this research gap.

Objectives of the study included examining differences in PDDs, self-reported moderate to severe depression symptoms, and undiagnosed depression. Kaiser Permanente Northern California (KPNC) members aged 15 to 45 years were included in the analysis.

Study methodology and eligibility criteria

Eligibility criteria included having a singleton live birth from January 1, 2013, to December 31, 2019, with 1 or more KPNC prenatal care visit. Self-reported race and ethnicity data was also required for inclusion.

California State birth records and KPNC databases were assessed to obtain race and ethnicity data, with 20 racial and ethnic groups included. International Classification of Diseases and International Statistical Classification of Diseases and Related Health Problems codes were used to define severe depression symptoms.

Symptoms were also identified using the Patient Health Questionnaire–9, with a score of 10 or higher indicating depression. Patients with this score but not diagnosed with depression were classified as having undiagnosed depression.

Relative risks (RRs) were reported using modified Poisson regression models after adjustments for cofounders, including maternal age, parity, and delivery year. Investigators analyzed the data using SAS 9.4 (SAS Institute) between December 2023 and August 2024.

Key findings

There were 258,452 participants aged a mean 30.7 years included in the final analysis. PDD was reported in 15.5% of these individuals, with 10.9% having moderate to severe symptoms. The lowest PDD rate of 4.7% was reported among Hmong patients and the highest rate of 26.7% among Puerto Rican patients.

For symptoms, the lowest rate was 7.5% among Japanese patients, while the highest rate was 17.3% for Black patients. The risk of PDD was significantly increased among Puerto Rican and Black patients vs White patients, with adjusted RRs (aRRs) of 1.28 and 1.03, respectively.

In Vietnamese, Mexican, and Central and South American patients, aRRs of 0.25, 0.75, and 0.82, respectively, were reported for PDD risk compared to White patients. This highlighted significantly reduced odds among these populations.

Additional risks

When evaluating the risks of moderate to severe depression symptoms, all racial and ethnic minority groups displayed an increased risk compared to White patients. These risk increases ranged from 9% among Chinese individuals to 108% among Black individuals.

Additionally, all groups except for American Indian or Alaskan Native and Puerto Rican reported an increase in undiagnosed depression risk. Asian subgroups often had an increased aRR compared with Black and Hispanic patients, with Hmong patients reporting the highest aRR of 2.10.

“The findings underscore the importance of disaggregating race and ethnicity data, especially among Asian and Hispanic populations, to better understand PDD burden and symptom severity,” concluded investigators.

References

1. Kelly-Taylor K, Aghaee S, Nugent J, et al. Prenatal depression and symptom severity by maternal race and ethnicity. JAMA Netw Open. 2025;8(3):e250743. doi:10.1001/jamanetworkopen.2025.0743
2. Prady SL, Pickett KE, Gilbody S, et al. Variation and ethnic inequalities in treatment of common mental disorders before, during and after pregnancy: combined analysis of routine and research data in the Born in Bradford cohort.BMC Psychiatry. 2016;16:99. doi:10.1186/s12888-016-0805-x