There is an association between residing in more disadvantaged neighborhoods and postpartum depression (PPD), according to a recent study published in JAMA Network Open.
Takeaways
- The study highlights a significant association between residing in more disadvantaged neighborhoods and an increased risk of postpartum depression (PPD).
- Approximately 15% to 20% of postpartum individuals in the United States experience PPD, with Black individuals being disproportionately affected. The study reveals racial disparities in PPD, with increased risk in Black individuals.
- PPD is linked to adverse effects on maternal and child health, including maternal morbidity and mortality, increased risk of infanticide, impaired parenting behaviors, and poor maternal-infant attachment.
- The study utilizes the Neighborhood Deprivation Index (NDI) to measure neighborhood disadvantage, encompassing factors such as housing conditions, education, occupation, and socioeconomic status. Higher NDI scores, indicating increased neighborhood deprivation, correlate with a higher risk of PPD.
- The findings suggest a need for social and public health policies that prioritize disadvantaged neighborhoods to improve postpartum mental health outcomes. By addressing socioeconomic disparities at the community level, interventions may mitigate the risk of PPD.
About 15% to 20% of postpartum individuals in the United States are impacted by PPD, with Black individuals proportionately affected. PPD is associated with adverse effects on maternal and child health, including maternal morbidity and mortality, increased risk of infanticide, impaired parenting behaviors, and poor maternal-infant attachment.
An association has been discovered between neighborhood-level disadvantage and adverse health outcomes. However, there is little data evaluating the association between neighborhood-level disadvantage and PPD.
To evaluate the association between neighborhood-level disadvantage and PPD based on race and ethnicity, investigators conducted a cross-sectional study. The study was conducted within Kaiser Permanente Northern California (KPNC), a large integrated health care delivery system including over 4.6 million members from racially and socioeconomically diverse populations.
Live births from October 7, 2012, to May 31, 2017, from patients aged 15 years or older who had a recorded address in the electronic health record (EHR) during pregnancy or when postpartum were included in the analysis. PPD was determined using a diagnosis from the International Classification of Diseases, Ninth Revision and Tenth Revision.
Perinatal depression screening was completed using the Patient Health Questionnaire-9 (PHQ-9). Patients completed the PHQ-9 twice during pregnancy and between 3 and 10 weeks postpartum, with screening completed in over 97% of perinatal KPNC members.
The Neighborhood Deprivation Index (NDI), a census-based socioeconomic index, was used to determine neighborhood disadvantage. NDI scores range from -3.6 to 2.8, and are measured based on housing conditions, education level, occupation, and socioeconomic status indicators of wealth and income. Higher scores indicate increased neighborhood deprivation.
Postpartum was defined as the day of delivery to 365 days after delivery. The address a patient resided in for the most days postpartum was used for the analysis, matched to the aggregate NDI score for that location in the 2015 American Community Survey.
EHR data was evaluated to determine race and ethnicity. Covariates included maternal age at delivery, prepregnancy body mass index categorized by obesity status, parity, and Charlson Comorbidity Index score.
There were 122,995 postpartum individuals included in the final analysis, 14.3% of which were aged under 25 years, 20% had at least 2 children, and 12.6% had PPD. In the least socioeconomically disadvantaged quartile, 20.8% of individuals had PPD, compared to 27.8% in the highest socioeconomically disadvantaged quartile.
The risk of PPD was increased by 30% in Black individuals after adjusting for covariates, decreased by 52% in Asian individuals, and decreased by 8.1% in Hispanic individuals. A significant interaction term was found for race and ethnicity with NDI.
A dose-response increase in PPD from 39% to 60% as NDI increased was observed among Black individuals. Higher NDI was associated with increased PPD risk for White individuals in the 2 most disadvantaged quartiles. An association between neighborhood disadvantage and PPD was not observed among Hispanic individuals.
These results indicated living in a neighborhood with greater socioeconomical disadvantage is associated with worse postpartum mental health outcomes. Investigators recommended social and public health policies prioritizing disadvantaged neighborhoods be implemented.
Reference
Onyewuenyi TL, Peterman K, Zaritsky E, et al. Neighborhood disadvantage, race and ethnicity, and postpartum depression. JAMA Netw Open. 2023;6(11):e2342398. doi:10.1001/jamanetworkopen.2023.42398
