Postpartum Depression in Women of Color

What is Postpartum Depression?

According to Statistics Canada, approximately one-quarter (23%) of mothers who give birth develop Postpartum depression (PPD).1 PPD is defined as a major depressive episode that presents at any trimester in pregnancy or within 4-weeks of delivery.2 As such, PPD is distinct from Baby Blues, which commonly occurs 2-5 days after delivery and resolves within 10-14 days.2 

Women of color are at a disproportionately greater risk of experiencing PPD than their white counterparts.3 The Canadian Mental Health Association estimates that up 20% of new Indigenous mother’s experience PPD.4 Studies also suggest that Black and Hispanic mothers report earlier onset of PPD symptoms than other groups.3

While PPD can present differently for each woman, common symptoms include2:

  • Depressive mood (subjective or observed) present most of the day
  • Loss of interest or pleasure in activities most of the day
  • Insomnia, sleep disturbances, or hypersomnia
  • Agitation, extreme anxiety or panic
  • Worthlessness, hopelessness, or guilt
  • Loss of energy or fatigue
  • Suicidal ideation or attempt and recurrent thoughts of death
  • Impaired concentration, or indecisiveness 
  • Change in weight or appetite

A combination of genetics, psychosocial and social life stressors put some women at a higher risk for PPD. Common risk factors for developing PPD include 2,5:

  • Previous history of depression and anxiety, premenstrual syndrome, or mood disorders
  • Family history of depression 
  • Feelings of anxiety during pregnancy 
  • History of sexual abuse 
  • Lack of social support
  • Intimate partner violence 
  • Smoking 
  • Decreased sleep 
  • Marital problems 
  • Being a teen mother 
  • Preterm (before 37 weeks) labor and delivery 
  • Pregnancy and birth complications, or having a newborn that has been hospitalized

What racial and ethnic disparities exist in Postpartum Depression Care?

Women of color face unique challenges that put them at a greater risk for PPD. One contributory factor is the disproportionate exposure of BIPOC women to certain risk factors of PPD. Recent evidence has shown that Black, Hispanic, and Native American mothers are more likely to be exposed to stressors including divorce, homelessness and IPV.6 A 2015 Voices and PHACES study conducted in Calgary also found that chronic stress and trauma were driving factors for prenatal depression in Indigenous women.7 Additionally, previous evidence suggest that BIPOC women are less likely to initiate and utilize PPD-related mental health services.8 This may be due to the lack of awareness of these resources or the lack of culturally-sensitive mental health resources that provide intersectional mental health strategies. 

Barriers to access and utilization of mental health services are in part due to:

  • Cultural and religious stigmas discouraging mental health counselling10 
  • Cultural expectations and perceptions of motherhood8 
  • Lack of access to mental health services, due to limited-service provision, low income, or lack of health insurance 11
  • “One-size fits all” screening tools which fail to recognize how perinatal mood disorders present differently among ethnic groups 9,12
  • Fear of discriminatory attitudes, racial stereotyping and racial stigma in mental health13 
  • Mistrust of the healthcare system stemming from systemic racism10
  • Language barriers13 
  • Lack of patient-provider racial/ethnic concordance and diversity of mental health providers 8,13

These factors highlight disparities related to outreach, detection, and service quality of PPD mental health services for BIPOC populations.8 Low treatment initiation and continuation of care mean that PPD remains largely under-recognized for low-income and racial/ethnic minorities. 

What is the impact of Postpartum Depression on Maternal and Child health?

PPD can have significant long-term impacts on the health and wellbeing of affected women, her family, and child. 

Negative consequences of PPD for mothers may include 14,15,16:

  • Withdrawn and unresponsive mothers are unable to interact and support their infants 
  • Weight problems, alcohol and illicit drug use
  • Social relationship problems
  • Breastfeeding problems 
  • Persistent depression

Negative consequences of PPD for infants may include 14,15,16:

  • Child may struggle to form secure attachment with their mothers 
  • Child may develop behavioral challenges and emotional maladjustment, including withdrawal, passivity, violent behavior, and self-regulatory behaviors (i.e., sucking on thumb) 
  • Children with poor cognitive functioning, that may develop skills later than other infants

Resources

Majority of women with PPD can be treated successfully. Common options for PPD treatment include the following mental health services: 

  • Psychotherapy– talking with a psychologist, psychiatrist, or other mental health counsellors. Includes individual and family therapy, and marriage counselling.    
  • Social supports – community groups or parenting education
  • Medications – antidepressants, hormone therapy

For more resources related to PPD available in Canada visit:

Authors  |  Elizabeth Dayo (Reproductive Health Portfolio)

References

  1. Statistics Canada. (2019). Maternal Mental Health in Canada, 2018/2019. Retrieved April 15, 2021, from: https://www150.statcan.gc.ca/n1/daily-quotidien/190624/dq190624b-eng.htm 
  2. Mughal, S., Azhar, Y., and Siddiqui, W. (Updated 2020 Nov 21). Postpartum Depression. StatsPearls [Internet]. StatPearls Publishing, Treasure Island (FL)
  3. Sandoiu, A. (2020). Postpartum depression in women of color: “More work needs to be done” Medical News Today. Retrieved April 15, 2021, from: https://www.medicalnewstoday.com/articles/postpartum-depression-in-women-of-color-more-work-needs-to-be-done#1
  4. Government of Canada. (n.d.). Original quantitative research – Mental health indicators among pregnant Aboriginal women in Canada: results from the Maternity Experiences Survey. Retrieved April 14, 2021 from: https://www.canada.ca/en/public-health/services/reports-publications/health-promotion-chronic-disease-prevention-canada-research-policy-practice/vol-38-no-7-8-2018/mental-health-indcators-pregnant-aboriginal-women-maternity-experiences-survey.html 
  5. Centers for Disease Control and Prevention. (n.d.). Reproductive Health: Depression Among Women. Retrieved April 20, 2021 from: https://www.cdc.gov/reproductivehealth/depression/index.htm 
  6. Koning, S.M., Ehrenthal, D.B. (2019). Stressor landscapes, birth weight, and prematurity at the intersection of race and income: Elucidating birth contexts through patterned life events. SSM Popul Health. 2019 Jul 23;8: 100460.
  7. Roy, A., Thurston, W. E., & the Voices and PHACES Study Team. (2015). Depression and mental health in pregnant Aboriginal women: Key results and recommendations from the Voices and PHACES study (Final report). Calgary, AB: University of Calgary. 
  8. Kozhimannil, K. B., Trinacty, C. M., Busch, A. B., Huskamp, H. A., & Adams, A. S. (2011). Racial and ethnic disparities in postpartum depression care among low-income women. Psychiatric services (Washington, D.C.), 62(6), 619–625.
  9. Carter, C.M. (n.d.). Black Moms are Suffering from Postpartum Depression in Silence and That Needs to Change. Retrieved on April 20, 2021 from: https://www.parents.com/baby/health/postpartum-depression/black-moms-are-suffering-from-postpartum-depression-in-silence-and-that-needs-to-change/ 
  10. Zhang, A. Y., & Gary, F. (2013). Discord of Measurements in Assessing Depression among African Americans with Cancer Diagnoses. International journal of culture and mental health, 6(1), 58–71. https://doi.org/10.1080/17542863.2011.623042
  11. Alegría, M., Cao, Z., McGuire, T.G., Ojeda, V.D., Sribney, B., Woo, M., Takeuchi, D. (2006). Health insurance coverage for vulnerable populations: contrasting Asian Americans and Latinos in the United States. Inquiry, 43(3): 231-54.
  12. Feldman, N., Pattani, A. (2019). Black Mothers Get Less Treatment for Their Postpartum Depression. Retrieved on April 28, 2021 from: https://www.npr.org/sections/health-shots/2019/11/29/760231688/black-mothers-get-less-treatment-for-their-postpartum-depression 
  13. McGuire, T. G., & Miranda, J. (2008). New evidence regarding racial and ethnic disparities in mental health: policy implications. Health affairs (Project Hope), 27(2), 393–403. https://doi.org/10.1377/hlthaff.27.2.393
  14. Depression in pregnant women and mothers: How children are affected. (2004). Paediatrics & child health, 9(8), 584–601. https://doi.org/10.1093/pch/9.8.584
  15. Maternal depression and child development. (2004). Paediatrics & child health, 9(8), 575–598. https://doi.org/10.1093/pch/9.8.575
  16. Slomian, J., Honvo, G., Emonts, P., Reginster, J. Y., & Bruyère, O. (2019). Consequences of maternal postpartum depression: A systematic review of maternal and infant outcomes. Women’s health (London, England), 15, 1745506519844044.