Abstract
Objective
Development of postpartum depressive symptoms (PDS) is influenced by many social determinants of health, including income, discrimination, and other stressful life experiences. Early recognition of PDS is essential to reduce its long-term impact on mothers and their children, but postpartum checkups are highly underutilized. This study examined how stressful life experiences and race-based discrimination influence PDS development and whether or not a women has a postpartum checkup.
Methods
Pregnancy Risk Assessment Monitoring System (2016–2022) was used for secondary data analysis of mothers from 9 sites (n = 8,851). Stressful life experiences prior to birth, race-based discrimination, PDS, and postpartum checkup data were collected using the PRAMS questionnaire. Covariates were collected using primarily birth certificate data.
Results
Women of multiple races and ethnicities were significantly more likely to experience PDS if they reported a greater number of stressful life experiences. Women of multiple races and ethnicities were more likely to experience PDS if they reported experiencing race-based discrimination, with Asian women having nearly 8 times greater odds. Black and Hispanic women were less likely to have a postpartum checkup if they reported a greater number of stressors. Black women were less likely to have a postpartum checkup if they had previously experienced race-based discrimination.
Conclusion
The influence of race-based discrimination was seen across a diverse group of races and ethnicities. Findings highlight the need to expand questionnaires focused on social determinants of health, specifically discrimination, in PRAMS to all 50 states to better assess their significant consequences for maternal wellbeing.
Significance
In the United States, social determinants of health have significantly exacerbated a growing perinatal health crisis. Disparities of perinatal health outcomes among racial groups are often reflective of an adverse, discriminatory social environment. This study will explore how both stressful life experiences and experiences of discrimination may worsen maternal health outcomes and present a barrier to intervention. This study’s focus on health outcomes and intervention services in a multi-state sample brings unique insight into the influence of discrimination on perinatal mental health.
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Data Availability
The data are available from Pregnancy Risk Assessment Monitoring System (PRAMS) working group and the Centers for Disease Control and Prevention. https://www.cdc.gov/prams/prams-data/researchers.htm.
Code Availability
Not Applicable.
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Acknowledgements
The authors would like to thank the families and staff that participated in the study. We also want to thank the PRAMS Working Group, which includes the PRAMS Team, Division of Reproductive Health, CDC and the following PRAMS sites for their role in conducting PRAMS surveillance and allowing the use of their data: PRAMS Florida, PRAMS Georgia, PRAMS Iowa, PRAMS Minnesota, PRAMS Missouri, PRAMS North Carolina, PRAMS Wisconsin, PRAMS Wyoming, and PRAMS New York City. The findings and conclusions in this report do not necessarily represent the official position of the Center for Disease Control and Prevention.
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Haley Ringenary: conceptualization, methodology, formal analyses, and writing – original draft; Jessilyn Froelich: conceptualization and writing – review and editing; Wanjikũ Njoroge: conceptualization and writing – review and editing; Emily Gerstein: conceptualization, methodology, resources, writing – review and editing, and supervision.
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Ringenary, H.L., Froelich, J.M., Njoroge, W.F.M. et al. What Influences Postpartum Depressive Symptoms? The role of Social Determinants of Health, Race-Based Discrimination and Stressful Life Experiences. Matern Child Health J 29, 183–193 (2025). https://doi.org/10.1007/s10995-025-04055-0
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DOI: https://doi.org/10.1007/s10995-025-04055-0