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Racial and Ethnic Disparities in Hospital-Based Care Associated with Postpartum Depression

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Abstract

Objective

To estimate racial and ethnic differences in rates of hospital-based care associated with postpartum depression.

Methods

This is a retrospective cohort study using International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) diagnosis codes within data from the Office of Statewide Planning and Development in California. We included primiparous women who underwent delivery hospitalization from 2008 to 2012. The primary outcome was the first postpartum hospital encounter with a ICD-9-CM code for depression over a 9-month period after delivery. We examined the cumulative incidence of hospital-based care for postpartum depression by race/ethnicity. Logistic regression was used to estimate relative risk.

Results

The study cohort consisted of 984,167 primiparous women: 314,037 (32%) were non-Hispanic White; 59,754 (6%) were non-Hispanic Black; 150,855 (15%) were non-Hispanic Asian; 448,770 (46%) were Hispanic; and 10,399 (1%) were other races. The cumulative incidence of hospital-based care for postpartum depression was highest for Black women (39; 95% CI = 34–44 per 10,000 deliveries) and lowest for Asian women (7; 95% CI = 5–8 per 10,000 deliveries). Compared with White women, hospital-based care for postpartum depression was more likely to be provided to Black women (OR = 2.3; 95% CI = 1.9–2.7), whereas care was less likely for Asians (OR = 0.4; 95% CI = 0.3–0.5) and Hispanics (OR = 0.8; 95% CI = 0.7–1.0). Similar findings were observed after excluding women with antepartum depression, adjusting for sociodemographic and clinical variables, and stratifying according to care settings.

Conclusion

Compared with White women, hospital-based care for postpartum depression more frequently impacts Black women. Identifying and improving inequities in access to and utilization of mental health care for postpartum women should be a maternal health priority.

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Author information

Authors and Affiliations

  1. Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA

    Avis L. Chan

  2. Department of Anesthesiology, Perioperative, and Pain Medicine (MC:5640), Stanford University School of Medicine, 300 Pasteur Drive, Stanford, CA, 94305, USA

    Nan Guo & Alexander J. Butwick

  3. Department of Epidemiology and Population Health, Stanford University School of Medicine, Stanford, CA, USA

    Rita Popat

  4. Department of Psychiatry, Icahn School of Medicine Mount Sinai, Manhattan, NY, USA

    Thalia Robakis

  5. Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, CA, USA

    Yair Y. Blumenfeld & Elliott Main

  6. California Maternal Quality Care Collaborative, Stanford University School of Medicine, Stanford, CA, USA

    Elliott Main

  7. Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California San Francisco, San Francisco, CA, USA

    Karen A. Scott

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  1. Avis L. Chan
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  2. Nan Guo
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  3. Rita Popat
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Correspondence to Alexander J. Butwick.

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The Stanford University Institutional Review Board approved this study (IRB protocol 14746).

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Chan, A.L., Guo, N., Popat, R. et al. Racial and Ethnic Disparities in Hospital-Based Care Associated with Postpartum Depression. J. Racial and Ethnic Health Disparities 8, 220–229 (2021). https://doi.org/10.1007/s40615-020-00774-y

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  • DOI: https://doi.org/10.1007/s40615-020-00774-y

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