Effects of Discrimination and Race-Related Stress on Postpartum Depression Among Black Mothers

Background and Purpose: Prior literature has established a robust association between discrimination, race-related stress, and increased risk of mental illnesses in adulthood (e.g., Mekawi et al., 2023). Historically, however, minoritized populations have been underrepresented in perinatal depression and anxiety research, and the relationship between racialized trauma and perinatal mental health outcomes remains under-characterized. By contrast, there have been well documented associations between racism and other perinatal health outcomes, particularly infant and maternal mortality (Villarosa, 2018). Given the vast perinatal health disparities that exist in the United States, we wanted to characterize the role of race-related stress (RRS) in the development of postpartum depression (PPD).

This study had two aims. First, we wanted to know whether RRS is associated with PPD. Second, we wanted to know whether mothers who were discordant on self-reported RRS and discrimination experiences were affected differently by PPD.

Methods: Data for this analysis came from the Early Life Adversity and Biological Embedding (eLABE) and Risk for Developmental Precursors of Mental Disorders study, which recruited 398 mother-infant dyads during pregnancy. The analytic sample size for these analyses was 111 Black mothers. Measures included the following: Index of Race-Related Stress – Brief Version (Utsey, 1999), the Everyday Discrimination Scale (Kim et al., 2014), the Edinburgh Postnatal Depression Scale (Cox et al., 1987), and a previously derived latent factor for social disadvantage (see Lean et al., 2022). We performed a linear regression with postpartum depression as the outcome variable. We then conducted ANOVAs on differences among RRS and discrimination categories and PPD.

Results: Discrimination was significantly associated with PPD (B = 0.24, p = .01, R2= 0.15). Mothers who scored high on both RRS and discrimination differed significantly by each of the subsequent three categories on depression symptoms (p = 0.00, n2 = .16).

Conclusions and Implications: The psychological impact of experiencing discrimination is not homogeneous. These findings support prior work which has established experiences of discrimination as a risk factor for postpartum depression. Importantly, however, race-related stress appears to be acting as a phenomenon in its own right, with its own set of predictors, correlates, and consequences. Here, we demonstrate that while race-related stress and discrimination both affect postpartum depression, race-related stress appears to be acting more as a comorbid condition rather than a predictor. Future work should explore the downstream effects of maternal race-related stress, particularly as it impacts infant development.