Structural racism, pandemic stressors associated with postpartum depression and anxiety among Black individuals

New research explored how structural and interpersonal racism and the novel coronavirus (COVID-19) has contributed to postpartum anxiety and depression in Black individuals who give birth.

The study was published in JAMA Psychiatry, and conducted by researchers in the Intergenerational Exposome Program of Children’s Hospital of Philadelphia and the Perelman School of Medicine at the University of Pennsylvania. Researchers sought to assess how the postpartum mental health of Black birthing individuals has been affected with the emergence of the COVID-19 pandemic that has disproportionately impacted Black communities.

According to the study, 151 Black pregnant participants at the average age of 30 years old were engaged from urban university medical center prenatal clinics. They were evaluated from pregnancy (April 17 to July 8, 2020) through the early postpartum period (August 11, 2020 to March 2, 2021). Participants were recruited via email and completed two online surveys. Researchers found that perinatal syndemic exposure was associated with negative postpartum mental health outcomes. In addition, more negative COVID-19 experiences, and more experiences of racism were associated with increased risk for postpartum depression and anxiety.

The study revealed that the association between higher negative COVID-19 pandemic experiences and postpartum depression may be influenced by experiences of interpersonal racism and systemic racism. Negative COVID-19 experiences were found to be associated with a greater likelihood of screening positive for depression only at higher levels of systemic racism and interpersonal racism, according to the research. Negative COVID-19 experiences were also associated with anxiety only at higher levels of interpersonal racism. Overall, 29 percent of the participants met screening criteria for postpartum depression and 13 percent for postpartum anxiety, the study found.

Researchers said more studies are needed to address how systemic racism perturbs biobehavioral pathways to magnify associations between acute stressors and mental health. This can inform the development of effective, culturally informed preventive interventions to improve the postpartum mental health of Black individuals, according to the study.

“The COVID-19 pandemic has had a disproportionate impact on the Black community, in large part due to structural racism and its impact on the social determinants of health, and our study shows this impact extended to the effects on the postpartum period,” said study first author Wanjikũ  F.M. Njoroge, MD, medical director of the Young Child Clinic, associate chair of Diversity, Equity, and Inclusion in the Department of Child and Adolescent Psychiatry and Behavioral Sciences, and PolicyLab Faculty at Children’s Hospital of Philadelphia in a statement. “Not only does this research point to an urgent need for policies that address the pandemic’s mental health effects on Black pregnant people, but it also highlights the need to follow the babies and toddlers of these people through early childhood to understand any potential impacts on their development and intervene where necessary.”