Skip to main content
PMC home page
NIHPA Author Manuscripts logoLink to NIHPA Author Manuscripts
. Author manuscript; available in PMC: 2023 Apr 1.
Published in final edited form as: Matern Child Health J. 2022 Mar 27;26(4):770–777. doi: 10.1007/s10995-022-03425-2

Prevalence and predictors of symptoms of Perinatal Mood and anxiety Disorders among a sample of Urban Black Women in the South

Natalie D Hernandez 1, Sherilyn Francis 2, Morgan Allen 1, Erica Bellamy 1, Omar T Sims 3, Hyejung Oh 4, Dominique Guillaume 5, Andrea Parker 6, Rasheeta Chandler 7
PMCID: PMC9054427  NIHMSID: NIHMS1800810  PMID: 35344149

Abstract

Objectives

Data are scarce regarding the prevalence and predictors of perinatal mood and anxiety disorders (PMADs) among Black women. The purpose of this study was to examine the prevalence and predictors of symptoms of PMADS among Black women.

Methods

Black women completed a paper survey between August 2019 and October 2019. Binomial logistic regression was employed to examine predictors of PMAD symptoms.

Results

The prevalence of symptoms of PMADs was 56%. A higher proportion of women with PMADs had experienced depression (16% vs. 32%, p = 0.006); physical (18% vs. 31%, p = 0.030), emotional (35% vs. 61%, p = 0.000), or sexual abuse (12% vs. 29%, p = 0.002); and symptoms of depression or anxiety before pregnancy (18% vs. 46%, p = 0.000). After adjusting for socio-demographics in multivariate analysis, experiencing symptoms of depression or anxiety before pregnancy (adjusted odds ratio [aOR] = 3.445, p = 0.001) was positively associated with experiencing symptoms of PMADs, whereas higher levels of self-esteem (aOR = 0.837, p = 0.000) were negatively associated with experiencing symptoms of perinatal mood and anxiety disorders.

Conclusions for Practice

The prevalence of PMAD symptoms among this sample of Black women was alarmingly high. Women who experienced PMADs were more likely to report adverse childhood experiences (e.g., physical, emotional, and/or sexual abuse). By understanding the prevalence of PMADs and the factors associated with these disorders, healthcare professionals can improve diagnosis and treatment rates among this understudied and underserved population.

Keywords: Black women, Perinatal mood and anxiety disorders, Self-esteem, Adverse childhood experiences, Depression and anxiety

Introduction

Perinatal mood and anxiety disorders (PMADs) are the most common complication of pregnancy. An estimated 15–21% of pregnant and postpartum women experience PMADs, with 1 in 7 affected by perinatal depression and 13–21% affected by perinatal anxiety (Fairbrother et al., 2015; Byrnes, 2018). An estimated 60% of women diagnosed with a unipolar depressive disorder during the perinatal period have been diagnosed with preexisting mental health disorders, a majority (80%) of which are anxiety disorders (Kendig et al., 2017; van Heyningen et al., 2017). Black women are more likely to experience PMADs compared to white women. More specifically, a higher prevalence of PMADs has been observed in populations of younger, single, Black women who are publicly insured. More than 40% of Black women experience postpartum depression; this is more than double the rate of the general population (Wisner et al., 2013). Additionally, among women who reported postpartum mental health concerns, Black women were less likely to receive follow-up treatment than white women (Kozhiminannil et al., 2011). The absence of follow-ups may result in underdiagnosis and lack of treatment. Consequently, when postpartum depression goes untreated, it can severely affect the health and wellbeing of the woman and her family (Kozhiminannil et al., 2011; Slomian et al., 2019).

Adverse childhood experiences (ACEs) such as physical, emotional, and sexual abuse have been shown to increase the risk of developing depression and anxiety disorders (Atzl et al., 2019). Higher ACE scores are associated with an increase in mental health challenges such as depression, anxiety, and stress (Atzl et al., 2019). As women transition into motherhood and experience emotional, cognitive, and behavioral stressors, memories of their childhood arise. Traumatic memories are especially salient, resulting in anxiety, stress, and depression (Atzl et al., 2019). Furthermore, ACEs often result in feelings of helplessness, shame, impotence, and worthlessness. Black women continue to be underrepresented within research that examines the impact of ACEs, despite the widespread presence of abuse in Black households. This underrepresentation presents a clear need for further investigation into this field of study.

Similarly, low self-esteem has been associated with mood and anxiety disorders during pregnancy. Black women report higher rates of general anxiety disorder, somatization, and panic disorder (Hall et al., 2019). In addition, Black women are more likely to report higher self-esteem despite prolonged exposure to discrimination and abuse (Twenge & Crocker, 2002)). Black women have historically demonstrated high levels of resilience under oppressive circumstances (Lekan, 2009). Moreover, due to the cultural pressure on Black women to display constant strength, many women hesitate to seek mental health services for fear of scrutiny (Ward & Heidrich., 2009). The overwhelming expectation of strength from Black women can result in underdiagnosis, misdiagnosis, or complete disregard of PMADs within this community.

Several social and structural ideologies impede healthcare resources for Black women because of intersecting demographic factors including their race, gender, class, and age (Lekan et al., 2009; Goodman, 2009). These factors leave women with minimal access to mental health services while in their most emotionally and physically vulnerable state. In lower socio-economic communities, mental health services are scarce, and people struggle with limited transportation, lack of insurance coverage, and cultural stigmas (Goodman, 2009). Consequently, approximately 60% of Black women who experience perinatal mental health challenges do not receive treatment (Chaudron et al., 2010). In 14 non-Medicaid Expansion states, low-income women cannot extend Medicaid coverage beyond 60 days postpartum (Ranji et al., 2019). This limitation is distressing, as 21% of the Black population is on Medicaid (KFF, 2013). Black women who cannot extend Medicaid coverage beyond 60 days postpartum may be left without medical coverage; consequently, postpartum depression and other PMADs may be underdiagnosed and undertreated in this population (Kozhimannil et al., 2011).

Despite the significant impact of PMADs on Black maternal health, their prevalence, impact on healthcare, and costs are understudied (McKee et al., 2020). Increasing the knowledge about PMADs among Black women will elucidate maternal health disparities and thereby reduce the stigma around Black maternal mental health. The immediate goal of this study was to estimate the prevalence of and to examine predictors of symptoms of perinatal mood and anxiety disorders among Black Women. The study’s broader goal is to close the health gap and decrease the maternal mortality rate in Black women.

Methods.

Study Design

We used community-based participatory research (CBPR) approaches to equitably engage community partners throughout the research process, including the identification of the research topic (PMADs), research questions and objectives, Institutional Review Board (IRB) application, informed consent protocols, participant enrollment, research design, and implementation. Additionally, the research team had monthly meetings with community organizations, participated in community events and meetings, hired community members as study personnel, and worked with a community advisory board (CAB) of diverse stakeholders who served and lived in the community. Prior to conduct of the study, the investigators entered the communities of the women who participated, made presentations, and gained community consent to conduct the research (Hernandez et al., 2019). These methods are not often used in mental health research but were important in identifying suitable data collection procedures and in creating/adapting instruments that were culturally sensitive to the target community. For example, study investigators proposed to use Edinburgh Postnatal Depression Scale (EPDS), commonly used tool to screen for depression, but the community thought the survey length was too long so investigators sought to address these concerns with survey redesign and finding measures that would decrease participant burden, improve response rates, and minimally burdensome on the community and community partners.

Black women were recruited from August 2019-October 2019 through word-of-mouth, flyers, and venue-based sampling from community partner organizations. Community-based organizations (CBOs), social service agencies, early education centers, and local health departments served as the primary recruitment sites. For venue-based sampling, we defined “venue” as a place (e.g., CBO), event (e.g., health fair), or activity (e.g., sister circles) where Black women congregated. Venues included baby showers; health fairs; food drives; parenting classes; and sister circles held at libraries, community centers, and CBOs. Venues were initially identified based on recommendations from the CAB and assessments by project staff. In these venues we used passive (i.e. print and electronic recruitment materials) and active (i.e. attend events sponsored by stakeholders) recruitment approaches to target women into the study.

Our research partner communities are located in South Atlanta and are majority Black (88%); have an average household income of $23,243, a 21% unemployment rate, and a 38% poverty rate; and are ranked the lowest on a constellation of neighborhood health and quality of life factors compared to other parts of Atlanta (Hernandez et al., 2019). Additionally, four Black-led CBOs with long-standing ties to the neighborhoods and residents participated in the CAB and served as primary recruitment sites and partners.

Eligibility criteria for inclusion in the study were: (a) self-identify as Black or African American; (b) 18 to 45 years of age; (c) live in Atlanta; (d) speak English; (e) currently pregnant or ≤ 18 months postpartum. Survey questionnaires were related to socio-demographics; adverse childhood experiences; self-esteem; and symptoms of depression or anxiety before pregnancy. All participants gave informed consent prior to their inclusion in the study. Of 358 women, 56 were excluded from the current analysis due to incomplete data on the dependent variable for the current analysis, yielding a sample of 302. The Institutional Review Board at Morehouse School of Medicine approved the study protocol (Protocol # 1,774,461).

Outcomes of Interest

Primary outcomes of interest were the prevalence of and predictors of symptoms of PMADs among Black women. Women who self-reported on a single question experiencing symptoms of depression or anxiety during or after their most recent pregnancy were defined as experiencing perinatal mood and anxiety disorders (Russell et al., 2017).

Independent Variables

Socio-demographics.

Participants self-reported socio-demographics (e.g. current age, age during most recent pregnancy, relationship status, education, employment, insurance status, having a regular health care provider, and annual household income).

Adverse Childhood Experiences.

The Behavioral Risk Factors Surveillance System Adverse Childhood Experiences (ACE) scale (Centers for Disease Control and Prevention [CDC], 2009) was used to assess participants’ exposure to adverse childhood experiences prior to the age of 18. The ACE is a 10-item self-report scale that assesses experiences of childhood verbal or emotional abuse, physical abuse, sexual abuse (i.e. reported that an adult > 5 years older than themselves ever touched them sexually, tried to make the participant touch them sexually, or forced them to have sex). The ACE also assesses whether, during childhood, participants lived with a household member, parent, or adult who had a mental illness, engaged in intimate partner violence, used illicit drugs or was a problem drinker, or was ever incarcerated. Finally, this measure asks whether the participant’s parents were divorced or legally separated. The current analysis only examined childhood physical, emotional, and sexual abuse; living with a household member or adult who had mental illness; and living with a household member or adult who used illicit drugs or was a problem drinker.

Self-Esteem.

The Rosenberg Self-Esteem Scale (Chao et al., 2017) was used to assess self-esteem. The Rosenberg Self-Esteem Scale is a 10-item, self-report, Likert scale (1 = strongly disagree to 4 = strongly agree) that measures global self-worth by measuring both negative and positive feelings about oneself. Higher scores indicate higher self-esteem.

Symptoms of Depression or Anxiety Before Pregnancy.

Women who self-reported experiencing symptoms of depression or anxiety before pregnancy (in response to a single question on the survey) were defined as experiencing symptoms of depression or anxiety before pregnancy (Russell et al., 2017).

Statistical Analysis

Measures of central tendency were used to characterize the sample. Expectation maximization was used to treat values that were infrequently missing on the Rosenberg Self-Esteem Scale. The independent samples t-test and chi-square were used to compare women with and without symptoms of perinatal mood and anxiety disorders on continuous and dichotomous variables. Binomial logistic regression was used to examine predictors of symptoms of perinatal mood and anxiety disorders. The binomial logistic regression model was without multicollinearity. All statistical analyses were conducted using SPSS Version 28.0.

Results

The mean (± standard deviation) age was 26.28 ± 6.06 years, and the mean age during most recent pregnancy was 25.13 ± 6.05 (Table 1). Most women were single (55%) and had an education ≤ high school. An equal number of women were with and without employment (50% vs. 50%, respectively), but the majority were insured (80%), had a regular health care provider (77%), and had an annual household income ≤ $9,999 (54%).

Table 1.

Sample Characteristics

Variables n (%)/ m ± sd
n = 302
Demographics
Current Age 26.28 ± 6.06
Age During Most Recent Pregnancy 25.13 ± 6.05
Relationship Status 166 (55%)
Single 134 (45%)
Married or living with partner
Highest Level of Education Completed 201 (67%)
≤ High School 44 (15%)
Trade/Technical College 57 (19%)
Undergraduate or Graduate/Professional Degree
Employed 151 (50%)
Insured 242 (80%)
Have a Regular Health Care Provider 233 (77%)
Annual Household Income 160 (54%)
≤ $9,999 57 (19%)
$10,000–$19,999 44 (15%)
$20,000–$29,999 19 (6%)
$30,000–$39,999 8 (3%)
$40,000–$49,999 11 (4%)
≥ $50,000
Adverse Childhood Experiences
As a Child:
Lived with a household member or adult who had a mental illness 67 (24%)
Lived with a household member or adult who used illicit drugs or was a problem drinker 86 (29%)
Experienced physical abuse 72 (25%)
Experienced emotional abuse 140 (49%)
Experienced sexual abuse 64 (21%)
Self-Esteem
Self-Esteem Scale Score 32.99 ± 5.36
Before Pregnancy: Symptoms of Depression or Anxiety
Symptoms of depression or anxiety before pregnancy 101 (33%)
Open in a new tab

Emotional abuse was the most frequently reported adverse childhood experience (49%), followed by living with a household member or adult who used illicit drugs or was a problem drinker (29%) and by physical abuse (25%). Nearly one-fourth of participants reported experiencing sexual abuse (21%) and having lived with a household member or adult who had a mental illness (24%). The mean self-esteem score was 32.99 ± 5.36. One-third of women (33%) reported experiencing symptoms of depression or anxiety before pregnancy.

The prevalence of symptoms of PMADs was 56% (Table 2). Compared to women without symptoms of PMADs, a higher proportion of women with symptoms of PMADs reported physical (18% vs. 31%, p = 0.030), emotional (35% vs. 61%, p = 0.000), and sexual (12% vs. 29%, p = 0.002) abuse from a household member or adult as a child and having lived with a household member or adult who had a mental illness (16% vs. 32%, p = 0.006) and used illicit drugs or was a problem drinker (23% vs. 35%, p = 0.02). Furthermore, a higher proportion of women with symptoms of PMADs experienced symptoms of depression or anxiety before pregnancy (46% vs. 18%, p = 0.000). Women without symptoms of PMADs had higher levels of self-esteem (35.40 ± 4.49 vs. 31.13 ± 5.24, p = 0.000). The two groups did not differ in other sociodemographic characteristics.

Table 2.

Bivariate Comparisons Between Black Women Without and With Symptoms of Perinatal Mood and Anxiety Disorders (PMADs)

Without Symptoms PMADs (n = 133, 44%) With Symptoms of PMADs (n = 169, 56%) p-value
n = 302
Demographics
Current age, m ± sd 26.03 ± 6.61 26.44 ± 5.60 0.562
Age During Most Recent Pregnancy, m ± sd 24.78 ± 6.49 25.36 ± 5.70 0.410
Relationship Status, n (%) 73 (56%) 93 (55%) 0.949
Single 58 (44%) 75 (45%)
Married or living with partner
Highest Level of Education Completed, n (%) 94 (71%) 106 (63%) 0.209
≤ High School 17 (13%) 27 (16%)
Trade/Technical College 21 (16%) 36 (21%)
Undergraduate or Graduate/Professional Degree
Employed, n (%) 70 (53%) 81 (48%) 0.380
Insured, n (%) 104 (79%) 137 (81%) 0.717
Have a Regular Health Care Provider, n (%) 101 (77%) 131 (78%) 0.838
Annual Household Income, n (%) 71 (54%) 88 (52%) 0.576
≤ $9,999 27 (21%) 30 (18%)
$10,000–$19,999 19 (14%) 25 (15%)
$20,000–$29,999 5 (4%) 14 (8%)
$30,000–$39,999 5 (4%) 3 (2%)
$40,000–$49,999 5 (4%) 6 (5%)
≥ $50,000
Adverse Childhood Experiences
As a child, n (%):
Lived with a household member or adult who had a mental illness 20 (16%) 47 (32%) 0.006
Lived with a household member or adult who used illicit drugs or was a problem drinker 30 (23%) 56 (35%) 0.020
Experienced physical abuse 22 (18%) 50 (31%) 0.030
Experienced emotional abuse 44 (35%) 96 (61%) 0.000
Experienced sexual abuse 16 (12%) 48 (29%) 0.002
Self-esteem
Self-esteem Scale Score, m ± sd 35.40 ± 4.49 31.13 ± 5.24 0.000
Before Pregnancy: Symptoms of Depression or Anxiety
Symptoms of depression or anxiety before pregnancy, m ± sd 24 (18%) 77 (46%) 0.000
Open in a new tab

After adjusting for socio-demographics in multivariate analysis (Table 3), symptoms of depression or anxiety before pregnancy (adjusted odds ratio [aOR] = 3.445, confidence interval [CI] 1.64–7.23, p = 0.001) were positively associated with symptoms of PMADs, whereas higher levels of self-esteem (aOR = 0.837, CI: 0.78–0.90, p = 0.000) were negatively associated with symptoms of PMADs.

Table 3.

Binomial Logistic Regression Predicting Symptoms of Perinatal Mood and Anxiety Disorders Among Black Women

Variables aOR 95% CI p-values
Symptoms of depression or anxiety before pregnancy (ref: no) 3.445 1.64–7.23 0.001
Self-esteem Scale Score 0.837 0.78–0.90 0.000
As a child lived with a household member or adult who had a mental illness (ref: no) 1.270 0.56–2.87 0.565
As a child lived with a household member or adult who used illicit drugs or was a problem drinker (ref: no) 0.890 0.40–1.98 0.775
As a child experienced physical abuse (ref: no) 0.948 0.38–2.36 0.909
As a child experienced emotional abuse (ref: no) 1.326 0.63–2.79 0.457
As a child experienced sexual abuse (ref: no) 1.921 0.82–4.50 0.135
Open in a new tab

Note. This table presents the model adjusted for age during most recent pregnancy, relationship status, education, employment and insurance status, having a regular health care provider, and income

Discussion

This study estimated the prevalence of and examined predictors of symptoms of PMADs among Black women. Several key findings emerged from the analysis. First, the prevalence of symptoms of PMADs among this sample of Black women was alarmingly high. Our finding of increased perinatal mood and anxiety disorders among Black women is supported in the literature, with reports demonstrating that pregnant Black women experience higher rates and symptom levels of mood disorders (e.g. perinatal depression) even after controlling for socioeconomic variables such as income and education level (Goodman et al., 2013; Howell et al., 2005). Previous studies have reported rates of PMADs among Black women between 7% and 40% (Evans et al., 2015; Liu & Tronick, 2014; Melville et al., 2010; Rich-Edwards et al., 2006). Furthermore, there is substantial evidence that the adverse effects of PMADs are not evenly distributed within the population, with Black women experiencing significantly higher rates of adverse outcomes compared to their white counterparts (Carrington, 2006; Ley et al., 2009; Goodman et al., 2013). This increase in adverse outcomes is partially attributed to the fact that Black women are often underdiagnosed or untreated for perinatal mood and anxiety disorders (Carrington, 2006; Ley et al., 2009; Goodman et al., 2013).

Despite that many women in our study had health insurance and a regular health care provider, over half of them experienced symptoms of PMADs. Several US national healthcare organizations (e.g. American College of Obstetricians and Gynecologists, American College of Nurse-Midwives) recommend screening for mental health conditions (e.g. depression) among perinatal women, emphasizing the need for early identification and referral (Rhodes & Segre, 2013). However, there is severely limited data evaluating whether Black women are being appropriately screened by health care providers during the perinatal period. Previous literature suggests that Black women over-all (including those who are not pregnant) face significant challenges in receiving mental health services. Challenges include delays in appointments and referrals (especially for those with public insurance), fear and mistrust, and implicit biases that are prevalent among mental health providers and health systems (Edge, 2011; Ley et al., 2009; Lacey et al., 2015). Such barriers will remain prevalent during the perinatal period for many Black women.

Our analysis demonstrated that Black women who experienced symptoms of depression or anxiety before pregnancy were 3.445 times more likely to experience symptoms of mood and anxiety disorders during pregnancy. Participants reported experiencing adverse socioeconomic health determinants such as high unemployment rates, high rates of poverty, and exposure to violence as children and adults, all of which have been linked to adverse mental health outcomes. These combined determinants were likely present prior to pregnancy and may have contributed to the development of mood and/or anxiety symptoms before pregnancy, with effects continuing throughout pregnancy. Healthcare providers urgently need to assess and treat depression and anxiety among Black women in general—especially before, during, and after pregnancy, when depression is likely to worsen.

Women who experienced PMADS were more likely to report adverse childhood experiences (e.g., physical, emotional, and/or sexual abuse) compared to women who were not experiencing perinatal mood and anxiety symptoms. In addition, between 25 and 49% of the women in our study reported adverse childhood experiences. Women who reported mood and/or anxiety disorders were also found to have lower rates of self-esteem compared to women who did not report mood and anxiety symptoms (p < 0.05). Research has demonstrated that maltreatment during childhood can be especially detrimental to the development of positive self-esteem during young adulthood, with numerous studies revealing strong connections between psychological maltreatment during childhood and resulting low self-esteem during adolescence and adulthood (Berber Çelik & Odacı, 2020; Karakuş, 2012; Miller-Perrin & Perrin, 2012; Sachs-Ericsson et al., 2010; Shen, 2009; Xiang et al., 2018).

Adverse childhood events and resulting low self-esteem can have sustained mental health effects during pregnancy; this has been demonstrated by women with childhood trauma experiencing higher rates of mood disorders, coupled with higher adverse outcomes with their children, during the first year after delivery (Choi et al., 2017). McDonnell and Valentino (2016) found that adverse childhood experiences prospectively predict levels and changes in depressive symptoms across the perinatal period; these researchers suggested that women with a history of childhood maltreatment may be more vulnerable to higher and more persistent levels of depressive symptoms (McDonnell & Valentino, 2016). Our findings parallel data from these studies, strongly emphasizing the need to address adverse childhood experiences when developing effective approaches for PMADs among Black women. It is imperative for childhood adversity to be included as an important risk category for perinatal mood and anxiety disorders in addition to postpartum mood and anxiety disorders (Kim et al., 2020).

Limitations and Strengths

The study had notable limitations and strengths. The study was cross-sectional in scope and relied heavily on self-report data. It was conducted in a southern state, thus limiting generalizability. Additionally, the study used single item questions to assess participants self-reported PMADs and symptoms of depression and anxiety before their most recent pregnancy, rather than a more reliable instrument for screening depression during pregnancy. Nonetheless, the study successfully recruited a relatively large sample of Black women who were pregnant or 18 months post-partum. The study also used CBPR approaches and was led by a team of Black, Indigenous, and people of color investigators who look like the participants. This race concordance between researchers and participants is important because it ensures that the needs of racial/ethnic minorities and other medically underserved populations are addressed, and that the research will be translated into action with the communities it intends to serve. The research team also prioritized centering the experiences of Black women who served on a CAB and whose experiences with PMADs guided the items used on the survey and how the survey would be implemented. The topic of PMADs, research questions, instrument development, and data analysis were led by local women working in areas of change. Centering their experiences was an opportunity to rethink conventional research practices, thereby identifying pathways that can contribute knowledge associated with PMADs. For example, the participants in the research study were seen as collaborators and not study subjects. The research team valued the study participants as authorities on their own lives and the conditions in those lives that affected their mental health. Study investigators had to adapt standard survey designs to be more culturally and contextually appropriate to engage Black women that are often excluded from research. Community partners that had trust in the community also led data collection. After collecting the data, the research team believed it was important to report findings back to the community and gather their thoughts and opinions, ensuring that study findings were reflective of community experience. Accordingly, the results—and what we can discern from them—represent a co-construction of knowledge. Taking a nontraditional approach within the discipline has the potential for far-reaching influence, both in academia and in women’s lives. The study also used two widely used scales with demonstrated psychometric properties to assess adverse childhood experiences and symptoms of PMADs. This analysis was limited to low-income Black women in Atlanta, so generalization to other Black women in rural Georgia or other racial/ethnic women is restricted.

Black women experience disproportionate rates of PMADs and early life adversity. By understanding the prevalence and associated factors of PMADs, healthcare professionals can potentially improve the diagnosis and treatment rates of these disorders among an understudied and underserved population of women. Childhood adversity is an important category of risk for PMADs and has been linked to negative outcomes like preterm delivery. Further research on ACES can lead to a greater understanding of the prevalence and impact these experiences may have on Black women’s mental health. Additionally, we found that high self-esteem was a protective factor against PMADs in this study; however, a significant portion of women in this study had low self-esteem scores. Self-esteem has been studied as a protective factor for many populations, but few studies have examined self-esteem as a protective factor for Black women. Shared knowledge from healthcare professionals, along with supportive environments, can raise a woman’s self-esteem. Future studies assessing PMADs and self-esteem across the perinatal period are imperative for optimizing both maternal and child health.

Significance.

Based on recent literature, it is already known that untreated PMADs can have severe consequences for the health and wellbeing of the affected woman and her family, including long-term con sequences for the cognitive, emotional, and behavioral development of her child. This study adds to the literature by providing new data on prevalence and risk factors for these disorders among Black women who are understudied. The prevalence of PMADs among this sample of women was higher than national estimates. This study provides practitioners with community-driven relevant data that may inform approaches to combat PMADs.

Funding

Supported in part by the National Center for Advancing Translational Sciences of the National Institutes of Health under Award Number UL1TR002378.

Footnotes

Conflict of interest The authors declare that they have no conflict of interest.

References

  1. Atzl VM, Narayan AJ, Rivera LM, & Lieberman AF (2019). Adverse childhood experiences and prenatal mental health: Type of ACEs and age of maltreatment onset. Journal of Family Psychology, 33(3), 304–314. 10.1037/fam0000510 [DOI] [PubMed] [Google Scholar]
  2. Berber Çelik Ç, & Odacı H (2020). Does child abuse have an impact on self-esteem, depression, anxiety and stress conditions of individuals? International Journal of Social Psychiatry, 66(2), 171–178. 10.1177/0020764019894618 [DOI] [PubMed] [Google Scholar]
  3. Byrnes L (2018). Perinatal mood and anxiety disorders. The Journal for Nurse Practitioners, 14(7), 507–513. 10.1016/j.nurpra.2018.03.010 [DOI] [Google Scholar]
  4. Carrington CH (2006). Clinical depression in African American women: Diagnoses, treatment, and research. Journal of Clinical Psychology, 62(7), 779–791. 10.1002/jclp.20289 [DOI] [PubMed] [Google Scholar]
  5. Chaudron LH, Szilagyi PG, Tang W, Anson E, Talbot NL, Wadkins HI … Wisner KL (2010). Accuracy of depression screening tools for identifying postpartum depression among urban mothers. Pediatrics, 125(3), e609–e617. 10.1542/peds.2008-3261 [DOI] [PMC free article] [PubMed] [Google Scholar]
  6. Chao RCL, Vidacovich C, & Green KE (2017). Rasch analysis of the Rosenberg Self-Esteem Scale with African Americans. Psychological Assessment, 29(3), 329–342. 10.1037/pas0000347 [DOI] [PubMed] [Google Scholar]
  7. Choi KW, Sikkema KJ, Vythilingum B, Geerts L, Faure SC, Watt MH … Stein DJ (2017). Maternal childhood trauma, postpartum depression, and infant outcomes: Avoidant affective processing as a potential mechanism. Journal of Affective Disorders, 211, 107–115. 10.1016/j.jad.2017.01.004 [DOI] [PubMed] [Google Scholar]
  8. Centers for Disease Control and Prevention [CDC]. (2009). Behavioral risk factor surveillance system survey questionnaire. Atlanta, GA: U.S. Department of Health and Human Services [Google Scholar]
  9. Edge D (2011). “It’s leaflet, leaflet, leaflet then, ‘see you later’”: Black Caribbean women’s perceptions of perinatal mental health care. British Journal of General Practice, 61(585), 256–262. 10.3399/bjgp11X567063 [DOI] [PMC free article] [PubMed] [Google Scholar]
  10. Evans MG, Phillippi S, & Gee RE (2015). Examining the screening practices of physicians for postpartum depression: implications for improving health outcomes. Women’s Health Issues, 25(6), 703–710. 10.1016/j.whi.2015.07.003 [DOI] [PubMed] [Google Scholar]
  11. Fairbrother N, Young A, Antony M, & Tucker E (2015). Depression and anxiety during the perinatal period. BMC Psychiatry, 15(206). 10.1186/s12888-015-0526-6 [DOI] [PMC free article] [PubMed] [Google Scholar]
  12. Goodman SH, Dimidjian S, & Williams KG (2013). Pregnant African American women’s attitudes toward perinatal depression prevention. Cultural Diversity and Ethnic Minority Psychology, 19(1), 50–57. 10.1037/a0030565 [DOI] [PubMed] [Google Scholar]
  13. Hall JC, Crutchfield J, & Jones AE (2019). Self-esteem, problem solving, and family coping responses: Determinants and consequences for Black women. Health & Social Work, 44(1), 39–47 [DOI] [PubMed] [Google Scholar]
  14. Hernandez ND, Dorsey J, Glass DM, Pope E, Worthy N, Blasingame E … Dotson Y (2019). Community-engaged approaches to address the ethical concerns of maternal mental health disparities research. Journal of Health Care for the Poor and Underserved, 30(4 Suppl), 12. [DOI] [PMC free article] [PubMed] [Google Scholar]
  15. Howell EA, Mora PA, Horowitz CR, & Leventhal H (2005). Racial and ethnic differences in factors associated with early postpartum depressive symptoms. Obstetrics and Gynecology, 105(6), 1442–1450. 10.1097/01.AOG.0000164050.34126.37 [DOI] [PMC free article] [PubMed] [Google Scholar]
  16. Karakuş Ö (2012). Relation between childhood abuse and self esteem in adolescence. Journal of Human Sciences, 9(2), 753–763. https://www.j-humansciences.com/ojs/index.php/IJHS/article/view/2348 [Google Scholar]
  17. Kendig S, Keats JP, Hoffman MC, Kay LB, Miller ES, Simas TAM … Lemieux L (2017). Consensus bundle on maternal mental health: Perinatal depression and anxiety. Journal of Obstetric, Gynecologic & Neonatal Nursing, 46(2), 272–281. 10.1016/j.jogn.2017.01.001 [DOI] [PubMed] [Google Scholar]
  18. Kim HG, Kuendig J, Prasad K, & Sexter A (2020). Exposure to racism and other adverse childhood experiences among perinatal women with Moderate to severe mental illness. Community Mental Health Journal, 56(5), 867–874. 10.1007/s10597-020-00550-6 [DOI] [PubMed] [Google Scholar]
  19. Kozhimannil KB, Trinacty CM, Busch AB, Huskamp HA, & Adams AS (2011). Racial and ethnic disparities in postpartum depression care among low-income women. Psychiatric Services, 62(6), 619–625. 10.1176/appi.ps.62.6.619 [DOI] [PMC free article] [PubMed] [Google Scholar]
  20. Lacey KK, Parnell R, Mouzon DM, Matusko N, Head D, Abelson JM, & Jackson JS (2015). The mental health of US Black women: The roles of social context and severe intimate partner violence. BMJ Open, 5. 10.1136/bmjopen-2015-008415 [DOI] [PMC free article] [PubMed] [Google Scholar]
  21. Lekan D (2009). Sojourner syndrome and health disparities in African American women. Advances in Nursing Science, 32(4), 307–321 [DOI] [PubMed] [Google Scholar]
  22. Ley CE, Copeland VC, Flint CS, White JS, & Wexler S (2009). Community-based perinatal depression services for African American women: The Healthy Start model. Social Work in Public Health, 24(6), 568–583. 10.1080/19371910802679622 [DOI] [PubMed] [Google Scholar]
  23. Liu CH, & Tronick E (2014). Prevalence and predictors of maternal postpartum depressed mood and anhedonia by race and ethnicity. Epidemiology and Psychiatric Sciences, 23(2), 201–209. 10.1017/S2045796013000413 [DOI] [PMC free article] [PubMed] [Google Scholar]
  24. McDonnell CG, & Valentino K (2016). Intergenerational effects of childhood trauma: evaluating pathways among maternal ACEs, perinatal depressive symptoms, and infant outcomes. Child Maltreatment, 21(4), 317–326. 10.1177/1077559516659556 [DOI] [PubMed] [Google Scholar]
  25. McKee KS, Admon LK, Winkelman TN, Muzik M, Hall S, Dalton VK, & Zivin K (2020). Perinatal mood and anxiety disorders, serious mental illness, and delivery-related health outcomes, United States, 2006–2015. BMC Women’s Health, 23(20), 150. 10.1186/s12905-020-00996-6 [DOI] [PMC free article] [PubMed] [Google Scholar]
  26. Melville JL, Gavin A, Guo Y, Fan MY, & Katon WJ (2010). Depressive disorders during pregnancy: Prevalence and risk factors in a large urban sample. Obstetrics and Gynecology, 116(5), 1064–1070. 10.1097/AOG.0b013e3181f60b0a [DOI] [PMC free article] [PubMed] [Google Scholar]
  27. Miller-Perrin CL, & Perrin RD (2012). Child maltreatment: An introduction. Sage [Google Scholar]
  28. Ranji U, Gomez I, & Salganicoff A (2019). Expanding postpartum Medicaid coverage. Washington DC: Henry J Kaiser Family Foundation Issue Brief [Google Scholar]
  29. Rhodes AM, & Segre LS (2013, August). Perinatal depression: A review of US legislation and law. Archives of Women’s Mental Health, 16(4), 259–270. 10.1007/s00737-013-0359-6 [DOI] [PMC free article] [PubMed] [Google Scholar]
  30. Rich-Edwards JW, Kleinman K, Abrams A, Harlow BL, McLaughlin TJ, Joffe H, & Gillman MW (2006). Sociodemographic predictors of antenatal and postpartum depressive symptoms among women in a medical group practice. Journal of Epidemiology & Community Health, 60(3), 221–227. 10.1136/jech.2005.039370 [DOI] [PMC free article] [PubMed] [Google Scholar]
  31. Russell K, Ashley A, Chan G, Gibson S, & Jones R (2017). Maternal mental health—women’s voices. Royal College of Obstetricians and Gynaecologists [Google Scholar]
  32. Sachs-Ericsson N, Gayman MD, Kendall-Tackett K, Lloyd DA, Medley A, Collins N … Sawyer K (2010). The long-term impact of childhood abuse on internalizing disorders among older adults: The moderating role of self-esteem. Aging and Mental Health, 14(4), 489–501. 10.1080/13607860903191382 [DOI] [PubMed] [Google Scholar]
  33. Shen ACT (2009). Self-esteem of young adults experiencing inter-parental violence and child physical maltreatment: Parental and peer relationships as mediators. Journal of Interpersonal Violence, 24(5), 770–794. 10.1177/0886260508317188 [DOI] [PubMed] [Google Scholar]
  34. Slomian J, Honvo G, Emonts P, Reginster JY, & Bruyère O (2019). Consequences of maternal postpartum depression: A systematic review of maternal and infant outcomes. Women’s Health, 15, 1745506519844044 [DOI] [PMC free article] [PubMed] [Google Scholar]
  35. Twenge JM, & Crocker J (2002). Race and self-esteem: meta-analyses comparing whites, blacks, Hispanics, Asians, and American Indians and comment on Gray-Little and Hafdahl (2000). Psychological Bulletin, 128(3), 371–408 [DOI] [PubMed] [Google Scholar]
  36. van Heyningen T, Honikman S, Myer L, Onah MN, Field S, & Tomlinson M (2017). Prevalence and predictors of anxiety disorders amongst low-income pregnant women in urban South Africa: a cross-sectional study. Archives of Women’s Mental Health, 20(6), 765–775. 10.1007/s00737-017-0768-z [DOI] [PMC free article] [PubMed] [Google Scholar]
  37. Ward EC, & Heidrich SM (2009). African American women’s beliefs about mental illness, stigma, and preferred coping behaviors. Research in Nursing & Health, 32(5), 480–492. 10.1002/nur.20344 [DOI] [PMC free article] [PubMed] [Google Scholar]
  38. Wisner KL, Sit DK, McShea MC, Rizzo DM, Zoretich RA, Hughes CL … Hanusa BH (2013). Onset timing, thoughts of self-harm, and diagnoses in postpartum women with screen-positive depression findings. JAMA Psychiatry, 70(5), 490–498. 10.1001/jamapsychiatry.2013.87 [DOI] [PMC free article] [PubMed] [Google Scholar]
  39. Xiang Y, Wang W, & Guan F (2018). The relationship between child maltreatment and dispositional envy and the mediating effect of self-esteem and social support in young adults. Frontiers in Psychology, 9, 1054. 10.3389/fpsyg.2018.01054 [DOI] [PMC free article] [PubMed] [Google Scholar]

RESOURCES