Racial, ethnic, and neighborhood disparities in diagnosis of perinatal psychiatric illness

Abstract

Background

Rates of maternal morbidity and mortality are a global health crisis, and perinatal psychiatric illness is the most common morbidity in pregnancy. Racial, ethnic, and socioeconomic disparities in perinatal psychiatric illness contribute to disparities in maternal morbidity and mortality. There is limited data on diagnosis rates across race/ethnicity and neighborhood deprivation.

Objective

To identify prevalence of perinatal psychiatric illness diagnosis and determine differences based on race, ethnicity, and neighborhood deprivation.

Study design

This cross-sectional study included women who gave birth between 2020 and 2023 at a Houston Methodist hospital. Houston Methodist is a hospital system serving the greater Houston area. During the study period, 20 015 women received perinatal care from and delivered at a Houston Methodist system hospital. The first birth per individual was used for analyses. 2 women were removed due to missing data. A final 20 013 were eligible for inclusion. Variables of interest included neighborhood deprivation, defined as a score on the Area Deprivation Index, a validated socioeconomic measure, and self-reported race and ethnicity as reported in electronic health record. The main a priori outcome was any psychiatric illness diagnosed between estimated date of conception and 3 months postpartum.

Results

The sample was distributed across race and ethnicity, with 2 098 (10.5%) Asian, 2 893 (14.5%) Black, 5 208 (26.0%) Hispanic White, 8 218 (41.1%) non-Hispanic White, and 1596 (8.0%) other. Mean age of women included in our analyses was 30.50 years (SD= 5.33). Perinatal psychiatric illness was diagnosed in 19.1% of patients. Non-Hispanic White women were diagnosed at the highest rates (24.8%), while Asian women were diagnosed at the lowest rates (9.1%). Rates trended higher as area deprivation increases across the total sample. However, this trend only held for non-Hispanic White women, for whom higher deprivation has significantly higher prevalence rates than lower deprivation (30.6% vs 18.7%, P<.001).

Conclusions

One in five women in our study was diagnosed with perinatal psychiatric illness. Our stratified findings were inconsistent with previous reports of higher symptom burden in women of color. Neighborhood deprivation has differential impact depending on race/ethnicity, highlighting the importance of accounting for sociocultural variables when analyzing prevalence.