Investigating Postpartum Depression In First-time Mothers Using Prams Data: Race, Ethnicity, Age, And Geographic Analysis

• By: BOMPELLI, Anusha (United States)
• Co-author(s): Dr Anusha Bompelli (Graduate Studies in Social and Administrative Pharmacy, University of Minnesota, Minneapolis, United States)
  Dr Angeline Carlson (Graduate Studies in Social and Administrative Pharmacy, University of Minnesota, Minneapolis, United States)
  
• Abstract:

  Background: Postpartum depression (PPD) is a significant public health concern that affects a substantial number of new mothers. PPD is more than mere psychological distress; it is emerging as a silent epidemic profoundly impacting mothers and families after childbirth and echoing through generations. While strides in understanding maternal mental health during the prenatal and postnatal period have been made, a knowledge gap exists in understanding underlying demographic factors that play a role in the experience of PPD particularly for first-time mothers. Additionally, the need for nationally representative samples versus region-specific studies remains an open question, as regional variations and state-level policies play a crucial role in shaping maternal mental health disparities.
  
  Objective: The objective of this study is to investigate self-reported postpartum depression rates using a geographically representative database that includes information on race/ethnicity, age, and geographic location among first-time mothers across U.S. states, the District of Columbia, and Puerto Rico to examine the association between these demographic variables and PPD.
  
  Methods: This cross-sectional study included survey data from the 2016-2021 Pregnancy Risk Assessment Monitoring System (PRAMS) for 43 reporting entities (41 U.S. states, the District of Columbia, and Puerto Rico). Study records were included if 1) the birth was documented as a live first birth, and 2) there was no evidence of the mother reporting depression or anxiety prior to or during the pregnancy. Two cohorts were defined – mothers identified with PPD using PRAMS survey questions and those without documented PPD. PRAMS data reports mothers aged ≤ 17 as 17, and ≥ 45 as 45. Chi-square and logistic regression were carried out using RStudio 2023 (R Foundation for Statistical Computing). P-values <0.05 were considered a priori as statistically significant. Geographical differences were plotted using RStudio to create a choropleth map of reported PPD rates.
  
  Results: 62,599 mothers met inclusion criteria; 6,118 (9.77%) with PPD and 56,481 (90.23%) without PPD. Chi-square analyses revealed significant disparities between cohorts on race/ethnicity and age (p<0.001) with mothers aged ≤25 of non-White racial groups having higher prevalence rates (Non-Hispanic Asian=17.7%, Non-Hispanic Hawaiian/other pacific islander=14.7%, Non-Hispanic Black=14.3%, Non-Hispanic Alaska Native=14%, Non-Hispanic American Indian=13.1%, Non-Hispanic White=6.9%, Non-Hispanic other/multiple racial groups=10%, and Hispanic in any racial group=9.1%). A logistic regression model including age and race/ethnicity found the interaction between the two significant (p<0.05). Non-Hispanic Asian mothers aged 26-30 and 36-40 were each 2.3 times more likely to report PPD following their first live birth. Geographic mapping of reported PPD prevalence rate by state identified three states with prevalence rates >15% (Mississippi=17.81%; Arkansas=15.38%; Alabama=15.23%), and one state with rates <5% (Arizona=4.93%).
  
  Conclusion: These findings suggest that age and race/ethnicity are factors in the reporting of PPD with non-White mothers in younger age groups reporting the highest rates following their first live birth. There are also large variations in prevalence rates by state. Healthcare policies and resources targeting PPD should consider age, race, ethnicity, and U.S. geographic location in developing interventions and support services for first-time mothers.