title: Racial discrimination, response to unfair treatment, and depressive symptoms among pregnant black and African American women in the United States.
abstract: OBJECTIVE
  To assess the association between self-reported racial discrimination and prenatal depressive symptoms among black women.
  
  
  METHODS
  Our study population consisted of two cohorts of pregnant women: the Asthma Coalition on Community, Environment, and Social Stress project (ACCESS) and Project Viva. We measured self-reported racial discrimination among black women using a modified Experiences of Discrimination scale (score 0-8). We assessed elevated depressive symptoms (EDS) with the Edinburgh Postnatal Depression Scale (≥13 on a 0-30 scale).
  
  
  RESULTS
  Fifty-four percent of ACCESS and 78% of Viva participants reported experiencing racial discrimination. After adjusting for age, marital status, income, education, and nativity, a 1-U increment in Experiences of Discrimination score was associated with 48% increased odds of EDS (odds ratio, 1.48; 95% confidence interval, 1.24-1.76) for ACCESS participants but was not significantly associated among Viva participants (odds ratio, 1.12; 95% confidence interval, 0.92-1.37). In both cohorts, responding to unfair treatment by talking to others was associated with the lowest odds of EDS.
  
  
  CONCLUSIONS
  Our findings suggest that higher levels of perceived racial discrimination may increase depressive symptoms during pregnancy among U.S. black women. Interventions involving talking to others may aid in reducing the risk of depressive symptoms among black women experiencing higher levels of racial discrimination.
authors.affiliation: Division of Biostatistics and Epidemiology, Department of Public Health, University of Massachusetts Amherst, Amherst, MA, USA. kertel@schoolph.umass.edu
authors.forename: Karen A
authors.initials: KA
authors.lastname: Ertel
authors.forename: Tamarra
authors.initials: T
authors.lastname: James-Todd
authors.forename: Kenneth
authors.initials: K
authors.lastname: Kleinman
authors.forename: Nancy
authors.initials: N
authors.lastname: Krieger
authors.forename: Matthew
authors.initials: M
authors.lastname: Gillman
authors.forename: Rosalind
authors.initials: R
authors.lastname: Wright
authors.forename: Janet
authors.initials: J
authors.lastname: Rich-Edwards
mesh_terms: D000293:Adolescent; D000328:Adult; D001741:Black or African American / Q000523:psychology* / Q000706:statistics & numerical data; D044383:Black People / Q000208:ethnology / Q000523:psychology* / Q000706:statistics & numerical data; D015331:Cohort Studies; D003863:Depression / Q000208:ethnology* / Q000209:etiology / Q000523:psychology; D005260:Female; D006801:Humans; D007407:Interviews as Topic; D016015:Logistic Models; D008404:Massachusetts / Q000453:epidemiology; D008603:Mental Health / Q000208:ethnology*; D011247:Pregnancy; D011287:Prejudice; D011295:Prenatal Care; D015995:Prevalence; D063505:Racism / Q000523:psychology*; D057566:Self Report; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D055815:Young Adult