title: Racial and ethnic differences in the relationship between antenatal stressful life events and postpartum depression among women in the United States: does provider communication on perinatal depression minimize the risk?
abstract: Multi-state population-based studies exploring the racial/ethnic differences in the prevalence and correlates of postpartum depression (PPD), which affects 10-20% of women in the US, are rare. The aim of this study was to examine the racial/ethnic disparities in the relationship between antenatal stressful life events and PPD among US women and to explore whether antenatal health care provider communication on perinatal depression was associated with a lower risk.
  
  
  
  Data from the 2009-2011 Pregnancy Risk Assessment Monitoring System (PRAMS) were used. For each racial/ethnic group, the distribution of PPD was compared according to different levels of the stressors and socio-demographic, pre-pregnancy, antenatal, delivery, and neonatal characteristics. Multivariable logistic regression analyses were performed with PPD as the outcome and all variables that were significant in bivariate analyses as predictors.
  
  
  
  Eleven percent of 87,565 women met the criteria for PPD with the prevalence ranging from 7.9% among Asian/Pacific Islanders to 14% among American Indian/Alaska Natives. Irrespective of race/ethnicity, having many bills to pay and having more than usual arguments with husband/partner were risk factors for PPD. Among non-Hispanic black (NHB) women, having a husband/partner who did not want the pregnancy was associated with PPD (adjusted odds ratio [aOR]: 1.47; 95% confidence interval [CI]: 1.14, 1.90), and among non-Hispanic whites (NHWs), drug/drinking problems of someone close was associated with PPD (aOR: 1.37; 95% CI: 1.21, 1.55). Provider communication was inversely associated with PPD among NHWs (aOR: 0.77; 95% CI: 0.69, 0.85) and NHBs (aOR: 0.74; 95% CI: 0.60, 0.93).
  
  
  
  The protective effect of provider communication on PPD suggests the benefit of a simple conversation about perinatal depression during antenatal care. Furthermore, risk factors for PPD varied by race/ethnicity suggesting that these vulnerabilities should be taken into consideration in identifying women at-risk for PPD.
authors.affiliation: a Department of Epidemiology , Robert Stempel College of Public Health & Social Work, Florida International University , Miami , FL , USA.
authors.forename: Soumyadeep
authors.initials: S
authors.lastname: Mukherjee
authors.affiliation: a Department of Epidemiology , Robert Stempel College of Public Health & Social Work, Florida International University , Miami , FL , USA.
authors.forename: Kristopher
authors.initials: K
authors.lastname: Fennie
authors.affiliation: b Department of Psychology , College of Arts and Sciences, Florida International University , Miami , FL , USA.
authors.forename: Stefany
authors.initials: S
authors.lastname: Coxe
authors.affiliation: a Department of Epidemiology , Robert Stempel College of Public Health & Social Work, Florida International University , Miami , FL , USA.
authors.forename: Purnima
authors.initials: P
authors.lastname: Madhivanan
authors.affiliation: a Department of Epidemiology , Robert Stempel College of Public Health & Social Work, Florida International University , Miami , FL , USA.
authors.forename: Mary Jo
authors.initials: MJ
authors.lastname: Trepka
mesh_terms: D000328:Adult; D015897:Comorbidity; D019052:Depression, Postpartum / Q000453:epidemiology* / Q000208:ethnology; D005260:Female; D006801:Humans; D016015:Logistic Models; D011203:Poverty; D011247:Pregnancy; D011295:Prenatal Care / Q000523:psychology*; D015995:Prevalence; D011369:Professional-Patient Relations; D012307:Risk Factors; D018454:Spouses / Q000523:psychology; D013315:Stress, Psychological / Q000453:epidemiology* / Q000208:ethnology; D014481:United States / Q000453:epidemiology; D055815:Young Adult
keywords: PRAMS; Racial and ethnic; postpartum depression; provider communication; stressful life events