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Ethnicity, psychosocial risk, and perinatal depression—a comparative study among inner-city women in the United Kingdom

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Abstract

Objective

The objective of this study was to explore the relationships between psychosocial risk, ethnicity, and prevalence of depressive symptoms in the perinatal period. A comparative study among a cohort of Black Caribbean and White British women was undertaken.

Methods

A predominantly inner-city sample (N=301) was recruited at a large teaching hospital and at community antenatal clinics in the north of England. Women were screened for depressive symptoms in the last trimester of their pregnancy and 6 weeks their delivery with the Edinburgh Postnatal Depression Scale (EPDS).

Results

Black Caribbean women reported higher levels of psychosocial risk for perinatal depression compared with their White British counterparts. They were more socially and socioeconomically deprived. To elaborate, the Black Caribbean women were more likely to live in the most deprived areas of the city (P=.002), to live on benefits (P=.014), and to be lone parents (P<.0001). However, despite higher levels of deprivation and other known risks for perinatal depression, Black Caribbeans were not more likely than White British women to score above the threshold on the EPDS (cutoff point, 12/13).

Conclusions

During and after pregnancy, approximately a quarter of the Black Caribbean women in this study recorded symptom scores suggestive of clinically significant morbidity. These findings are not reflected in clinical practice, suggesting that there may be substantial levels of undetected and untreated perinatal depression among this ethnic group. This has potentially serious implications not only for the mental health and well-being of individual women but also for their families.

Introduction

Perinatal depression is a serious public health issue that carries a significant disability burden [1], [2]. For some women, depression during pregnancy and in the early postnatal period heralds the onset of a recurrent and enduring mental illness [3], [4] and an increased risk of committing suicide [5], [6], [7]. Depression may also adversely affect the physical, cognitive, and psychologic development of children [8], [9], [10], [11], [12] and trigger depression in fathers [13], [14]. Although rates vary according to the strictness of criteria and screening methods [15], [16], [17], perinatal depression affects approximately 15% of childbearing women worldwide [4]. However, there is a growing body of evidence that Black women, particularly those from deprived backgrounds, may be at increased risk for onset but less likely to receive care and treatment [18], [19], [20], [21], [22].

Known psychosocial risks for perinatal depression include (a) low socioeconomic status, (b) lack of social support and isolation, (c) poor educational attainment, (d) lone parenthood, and (e) having a history of mental illness [21], [23], [24], [25], [26]. Despite high levels of these factors among Black Caribbean women in the United Kingdom [27] and research consistently linking ethnicity, deprivation, and poorer mental health [28], [29], [30], anecdotal evidence from midwives, health visitors, and mental health professionals in primary care suggests that Black Caribbean women are less likely than women from other ethnic groups to be diagnosed with perinatal depression. Reasons for this remain unclear because, unlike for South Asians, there has been limited research into perinatal depression among Black Caribbean women in the United Kingdom.

Therefore, a comparative study among Black Caribbean and White British women in the north of England was undertaken to examine the relationships between ethnicity, psychosocial factors, and prevalence of perinatal depressive symptoms.

Section snippets

Sample

A predominantly inner-city sample was recruited at antenatal clinics in the community and at a large teaching hospital. The participants were included only if they identified themselves as being of Black Caribbean or White British origin, based on the ethnic categories used by the National Health Service [31]. Although there is considerable diversity among Black Caribbean women, there was relative homogeneity in this subsample. Most (80%, n=80) were born in the United Kingdom, and, of those,

Antenatal findings

Of 429 women (White British, n=297; Black Caribbean, n=132) who were approached consecutively, 200 White British women and 101 Black Caribbean women consented to participate in the study, yielding an overall response rate of 70% (67.3% White British women, 76.5% Black Caribbean women). Table 1 shows that, based on the overall deprivation indices of the Department of the Environment, Transport, and the Regions [39], Black Caribbean women were significantly more likely to live in the most

Discussion

Up to a third of the White British women and a quarter of the Black Caribbean women in this study had potentially clinically significant depression at some point in the perinatal period. Although more socially and materially deprived than the White British women living in the same area, the Black Caribbean women in this study were not more likely to record above-threshold depression scores as measured by the EPDS. This is reflected by the fact that Black Caribbean women were significantly less

Acknowledgments

I thank the women who took part in this study and the staff of the Maternity Services Department of the Central Manchester Healthcare National Health Service Trust who facilitated the research, particularly the following: Dr. Michael Maresh, Anne Scott, and Karen Connolly. I also thank Dr. Angelika Wieck (Consultant Psychiatrist, Mother and Baby Unit, Wythenshawe Hospital, Manchester) and Dr. David Reeves (University of Manchester) for clinical and statistical advice.

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  • Cited by (0)

    This research was jointly funded by the National Health Service Executive North–West Research and Development Fund and the University of Salford.

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