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Racial/Ethnic Disparities in Hospital Admission for Postpartum Depression


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Racial and Ethnic Disparities in Hospital Admission for Postpartum Depression

Avis Chan1, Nan Guo2, Rita Popat1, Yair Blumenfeld3, Alexander Butwick2

Department of Health Research and Policy (Division of Epidemiology)1, Department of Anesthesiology, Perioperative and Pain Medicine2,

Department of Obstetrics and Gynecology (Maternal Fetal Medicine)3, Stanford University School of Medicine, California, USA



Postpartum depression (PD) affects 13-19% women within 12 months after delivery [1].

Although racial and ethnic differences have been reported for adverse pregnancy outcomes (e.g. pre-eclampsia, preterm birth) [2], it is unclear whether disparities exist in the  risk of hospital care for PD.


To examine if racial/ethnic disparities exist in the risk of hospital-based care for PD in large contemporary obstetric cohort in California, USA.


•A population-based retrospective cohort study of primiparous women who had hospital admissions for PD in California between 2008-2012.
•We excluded: women with non-hospital births, age <15 or >50 years, births <22 or ≥43 weeks of gestation, and missing dates of admission.
•PD was identified by an ICD-9-CM code for depression (296.2x, 296.3x, 296.82, 296.90, 300.4, 309.0, 309.1, 309.28, 311) associated with a postpartum hospital encounter upto 9 months after delivery.
•Race and ethnicity data were sourced from linked birth records or maternal hospital discharge data.
•The cumulative incidence of PD was calculated for women with a principal +/- secondary diagnosis code for PD.
•Univariate logistic regression was used to examine the risk of PD in different racial/ethnic groups compared to non-Hispanic white women.


•The overall cumulative incidence for postpartum hospital care for PD as a principal diagnosis only and as a principal or secondary diagnosis were 15.9 and 53.6 per 10,000 deliveries, respectively.

•Non-Hispanic black women had the highest cumulative incidence while non-Hispanic Asian women had the lowest (Table).
•The risk of PD was attenuated for non-Hispanic black women (Table) when PD was classified using a principal or secondary diagnosis code.


•Our findings suggest that racial/ethnic disparities exist in hospital care for PD, with non-Hispanic black  women incurring the highest risk of PD.

•Further research is needed to determine causative factors and identify ways to improve mental health care and support for black women after delivery.


[1] Annu Rev Clin Psychol. 2013;9:379-407.

[2] Obs Gynecol. 2015;126(6):e130-4.

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