Tamene Mahader, McKenzie-Sampson Safyer, Ahern Jennifer, Bradshaw Patrick T, Carmichael Suzan L, Mujahid Mahasin S
Division of Epidemiology, University of California, Berkeley School of Public Health, USA.
Division of Neonatology and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine, USA.
Soc Sci Med. 2025 Sep;381:118296. doi: 10.1016/j.socscimed.2025.118296. Epub 2025 Jun 9.
Perinatal mental disorders (PMD) affect birthing persons during pregnancy and postpartum. While racial and ethnic differences are documented, how structural racism influences these differences remains understudied.
To estimate associations between the index of concentration at the extremes (ICE) -a proxy for anti-Black structural racism- and hospital-reported PMD, we analyzed data from a population-based cohort of all California live hospital births, 1997 to 2018 (N = 10,155, 036). PMD outcomes were identified from hospital discharge records throughout the perinatal period. Black-white ICE race-income was calculated and categorized into tertiles from most structurally deprived to privileged at the census tract level. Race and ethnicity-stratified mixed effects log-binomial models estimated the risk of hospital-reported PMD, adjusting for maternal age, education, and insurance, and accounting for clustering by census tract.
In fully adjusted models, Black (aRR = 0.75, 95 % CI = 0.70, 0.81), Asian or Pacific Islander (aRR = 0.78, 95 % CI = 0.72, 0.84), and Hispanic (aRR = 0.65, 95 % CI = 0.62, 0.68) birthing persons living in the most structurally deprived neighborhoods had a reduced risk of hospital-reported PMD. Conversely, white (aRR = 1.09, 95 % CI = 1.05, 1.13) birthing persons living in the most structurally deprived neighborhoods had an increased risk of hospital-reported PMD.
Findings reveal a complex association between racialized economic segregation and hospital-reported PMD. Living in structurally deprived neighborhoods might reflect underdiagnosis for minoritized populations or confer protection, while white counterparts can more readily access mental healthcare elsewhere. Further research may help inform place-based interventions aimed at improving perinatal mental health outcomes.
围产期精神障碍（PMD）会影响孕期和产后的产妇。虽然种族和民族差异已有记录，但结构性种族主义如何影响这些差异仍未得到充分研究。
为了估计极端集中度指数（ICE）——一种反黑人结构性种族主义的代理指标——与医院报告的PMD之间的关联，我们分析了1997年至2018年加利福尼亚州所有医院活产的基于人群队列的数据（N = 10155036）。围产期精神障碍结局是从整个围产期的医院出院记录中确定的。计算了黑人和白人的ICE种族收入，并在人口普查区层面将其分为从结构上最贫困到最优越的三个等级。种族和民族分层的混合效应对数二项式模型估计了医院报告的PMD风险，对产妇年龄、教育程度和保险进行了调整，并考虑了按人口普查区聚类的情况。
在完全调整的模型中，生活在结构上最贫困社区的黑人（aRR = 0.75，95%CI = 0.70，0.81）、亚裔或太平洋岛民（aRR = 0.78，95%CI = 0.
