How We Heal: Exploring Culturally Responsive Behavioral Health Services to Address Perinatal Depression and Perceived Stress Among Black Women

Background and Purpose: Evidence suggests perinatal depression disproportionately impacts Black women in the United States. Black women experience a greater risk of perinatal depression due to lifetime psychosocial stressors including racism and discrimination. However, Black women are underrepresented in the utilization of behavioral health services. Guided by the integration of the Reproductive Justice Framework, Black Feminist Theory, and Radical Healing Framework, this study addresses the following research aims: 1) Explore how experiences of interpersonal and structural racism influence perinatal depression and perceived stress among pregnant and postpartum Black women; 2) Assess gaps and opportunities within perinatal behavioral health services through examining racial differences in patient characterization across pregnancy; and 3) Explore pregnant and postpartum Black women’s preferences and priorities for culturally responsive behavioral healthcare addressing perinatal depression and perceived stress.

Methods: The study uses a convergent parallel mixed methods design. Among a sample of pregnant and postpartum women (N = 18), qualitative, phenomenological methodology is used to explore how experiences of racism and discrimination influence perinatal depression and stress, and to explore culturally responsive behavioral health services to address perinatal depression and stress. The mean age of participants was 29.2 years (SD = 2.5). Using quantitative data from the 2023 Ohio Pregnancy Assessment Survey, a representative survey of women who gave birth in Ohio, a cross-sectional survey design was employed to assess racial differences in behavioral health screening, diagnosis, and symptom management across the preconception, antenatal, and postpartum periods of pregnancy. Among a sample of postpartum women surveyed two to four months after delivery (N = 2,479), a series of logistic regressions were conducted to assess these differences. Majority of respondents were between 30 – 34 years old (33.6%).

Results: There were four overarching themes that emerged from the qualitative data including 1) experiences of racism and discrimination in obstetric care; 2) everyday experiences of racism and discrimination; 3) impacts of racism and discrimination on mental health; and 4) preferences for culturally responsive maternal mental healthcare. The results of the quantitative analyses revealed that compared to White women, Black women had lower odds of receiving a mental health screening (OR 0.67; 95% CI 0.51, 0.87), depression diagnosis (OR 0.35; 95% CI 0.35, 0.48), and healthcare visit for depression and anxiety before becoming pregnant (OR 0.41; 95% CI 0.30, 0.56). In addition, Black women had lower odds of receiving a depression diagnosis during pregnancy (OR 0.58; 95% CI 0.42, 0.82) and being prescribed medications for depression and anxiety postpartum (OR 0.70; 95% CI 0.52, 0.93). There were no significant relationships found between race and receiving mental health screening and counseling services during the antenatal and postpartum periods of pregnancy. Data were integrated using a contiguous approach that informed the development of a conceptual model.

Conclusions and Implications: The results of the study provide insights into how experiences of racism and discrimination influence mental health symptoms, patient preferences for culturally responsive behavioral health services, and the need for strategies that improve the accessibility of perinatal behavioral health services across the perinatal period.