Disaggregating Race and Ethnicity Data in Prenatal depression diagnosis may help assess real disease burden accurately: JAMA

Recent study investigates treatment-initiation disparities in prenatal depression (PDD) among racially and ethnically diverse pregnant individuals, emphasizing the impact of various social and cultural factors that can hinder engagement in mental health treatment. It identifies that Black, Hispanic, and Asian pregnant individuals often experience higher severity of depression symptoms but are less likely to pursue treatment, an issue compounded by clinical underdiagnosis. By examining a broad cohort, the research aims to clarify the nuances in PDD experiences across different racial and ethnic groups.

Critical Roles of Attitudes and Segregation

Central to the findings is the suggestion that attitudes towards mental illness, a lack of cultural competence in healthcare settings, and factors such as residential segregation play critical roles in contributing to disparities in treatment engagement. For example, stigma associated with mental illness can deter individuals from seeking help, while healthcare providers' cultural awareness influences the perceived accessibility and relevance of treatment options. Residential segregation may further entrench these disparities, limiting access to healthcare resources and culturally competent providers, thus affecting engagement levels. The study utilizes a population-based cross-sectional methodology, focusing on members of Kaiser Permanente Northern California (KPNC) from 2013 to 2019 who had self-reported race and ethnicity data. This broad and diverse membership is a key strength, permitting a more comprehensive look at diverse ethnic experiences and the intersectionality of race, ethnicity, and socioeconomic factors in the context of prenatal depression. Participants included a wide range of racial and ethnic groups, allowing for stratified analyses that elucidate significant within-group differences that may have been overlooked in previous research that aggregated these populations.

Outcomes and Undiagnosed Depression Insights

Key outcomes were identified using the International Classification of Diseases coding and Patient Health Questionnaire-9 (PHQ-9) scores. The study defined PDD and severe symptoms through standardized metrics. The examination of undiagnosed depression offers crucial insights, revealing that a significant number of individuals with high PHQ-9 scores did not have an official diagnosis, highlighting an alarming trend where mental health needs go unrecognized among specific racial and ethnic subgroups.

Importance of Disaggregated Data

The analysis also demonstrates the importance of disaggregating data among Asian and Hispanic groups, revealing significant internal heterogeneity. Variants such as nativity status (e.g., U.S.-born versus non-U.S.-born individuals) and levels of acculturation appear to contribute substantially to differences in depression symptoms and the likelihood of diagnosis. For instance, understanding these differences can facilitate tailored approaches to screening and treatment, thereby promoting better health outcomes among specific populations. However, a limitation noted in the study is its potential lack of generalizability to uninsured pregnant individuals. While the KPNC setting provides strong data regarding those with insurance coverage, the findings may not accurately represent the experiences of uninsured individuals who may face additional barriers to care, such as financial constraints and lower access to mental health resources.

Need for Interventions and Future Research

Ultimately, the study underscores the urgent need for interventions to increase cultural competence in healthcare and to address systemic barriers, including those sparked by societal attitudes towards mental illness. Future research is essential to explore these themes in more depth, promoting equitable maternal mental health care across diverse populations.

Key Points

- Treatment-initiation disparities in prenatal depression (PDD) are particularly pronounced among racially and ethnically diverse pregnant individuals, with Black, Hispanic, and Asian groups reporting higher symptom severity but lower treatment engagement, often due to clinical underdiagnosis. - Attitudes towards mental illness, cultural competence of healthcare providers, and residential segregation are critical barriers affecting the willingness and ability of individuals from diverse backgrounds to engage in mental health treatment.

- A population-based cross-sectional methodology was utilized, analyzing data from Kaiser Permanente Northern California (KPNC) between 2013 and 2019, allowing for a robust examination of diverse racial and ethnic experiences related to prenatal depression.

- The study reveals that many individuals with high Patient Health Questionnaire-9 (PHQ-9) scores for depression were undiagnosed, indicating a significant gap in recognizing mental health needs among various racial and ethnic subpopulations.

- The findings highlight the necessity of disaggregating data within Asian and Hispanic groups, as factors such as nativity status and acculturation levels significantly influence both depression symptoms and likelihood of diagnosis, suggesting the need for tailored screening and treatment strategies.

- There is a recognized limitation in generalizability regarding uninsured pregnant individuals, as the study's findings may not reflect their experiences due to potential additional barriers related to financial constraints and restricted access to mental health resources.

Reference –

Kendria Kelly-Taylor et al. (2025). Prenatal Depression And Symptom Severity By Maternal Race And Ethnicity. *JAMA Network Open*, 8. https://doi.org/10.1001/jamanetworkopen.2025.0743