Discrimination and perinatal depressive symptoms: The protective role of social support and resilience

Claire Masters; Jessica B Lewis; Ashley Hagaman; Jordan L Thomas; Rogie Royce Carandang; Jeannette R Ickovics; Shayna D Cunningham

doi:10.1016/j.jad.2024.03.039

Discrimination and perinatal depressive symptoms: The protective role of social support and resilience

J Affect Disord. 2024 Jun 1:354:656-661. doi: 10.1016/j.jad.2024.03.039. Epub 2024 Mar 12.

Authors

Claire Masters¹, Jessica B Lewis², Ashley Hagaman³, Jordan L Thomas⁴, Rogie Royce Carandang⁵, Jeannette R Ickovics⁶, Shayna D Cunningham⁷

Affiliations

¹ Department of Health Policy and Management, Yale School of Public Health, New Haven, CT 06510, USA.
² Department of Internal Medicine, Yale School of Medicine, New Haven, CT 06519, USA.
³ Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT 06510, USA; Center for Methods in Implementation and Prevention Sciences, Yale University, New Haven, CT 06510, USA.
⁴ Department of Psychology, University of California, Los Angeles, CA 90095, USA.
⁵ Department of Public Health Sciences, University of Connecticut School of Medicine, Farmington, CT 06030, USA.
⁶ Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT 06510, USA.
⁷ Department of Public Health Sciences, University of Connecticut School of Medicine, Farmington, CT 06030, USA. Electronic address: scunningham@uchc.edu.

PMID: 38484882
DOI: 10.1016/j.jad.2024.03.039

Abstract

Background: Discrimination is an important social determinant of perinatal depression; however, evidence is limited regarding modifiable social and psychological factors that may moderate this association. We examined whether social support and resilience could protect against the adverse effects of discrimination on perinatal depressive symptoms.

Methods: Pregnant people (N = 589) receiving Expect With Me group prenatal care in Nashville, TN and Detroit, MI completed surveys during third trimester of pregnancy and six months postpartum. Linear regression models tested the association between discrimination and depressive symptoms, and the moderating effects of social support and resilience, during pregnancy and postpartum.

Results: The sample was predominantly Black (60.6 %), Hispanic (15.8 %) and publicly insured (71 %). In multivariable analyses, discrimination was positively associated with depressive symptoms during pregnancy (B = 4.44, SE = 0.37, p ≤0.001) and postpartum (B = 3.78, SE = 0.36, p < 0.001). Higher social support and resilience were associated with less depressive symptoms during pregnancy (B = -0.49, SE = 0.08, p < 0.001 and B = -0.67, SE = 0.10, p < 0.001, respectively) and postpartum (B = -0.32, SE = 0.07, p < 0.001 and B = -0.56, SE = 0.08, p < 0.001, respectively). Social support was protective against discrimination (pregnancy interaction B = -0.23, SE = 0.09, p = 0.011; postpartum interaction B = -0.35, SE = 0.07, p < 0.001). There was no interaction between discrimination and resilience at either time.

Limitations: The study relied on self-reported measures and only included pregnant people who received group prenatal care in two urban regions, limiting generalizability.

Conclusions: Social support and resilience may protect against perinatal depressive symptoms. Social support may also buffer the adverse effects of discrimination on perinatal depressive symptoms, particularly during the postpartum period.

Keywords: Discrimination; Group prenatal care; Perinatal depression; Resilience; Social support.

MeSH terms

Depression / psychology
Depression, Postpartum* / diagnosis
Depression, Postpartum* / epidemiology
Depression, Postpartum* / prevention & control
Female
Humans
Postpartum Period / psychology
Pregnancy
Prenatal Care
Resilience, Psychological*
Social Support