Black Women Face Higher Rates of Bipolar Disorder, More Severe Symptoms and Higher Rates of Trauma
A new study has revealed striking disparities in postpartum mental health outcomes between Black and white women. The study, published in the Journal of Clinical Psychiatry, found that Black women experience higher rates of bipolar disorder (BD), severe depressive symptoms, and trauma compared to white women. The findings highlight the need for urgent, targeted interventions to address inequities in maternal mental health care.
The research team, led by Dr. Crystal Clark, associate head of research at the Department of Psychiatry, Women’s College Hospital, analyzed data from over 1,800 postpartum women in an urban maternity hospital in Pittsburgh, Pennsylvania, USA, who screened positive for postpartum depression using the Edinburgh Postpartum Depression Scale (EPDS), a popular self-report questionnaire for pregnant and postpartum women.
KEY FINDINGS
- Screening and Diagnosis Rates:
Black women had almost double the positive screen rate on the EPDS compared to white women (19.4% vs. 11.5%). Among those who screened positive, rates of major depressive disorder (MDD) were similar (40% for Black vs. 36% for White participants), but BD was significantly more common in Black participants (19% vs. 11.5%).
- Socioeconomic Inequities:
Black women with MDD or BD were more likely to experience socioeconomic disadvantages, including lower education levels, lack of private insurance, and being unmarried, compared to white women.
- Disparities in Symptom Severity and Trauma:
Black women with MDD reported significantly higher severity of symptoms. PTSD was more common among Black women diagnosed with MDD and BD. Black women also reported higher rates of past trauma (62.7% vs. 49%), which may contribute to differences in mental health outcomes.
- Diagnostic Bias:
Historical biases in mental health diagnoses have contributed to the underdiagnosis or misdiagnosis of bipolar disorder as schizophrenia in Black populations, perpetuating disparities in care. The use of standardized clinician assessments in this study increased the likelihood that Black participants with bipolar disorder were accurately diagnosed.
“Black women experience more severe symptoms and higher rates of trauma and often face greater challenges in accessing adequate diagnosis and treatment.” says Dr. Crystal Clark, associate head of research at the Department of Psychiatry, Women’s College Hospital, and senior author on the study. “These findings emphasize the pressing need to address systemic barriers and biases and develop targeted and strategic interventions for mental health care among Black women.”
IMPLICATIONS FOR POLICY AND PRACTICE
This study underscores the importance of integrating culturally sensitive, trauma-informed approaches in postpartum mental health care to address the unique needs of Black women and other marginalized populations.
Clinicians must receive training to recognize potential biases and ensure accurate and equitable diagnoses. Furthermore, public health policies should focus on addressing systemic inequities that disproportionately impact Black women, including socioeconomic barriers and access to mental health resources.
“This study underscores the critical need for culturally responsive care and the utility of standardized diagnostic clinical tools,” adds Dr. Clark, who is also a scientist at the Women’s College Hospital Research and Innovation Institute. “Equally important, it highlights the gaps in data collection, particularly in Canada, where race-based health data is not systematically gathered. Without this data, disparities like those identified in this study may remain hidden, perpetuating inequities in care.”
In Canada, the lack of standardized race-based healthcare data hinders the ability to identify and address disparities in maternal mental health outcomes. While studies like this one provide valuable insights, the absence of localized data makes it challenging to understand the scope of the issue within Canada’s diverse populations.
“These disparities are not just numbers; they represent real challenges faced by real families,” concludes Dr. Clark. “Improving postpartum mental health care is essential for ensuring healthier outcomes for both parents and their children.”