Racial/ethnic disparities in depression symptoms during pregnancy among women: The contribution of income and neighborhood poverty

Background. Racial/ethnic disparities in depressive symptoms during pregnancy are substantial. Given that socioeconomic factors are related to depression and that there are tremendous differences in socioeconomic factors according to race/ethnicity, we hypothesized that racial/ethnic disparities in depressive symptoms would be eliminated for women with similar incomes living in neighborhoods experiencing similar poverty levels. Methods. Individual-level data were drawn from the 2003-2010 California Maternal and Infant Health Assessment (MIHA), an annual statewide-representative mail and telephone survey of postpartum women who gave birth to a live infant. Neighborhood poverty trajectories were obtained from latent class growth modeling of census tract data from 1970-2009. Logistic regression models were constructed to examine racial/ethnic disparities in depressive symptoms during pregnancy, adjusting for age, parity, marital status, and maternal education. These models were then stratified by individual-level income (poor, not poor) and neighborhood poverty (long-term high poverty, long-time moderate poverty, long-term low poverty). Results. Very few statistically significant racial/ethnic disparities were observed in the stratified models among poor women. However, among non-poor women, significant disparities were observed for women living in long-term moderate and low poverty neighborhoods (40-80% increased odds for African American, Asian/Pacific Islander, immigrant Latina, and US-born Latina women compared with White women). Conclusions. Racial/ethnic disparities were generally eliminated among poor women. However, racial/ethnic disparities remained among women living in the most socioeconomically advantaged circumstances, suggesting that women of color may not enjoy the same mental health advantages from living in higher status circumstances compared with their White counterparts.