Get a 10 % discount on an order above $ 100!
Maternal and Child Nursing Discussion
Maternal and Child Nursing Discussion
Rates and Predictors of Postpartum Depression by Race and Ethnicity: Results from the 2004 to 2007 New York City PRAMS Survey (Pregnancy Risk Assessment Monitoring System)
Cindy H. Liu • Ed Tronick
Published online: 25 October 2012
� Springer Science+Business Media New York 2012
ORDER ORIGINAL, PLAGIARISM-FREE ESSAY PAPERS HERE
Permalink: https://eaziessay.com/maternal-and-chi…rsing-discussion/
Abstract The objective of this study was to examine
racial/ethnic disparities in the diagnosis of postpartum
depression (PPD) by: (1) identifying predictors that account
for prevalence rate differences across groups, and (2) com-
paring the strength of predictors across groups. 3,732 White,
African American, Hispanic, and Asian/Pacific Islander
women from the New York City area completed the Preg-
nancy Risk Assessment Monitoring System from 2004 to
2007, a population-based survey that assessed sociodemo-
graphic risk factors, maternal stressors, psycho-education
provided regarding depression, and prenatal and postpartum
depression diagnoses. Sociodemographic and maternal
stressors accounted for increased rates in PPD among Blacks
and Hispanics compared to Whites, whereas Asian/Pacific
Islander women were still 3.2 times more likely to receive a
diagnosis after controlling for these variables. Asian/Pacific
Islanders were more likely to receive a diagnosis after their
providers talked to them about depressed mood, but were less
likely than other groups to have had this conversation. Pre-
natal depression diagnoses increased the likelihood for PPD
diagnoses for women across groups. Gestational diabetes
decreased the likelihood for a PPD diagnosis for African
Americans; a trend was observed in the association between
having given birth to a female infant and increased rates of
PPD diagnosis for Asian/Pacific Islanders and Whites. The
risk factors that account for prevalence rate differences in
postpartum diagnoses depend on the race/ethnic groups
being compared. Prenatal depression is confirmed to be a
major predictor for postpartum depression diagnosis for all
groups studied; however, the associations between other
postpartum depression risk factors and diagnosis vary by
race/ethnic group. Maternal and Child Nursing Discussion
Keywords Postpartum depression � Health status disparities � Asian Americans � Prenatal depression � Gestational diabetes
Introduction
Postpartum depression (PPD) is a serious health concern
affecting approximately 13 % of all women [1]. At least
19.2 % of women experience depression within 12 months
after giving birth [2]. The associations between prenatal
depression and PPD depression are well documented [3–5].
Psychosocial factors including high stress, low social sup-
port, and low marital satisfaction are also predictors [4, 5].
Surprisingly little is known about the extent to which
postpartum depression varies by race and ethnicity, given the
effects of culture on the experiences and manifestations of
depression [6, 7]. This dearth of information on postpartum
depression in ethnic minorities is well recognized. In a
published review of maternal depression, the Agency for
Healthcare Research and Quality found ‘‘screening instru-
ments [to be] poorly representative of the U.S. population,’’
and that ‘‘populations [from studies] were overwhelmingly
Caucasian’’ [8]. A review by O’Hara found that meta-anal-
yses on postpartum depression had omitted race and eth-
nicity as risk factors for postpartum depression [4].
Research studies on postpartum depression that have
included ethnic minorities generally compare African
C. H. Liu (&) Beth Israel Deaconess Medical Center, Harvard Medical School,
75 Fenwood Road, Boston, MA 02115, USA
e-mail: cliu@bidmc.harvard.edu
E. Tronick
Child Development Unit, University of Massachusetts,
100 Morrissey Blvd, Boston, MA 02125, USA
e-mail: Ed.Tronick@umb.edu
123
Matern Child Health J (2013) 17:1599–1610
DOI 10.1007/s10995-012-1171-z
ORDER ORIGINAL, PLAGIARISM-FREE ESSAY PAPERS HERE
Americans and Hispanics with Whites. In these studies,
group differences in prevalence rates have shown to be
inconsistent. Across studies, the rates of postpartum
depression in African American and Hispanic women were
found to be higher [9], lower [10], or no different [11]
compared to Whites. What accounts for observed racial and
ethnic differences in prevalence is unclear. In some studies,
sociodemographic risk variables were associated with
higher levels of depressive symptomatology among Afri-
can Americans, raising the possibility that sociodemo-
graphic variables rather than race and ethnicity account for
different levels of postpartum depression [12–14]. In con-
trast, others have shown greater levels of depressive
symptomatology among African Americans and Hispanics
than Whites, after accounting for sociodemographic factors
[9]. While certain social factors could increase risk, some
factors might buffer against postpartum depression within
groups. For instance, low income foreign-born Hispanic
women with social support exhibited lower rates of post-
partum depression [15], whereas bilingual Hispanic women
were at greater risk than those who spoke only Spanish
[11]. It is possible that factors such as social support or
nativity and its effect on the likelihood of postpartum
depression differ by race/ethnicity because they express
different meanings or incur different implications for each
group. Moreover, stigmas about psychological problems
and help-seeking may have an effect on identifying post-
partum depression, resulting in a subsequent effect on
reported prevalence of postpartum depression rates [6, 16].
Given the mixed picture across groups, this study aimed to
systematically determine the extent to which prevalence
rates across race and ethnicity are explained by factors
associated with postpartum depression.
This study uniquely includes Asian/Pacific Islander
(API) women within the U.S. As the fastest growing ethnic
minority group, over 16 million APIs are estimated to be
living in the U.S [17, 18]. The research on API postpartum
experiences is limited, which is striking given that API
women may hold several risk factors.
If psychiatric history is a major predictor, API women
may be at greatest risk: those between the ages of
15–24 years have the highest rate of depression and su-
icidality compared to any other ethnicity, gender, or age
[19–21]. One study showed APIs to be at lower risk for
postpartum depressive symptoms compared to Whites,
African Americans, and Hispanics [14], while another
study reported a greater percentage of APIs with post-
partum symptoms compared to White Americans [22].
Analyses conducted by the New York City Department of
Health and Mental Hygiene on data from the 2004 to 2007
New York City (NYC) Pregnancy Risk Assessment Mon-
itoring System (PRAMS) revealed a higher rate of PPD
diagnoses among APIs compared to other groups [23–25].
From the most recent sample in 2007, 10.4 % of API
received a PPD diagnosis compared to 1.7 % of non-His-
panic White women [26]. These findings suggest a poten-
tial risk for postpartum depression in APIs.
This study examines racial/ethnic disparities in PPD
diagnosis by identifying predictors accounting for preva-
lence differences. Because previous studies have either
focused mostly on small samples of one group, or did not
examine these risk factors by race/ethnicity, we hypothe-
size that associations of risk factors and PPD differ by race/
ethnic group. The risk factors evaluated were selected
based on the current literature [27–31]. Our study also
sought to explain disparities in PPD rates from a published
report by the NYC Department of Health and Mental
Hygiene. We utilized the study’s comprehensive popula-
tion-based dataset. We also sought to determine the
strength of predictors within each group and differences
across groups. Accordingly, we stratified our analyses by
race/ethnicity. Determining the strength of predictors by
group is essential for identifying individuals most at risk,
and may inform the possible causes of depression for dif-
ferent groups. Unique to this study was the use of diagnosis
as an outcome measure, the inclusion of information on
whether providers talked to women about depressed mood,
and an adequate sample size of APIs. This allowed us to
also examine disparities in psycho-education and diagnosis
across groups.
Methods
Sample
This study used the NYC PRAMS from 2004 to 2007, a
population-based survey administered to postpartum
women from NYC. Coordinated by the Centers for Disease
Control and Prevention and state health departments,
PRAMS’ goal is to monitor maternal behaviors and expe-
riences of women before, during, and after live birth
pregnancies. The dataset was provided by the NYC
Department of Health and Mental Hygiene (DOHMH).
The participants were part of an ongoing population-
based random sampling of NYC live births. NYC mothers
of approximately 180 infants with registered birth certifi-
cates that gave birth during the previous 2–4 months were
contacted for participation monthly. Eighty-three percent
responded by mail and 17 % by phone. The sample was
randomized without replacement and stratified by birth
weight. The final dataset was weighted for stratification,
nonselection, and nonresponse.
According to the DOHMH, a total of 4,813 responses
were received with response rates of at least 70 % from
July to December of 2004, May to December of 2005, and
1600 Matern Child Health J (2013) 17:1599–1610
123
January to December of 2006. A rate of 65 % was achieved
from January to December of 2007. For 2004–2005,
responses were weighted to represent 138,266 live births.
For 2006 and 2007, responses represented 119,079 and
122,222 live births, respectively. Based on the DOHMH
analysis, respondents differed from non-respondents on
some key sociodemographic variables (p \ .05). APIs compared to other racial and ethnic groups, younger
women, and women with less education were less likely to
respond to the survey.
Measures
The birth certificate provided information on maternal race/
ethnicity and nativity (i.e., U.S. or non-U.S. born mothers).
Women were classified as Hispanic or non-Hispanic based
on self-report. Non-Hispanic women were categorized in
one of the following groups: White, African American,
Asian/Pacific Islander, and American Indian/Alaskan
Native. Maternal age, nativity (U.S. Born versus Foreign
Born) and education (categorized as: 0–8, 9–11, 12, 13–15,
and[16 years) were based at the time of infant birth from information in the birth certificate. Mean infant age at the
time of survey completion was 9.7 months; there were no
significant differences in infant age across groups.
The PRAMS survey itself provided information for
remaining variables. To obtain income, women were asked
to indicate ‘‘total household income before taxes in the
12 months before the new baby was born’’ by checking off
one of the following options:\$10,000, $10,000–$14,999, $15,000–$19,999, $20,000–$24,999, $25,000–$34,999,
$35,000–$49,999, $50,000–$74,999, and[$75,000. Stress- ful events during pregnancy were obtained by ‘‘yes’’ or
‘‘no’’ responses to events that may have occurred during
the last 12 months before the new baby was born. Exam-
ples include ‘‘I moved to a new address,’’ ‘‘I had a lot of
bills to pay,’’ ‘‘I got separated or divorced from my hus-
band or partner,’’ and ‘‘Someone very close to me died.’’
These events were counted and categorized into the fol-
lowing: 0, 1–2, 3–5, and 6–13 events. A ‘‘yes’’ or ‘‘no’’
response was also used to obtain information on following:
gestational diabetes (‘‘High blood sugar (diabetes) that
started during this pregnancy’’), social support from partner
(responses of ‘‘My husband or partner’’ to the question
‘‘During your most recent pregnancy, who would have
helped you if a problem had come up’’), NICU (Neonatal
Intensive Care Unit) (‘‘After your baby was born, was he or
she put in an intensive care unit?’’), unintended pregnancy
(‘‘When you got pregnant with your new baby, were you
trying to get pregnant?’’). The NYC PRAMS included
additional questions related to depression. Mothers were
asked to respond ‘‘yes’’ or ‘‘no’’ regarding prenatal
depression (‘‘At any time during your most recent
pregnancy, did a doctor, nurse, or other health care worker
diagnose you with depression?’’), and discussion about
mood (‘‘At any time during your most recent pregnancy or
after delivery, did a doctor, nurse, or other health care
worker talk with you about ‘‘baby blues’’ or postpartum
depression?’’). In addition, mothers were asked about PPD
diagnosis (‘‘Since your new baby was born, has a doctor,
nurse, or other health care worker diagnosed you with
depression?’’). The response to this item was the outcome
variable used for the analyses in this study.
The language of the survey (English or Spanish version)
was also noted.
Variables
Covariates included maternal age, household income,
maternal education, nativity, and infant age at the time the
mother completed the questionnaire. Variables considered
as potential stressors included: gestational diabetes,
stressful events, social support, NICU, intention for preg-
nancy, and prenatal depression. Discussion about mood
served as an additional predictor of PPD diagnosis.
Responses with missing variables of interest for this
study were eliminated. Variables with less than a 100 %
response rate included household income (86.9 %),
maternal education (99.3 %), maternal age (97.0 %), and
PPD diagnosis (99.4 %) resulting in an unweighted study
sample of 3,732.
Statistical Analyses
To account for the stratified and weighted sample, the data
was analyzed using the complex samples module of SPSS
version 17.0 (SPSS Inc., Chicago, IL). A non-race stratified
model was conducted to determine the likelihood of
receiving a PPD diagnosis for each race/ethnic group with
Whites as the reference group. A series of four logistic
regression models were employed where the variables of
interest (race/ethnicity, sociodemographic, stressors, and
discussion about mood) were sequentially added to the
model, allowing incremental examination of the variables’
effects in identifying factors that explain racial/ethnic
disparities in PPD.
Prevalence estimates within each group were generated
according to predictors. To compare the characteristics of
those with and without PPD and to understand associated
predictors, race-stratified logistic regressions incorporated
all predictors, with sociodemographic variables as covari-
ates. Adjusted odds ratios for each predictor were gener-
ated by race/ethnic group. Note that our models failed to
converge with the inclusion of language, nativity, and
NICU variables because of low cell sizes; thus, these
variables were dropped from our analyses. Unless
Matern Child Health J (2013) 17:1599–1610 1601
123
otherwise noted, all reported proportions represent weigh-
ted averages.
Results
Compared to other groups, API women showed the highest
rate for PPD, followed by Hispanics and African Ameri-
cans. White women had the lowest rate of PPD. The high
rate of a PPD diagnosis among API women is consistent
with previous analyses from this dataset, which utilized a
larger sample size than the dataset here, as this set includes
only women with complete data on the predictor variables.
Other racial/ethnic differences among assessed variables
are presented (Table 1).
A major objective was to determine whether sociode-
mographic variables, stressor variables, and discussion
about mood accounted for PPD differences. In the unad-
justed model, likelihood estimates indicate that API women
were 4.6 times more likely and Hispanic women 2.7 times
more likely than Whites to receive a PPD diagnosis.
African American were 1.7 times more likely to receive the
diagnosis than Whites, although this was not statistically
significant (Table 2). Once sociodemographic factors were
entered, African Americans were no more likely to receive
a diagnosis than Whites. For Hispanics, the greater likeli-
hood for a diagnosis compared to Whites was less pro-
nounced after accounting for sociodemographic factors and
was eliminated with the inclusion of stressors. The diag-
nosis likelihood was slightly reduced for APIs after
accounting for sociodemographic factors, and significantly
reduced with stressor variables, although diagnosis likeli-
hood was still more than double the rate of Whites and
African Americans. In contrast to the other groups, diag-
nosis likelihood for APIs increased to 3.2 times relative to
Whites, after accounting for reports of having discussed
mood with a provider. Prenatal depression was by far the
strongest predictor for all women compared to other
stressors, although women who gave birth to females were
more likely to receive a diagnosis than women with male
infants. Overall, those who had a discussion about mood
were also more likely to receive a diagnosis.
Profiles of women with PPD diagnoses compared to
women without a diagnosis differed by race/ethnicity. The
majority of White women reporting a PPD diagnosis
received a postgraduate education, while API and African
American women with the diagnosis tended to be high
school graduates. Approximately half of the White women
with PPD had household incomes above $75,000 per year.
Among APIs, Hispanics, and African Americans, more
women with PPD had less than $15,000 of household
income per year than those without a diagnosis (Table 3).
With regard to stressors, we found a significantly higher
rate of gestational diabetes among those with PPD than
those without PPD, but only for White women. However,
after controlling for sociodemographic variables through
our race-stratified adjusted model, gestational diabetes did
not significantly predict PPD in White, API, or Hispanic
women (Table 4). In fact, African American women with
gestational diabetes were less likely to receive a diagnosis
of PPD.
Compared to those without PPD, there was a higher
percentage among APIs and Hispanics with the diagnosis
who had an unintended pregnancy. In addition, the
majority of APIs with PPD had a diagnosis of prenatal
depression compared to the other groups. Stressful events
were not associated with greater likelihood for PPD, but
API women who reported having 6–13 stressful events
were significantly more likely to have PPD, a rate that was
statistically significant. The association between prenatal
depression and PPD persisted for all groups, even after
controlling for sociodemographic variables.
Overall, there was a higher rate of women with PPD
who had a discussion about mood with their providers than
women without the diagnosis. However, the association
between PPD and discussion about mood with providers
was specific to only API and African American women in
the adjusted model.
Women from all groups who received a diagnosis of
PPD were more likely to have given birth to females
although the differences were not statistically significant.
However, having a female infant seemed to slightly
increase the likelihood of a PPD diagnosis among White
and API women based on the race-stratified analyses.
Discussion
This study assessed PPD estimates and identified predictors
of PPD as defined by women’s reports of receiving a
diagnosis from a health care provider. We included API
women and used race-stratified analyses, allowing us to
determine whether predictors varied by race/ethnicity.
This study also sought to identify factors that explained
racial/ethnic disparities obtained in a previous analysis of
the dataset by the NYC Department of Health and Mental
Hygiene. As with other studies, we found that sociode-
mographic factors accounted for the higher rates of PPD
among African Americans and Hispanics. Based on such
findings, some have argued for prevention or intervention
programs to provide resources (e.g., financial support,
education) in addressing the racial/ethnic disparities of
PPD for African Americans and Hispanics [12]. However,
unlike other studies that primarily assessed reported
symptoms [9, 12, 14], we used the diagnosis of PPD as the
1602 Matern Child Health J (2013) 17:1599–1610
123
outcome measure. This raises the possibility that sociode-
mographic status accounts for the rates at which one
receives a diagnosis; in our study, African Americans and
Hispanics with lower sociodemographic statuses were less
likely to receive a diagnosis compared to Whites. If race/
ethnic disparities are found among rates of diagnosis, then
the diagnostic process may be another area to target for
improvement among lower sociodemographic status
groups.
Among ethnic minorities in our study, API women were
the most likely to receive a PPD diagnosis, and unlike
African Americans and Hispanics, the likelihood of
receiving a PPD diagnosis for APIs remained significantly
higher even after accounting for other variables (e.g.,
sociodemographic factors). Prenatal depression was asso-
ciated with PPD for all groups in our study, but the like-
lihood was highest for APIs. Although psychiatric history
for depression was not available, the strong association
between prenatal depression and PPD observed among the
API women in our sample adds to the growing concern of
depression experiences and its effects on API women
during motherhood [19–21]. A number of factors specific
to API women’s experiences are potentially associated
with later postpartum mood. The high rate of depression
and suicidal ideation during adolescence and young
adulthood may reflect family and societal pressures faced
by young women to uphold high academic standards and
traditional gender roles [32]. These young women likely
must negotiate their cultural values and beliefs when
assuming a mother’s identity [33, 34]. In addition, the
cultural preference for male infants may affect PPD.
Table 1 Weighted percentage distribution of mothers who recently gave birth that completed the NYC PRAMS from 2004 to 2007, by
characteristic, according to race/ethnicity
White Asian/
Pacific
Islander
Hispanic Black
(n = 1,043) (n = 425) (n = 1,253) (n = 1,027)
Maternal age
\20 2.4a 0.9a 9.9b 6.9c
20–34 70.1a 75.4b 76.8b 73.8a,b
C35 27.5a 23.7a,b 13.3c 19.3b,d
Maternal education
0–8 1.7a 2.7a 11.7b 1.6a
9–11 4.2a 10.7b 19.6c 15.8d
12 22.6a 26.1a 34.4b 32.1b
13–15 16.2a 14.7a 21.1b 28.1c
C16 55.4a 45.8b 13.2c 22.4d
Income
\10,000 10.0a 20.4b 40.3c 29.2d
10,000–14,999 6.7a 15.1b 14.3b 10.3c
15,000–19,999 4.6a 8.0b 8.8b 8.6c
20,000–24,999 4.7a 5.8a 6.8b 9.2c
25,000–34,999 6.8a 5.7a 9.5b 13.2c
35,000–49,999 8.7a 6.0a 6.7a 10.1a
50,000–74,999 12.1a 9.9a 6.3a 10.2a
C75,000 46.4a 29.1b 7.1c 9.0d
Maternal nativity
U.S. born 68.4a 11.1b 34.1c 56.3d
Non-U.S. born 31.1 88.9 65.6 43.0
Missing data 0.5 0 0.3 0.7
Language of questionnaire
English 99.1a 99.5a 51.2b 98.8a
Spanish 0 0 48.5 0
Missing data 0.5 0.5 0.3 1.2
NICU
Yes 5.1 5.9 6.4 14.4
No 94.9a 94.1a 93.6a 85.5b
Don’t know 0 0.1 0 0.1
Gender
Male 49.3a 52.1a 51.1a 52.0a
Female 50.7 47.9 48.9 48.0
Diabetes
No 92.4 85.1 89.9 89.9
Yes 7.6a 14.9b 10.1c 10.1c
Stresses
0 45.1a 49.1a 31.6b 26.5c
1–2 41.8a 38.7a 41.5a 42.8a
3–5 12.1a 11.3a 23.3b 25.2b
6–13 1.1a 0.8a 3.6b 5.5c
Social support
No 90.4 90.8 76.9 75.2
Yes 9.6a 9.2a 23.1b 24.8b
Table 1 continued
White Asian/
Pacific
Islander
Hispanic Black
(n = 1,043) (n = 425) (n = 1,253) (n = 1,027)
Intention for pregnancy
No 30.9a 35.1a 59.0b 66.5c
Yes 69.1 64.9 41.0 33.5
Prenatal depression diagnosis
No 97.2 87.6 92.4 94.5
Yes 2.8a 12.4b 7.6c 5.5d
Discussion about mood
No 46.0 61.4 42.7 39.3
Yes 54.0a 38.6b 57.3a,c 60.7c
Postpartum depression diagnosis
No 97.4 89.3 93.6 96.3
Yes 2.6a 10.7b 6.4c 3.7a
Lower case superscripts that differ across each row represent statistically
different values across racial/ethnic groups. Conversely, groups within a
row that share the same superscript demonstrate no statistically significant
difference in values within p \ .05
Matern Child Health J (2013) 17:1599–1610 1603
123
Table 2 Logistic regression models of race/ethnicity, other sociodemographic factors, stressors, and discussion of mood with provider, with adjusted odds of postpartum depression diagnosis
Model 1 Model 2 Model 3 Model 4
OR CI OR CI OR CI OR CI
Race
White 1.0 1.0 1.0 1.0
Asian/Pacific Islander 4.6*** 2.6–8.2 4.0*** 2.2–7.2 2.7** 1.4–4.9 3.2*** 1.7–6.0
Hispanic 2.7*** 1.7–4.5 1.8* 1.0–3.1 1.5 0.9–2.7 1.5 0.9–2.7
Black 1.7� 1.0–3.0 1.2 0.6–2.2 0.9 0.5–1.8 0.9 0.4–1.8 Maternal and Child Nursing Discussion
Maternal age
\20 1.0
20–34 0.5 0.3–1.1 0.5 0.2–1.1 0.5 0.2–1.2
C35 0.7 0.3–1.6 0.7 0.3–1.7 0.7 0.3–1.9
Maternal education
0–8 1 1 1
9–11 0.8 0.3–1.9 1.2 0.4–3.2 1.1 0.4–3.0
12 1.0 0.5–2.1 1.6 0.7–4.1 1.6 0.7–4.0
13–15 1.1 0.5–2.5 1.6 0.6–4.2 1.6 0.6–4.3
C16 0.8 0.4–1.8 1.5 0.6–4.0 1.6 0.6–4.2
Income
\10,000 1.0 1.0 1.0
10,000–14,999 1.2 0.7–2.1 1.5* 0.8–2.8 1.5* 0.8–2.8
15,000–19,999 0.8* 0.3–1.6 1.1 0.5–2.4 1.0 0.5–2.2
20,000–24,999 0.5 0.2–1.2 0.6 0.3–1.4 0.6 0.2–1.3
25,000–34,999 0.6 0.3–1.3 0.7 0.3–1.7 0.7 0.3–1.6
35,000–49,999 0.3 0.1–0.7 0.3 0.1–0.9 0.3 0.1–0.8
50,000–74,999 0.4 0.2–0.9 0.5 0.2–1.3 0.5 0.2–1.3
C75,000 0.5 0.3–1.0 0.7 0.3–1.5 0.7 0.3–1.4
Gender
Male 1.0 1.0
Female 1.6* 1.1–2.4 1.7* 1.1–2.5
Diabetes
No 1.0 1.0
Yes 0.8 0.4–1.5 0.8 0.4–1.6
Stresses
0 1.0 1.0
1–2 0.8 0.5–1.3 0.8 0.5–1.3
3–5 1.0 0.6–1.8 1.0 0.6–1.8
6–18 1.8� 0.7–4.9 2.0� 0.8–5.1
Social support
No 1.0 1.0
Yes 1.1 0.7–1.9 1.2 0.7–2.0
Intention for pregnancy
No 1.0 1.0
Yes 1.2 0.8–1.8 1.2 0.8–1.8
Prenatal depression diagnosis
No 1.0 1.0
Yes 17.3*** 10.9–27.5 15.0*** 9.4–23.8
Discussion about mood
No 1.0
Yes 2.6*** 1.6–4.1
� p \ 0.1; * p \ .05; ** p \ .01; *** p \ .001
1604 Matern Child Health J (2013) 17:1599–1610
123
Table 3 Weighted percentage of mothers who completed the NYC PRAMS from 2004 to 2007, by characteristic according to race/ethnicity and postpartum depression diagnosis
White Asian/Pacific Islander Hispanic Black
No PPD PPD No PPD PPD No PPD PPD No PPD PPD
(n = 1,010) (n = 33) (n = 383) (n = 42) (n = 1,162) (n = 91) (n = 979) (n = 48)
Maternal age
\20 2.3 5.9 1 0 9.6 13.4 6.2 25.2*** 20–34 70.4 62 74.1 86.1� 77.7 63.7** 74.2 63.4�
C35 27.4 32.1 24.9 13.9 12.6 22.9** 19.6 11.5
ORDER ORIGINAL, PLAGIARISM-FREE ESSAY PAPERS HERE
Maternal education
0–8 1.7 0 2.4 4.9 11.5 15.8 1.7 0.7
9–11 4 9 10.6 11.4 19.3 23 15.9 12.5
12 22.9 12.1 23 52.8*** 34.9 25.9� 31.4 49.3***
13–15 16.5 5.3 14.5 16.5 20.7 27.7 28.2 26.2
C16 54.9 73.6� 49.5 14.3*** 13.6 7.6 22.8 11.4
Income
\10,000 9.9 15.4 18.7 34.2* 40.1 44.2 28.6 46.9*** 10,000–14,999 6.7 4.7 14.8 18.2 13.5 27*** 9.8 21.8***
15,000–19,999 4.8 0 7.3 13.5 9.1 5.3 8.4 14.9*
20,000–24,999 4.8 0 6 4.5 6.7 8.5 9.6 0.6**
25,000–34,999 7 0.5 4.6 15.3 9.7 5.8 13.5 4.8*
35,000–49,999 8.5 15.1 6.7 0.3 7.1 0.5* 10.5 1.7**
50,000–74,999 12.1 11.5 10.7 3.6 6.5 4.4 10.6 0.5**
C75,000 46.2 52.7 31.3 10.3** 7.3 4.3 9 8.8
Maternal nativity
U.S. born 68.4 66.7 12.3 100*** 35.0 23.1* 56.4 54.2
Non-U.S. born 31.1 30.3 87.7 0 64.7 76.9 42.9 45.8
Missing data 0.5 0.3 0 0 0.3 0 0.7 0
Language of questionnaire
English 99.2 97.0 99.5 100 50 46.2 98.8 100
Spanish 0 0 0.1 0 50 53.8 1.1 0
Missing data 0.8 3.0 0.4 0 0 0 0.1 0 Maternal and Child Nursing Discussion
NICU
No 94.9 94.2 93.6 98.1 93.7 91.9 85.7 82.3
Yes 5.1 5.8 6.3 1.9 6.3 8.1 14.3 17.3
Don’t know 0 0 0.1 0 0 0 0.1 0.5
Gender
Male 49.5 40.2 53.2 43 51.7 43.8 52.3 44.7
Female 50.5 59.8 46.8 57 48.3 56.2 47.7 55.3
Diabetes
No 92.5 90 85.6 81.4 90.2 86.2 89.6 98.9
Yes 7.5 10* 14.4 18.6 9.8 13.8 10.4 1.1
Stresses
0 45.6 26.4* 47.6 61.2 31.6 30.8 27 12.5**
1–2 41.4 54.3 39.9 28.8 42.6 25 42.9 39.4
3–5 12 14.2 12.1 5.4 22.7 32.1 24.6 41.2
6–13 1 5.1* 0.4 4.5** 3 12.1 5.4 6.9
Social support
No 9.4 15.3 8.6 13.7 22.7 28.3 24.6 31.4
Yes 90.6 84.7 91.4 86.3 77.3 71.7 75.4 68.6
Intention for pregnancy
Matern Child Health J (2013) 17:1599–1610 1605
123
Chinese women with a female infant were more likely to
experience PPD [35, 36]. In another study on Indian
women, having a female infant increased the effects of
other risk factors [37]. Recent findings have also demon-
strated a greater likelihood for Asian women to develop
gestational diabetes, which is associated with PPD [38–40].
Other explanations for Asian American depression in the
literature range from biological [41] to social [42]. Toge-
ther, these explanations may represent a general vulnera-
bility for depression generalizing to API women’s
depressed mood during the postpartum period. Future
studies in PPD research may want to specifically examine
the association between psychiatric history and PPD by
race/ethnicity to determine if psychiatric history predicts
PPD more strongly in API women. Maternal and Child Nursing Discussion
Furthermore, discussing depressed mood with providers
increased the likelihood for women to receive a diagnosis.
This was especially true for APIs where the likelihood of
receiving a diagnosis was 3.2 times more than White
women after our analyses considered such discussions as a
factor. These high rates could reflect the quality of the
diagnostic processes that take place between API women
and their providers. The use of a diagnostic criterion by the
NYC PRAMS to assess PPD is unlike other prevalence
studies that typically use structured assessments for PPD
(e.g., a single question on depressive mood during preg-
nancy, multiple items covering symptomatology, etc.) [9,
12–14]. APIs tend to endorse somatic experiences rather
than psychological symptoms [43, 44]. Conversations with
a provider could increase sensitivity during the assessment,
thus facilitating a positive diagnosis. Increased research on
the diagnostic process within a health care setting would
greatly enhance understanding of how dialogues between
provider and patient result in diagnoses. In particular,
future research should consider differences in the charac-
teristics of providers and clinics among those who did and
did not receive a PPD diagnosis, and the nature of the
actual exchanges occurring between providers and patients.
It was particularly striking that approximately half of the
providers did not talk to women about PPD. Racial/ethnic
disparities were also found when assessing these rates.
While the majority of African American, Hispanic, and
White women reported having had a conversation with
their providers, only 38.6 % of API women in our study
reported this. Given that Asians tend to minimize their
psychological distress [6, 16], providers may not realize
distress nor recognize the need to bring up depressed mood.
APIs who had a conversation were 9.1 times more likely to
receive a diagnosis than APIs without, regardless of their
sociodemographic background. Thus, although APIs were
the group most likely to benefit from information about
depressed mood, they were the least likely to be provided
with it. Additionally, African Americans showed the
highest rate of having been presented with information
about mood compared to the other groups; those with a
conversation were 5.8 times more likely to receive a
diagnosis.
Altogether, and of greatest concern were the low rates of
assessment for all groups, and especially for APIs. Our
findings suggest that the information presented by a pro-
vider has powerful implications for determining diagnosis,
especially for APIs and African Americans. This finding
has implications for studies obtaining prevalence rates
without considering racial/ethnic disparities within the
screening or diagnostic process. Differences in prevalence
rates may be attributed to the lack of medical information
and treatment opportunities available to certain groups.
Our inclusion of known predictors for PPD in race-
stratified analyses allowed us to compare the strength of
stressors across groups. Most of the group differences in
the predicted likelihood for PPD were not statistically
significant suggesting few group differences in the
Table 3 continued
White Asian/Pacific Islander Hispanic Black
No PPD PPD No PPD PPD No PPD PPD No PPD PPD
(n = 1,010) (n = 33) (n = 383) (n = 42) (n = 1,162) (n = 91) (n = 979) (n = 48)
No 31.1 26.3 33.4 49.2 58.2 69.8 66.4 67.6
Yes 68.9 73.7 66.6 50.8* 41.8 30.2** 33.6 32.4
Prenatal depression diagnosis
No 98 67.1 93.8 35.8 95 54.4 95.4 71
Yes 2 32.9*** 6.2 64.2*** 5 45.6*** 4.6 29***
Discussion about mood
No 46.5 26.1 66.2 21.1 43.5 30.5 40.5 8.6
Yes 53.5 73.9* 33.8 78.9*** 56.5 69.5** 59.5 91.4***
� p \ 0.1; * p \ .05; ** p \ .01; *** p \ .001
1606 Matern Child Health J (2013) 17:1599–1610
123 Maternal and Child Nursing Discussion
Permalink: https://eaziessay.com/maternal-and-chi…rsing-discussion/
association between stressors and PPD. Furthermore,
stressful events were not associated with a greater likeli-
hood at a statistical level, with the exception of API
women; those who reported 6-13 stressful events were
significantly more likely to receive a diagnosis. The
explanation may reside in the distribution of reported
stressful events for APIs; compared to other groups, the
majority of API women reported zero stressful events. As
such, the few APIs who disclosed high numbers of stressful
events may have been the most likely to receive a diag-
nosis. APIs may still minimize their experience of stress
despite being asked to state the occurrence of stressful
events given their tendency to minimize psychological
problems in general [6, 16]. Providers may want to inquire
further about actual events and how it affects their API
patients both psychologically and physically.
A number of associations between stressors and PPD
require clarification through further research. There was a
trend for increased PPD rates among API and White
women who gave birth to female infants. Few studies have
included infant gender in PPD studies within the U.S.;
those that have find no association [45, 46]. Given these
studies’ small samples (n \200), any effects may have been too small to detect. One study did find increased self-
esteem in mothers of male infants, although this association
was mediated by paternal support [47]. The statistical trend
in our data may indicate actual preferences for infant
gender, but it could also reflect other factors moderated by
infant gender. Our findings demonstrate the need to include
infant gender in future studies and to identify mechanisms
that explain this association.
In addition, we did not find a general link between
gestational diabetes and PPD, despite a previous study’s
results [39]. When examining groups separately, APIs in
our study were more likely to have gestational diabetes;
however, this did not predict PPD. Instead, we found a
decrease in the likelihood for PPD diagnoses among
African Americans with gestational diabetes. There is
evidence to suggest that African Americans may be less
inclined to disclose symptoms even though providers speak
Table 4 Race/ethnicity stratified logistic regression showing adjusted odds of postpartum depression diagnosis per predictor by race/ethnic group
White Asian/Pacific Islander Hispanic Black
OR CI OR CI OR CI OR CI
Gender
Male 1.0 1.0 1.0 1.0
Female 2.2� 0.9–5.8 2.6� 0.9–7.2 1.5 0.8–2.7 1.5 0.5–4.1
Diabetes Maternal and Child Nursing Discussion
No 1.0 1.0 1.0 1.0
Yes 1.0 0.3–3.8 0.8 0.2–3.7 1.4 0.6–3.3 0.1** 0.0–0.5
Stresses
0 1.0 1.0 1.0 1.0
1–2 2.3� 0.8–6.7 0.8 0.3–2.2 0.4* 0.2–0.9 1.8 0.3–10.2
3–5 1.2 0.2–8.5 0.1 0.0–1.1 0.8� 0.4–1.8 3.1 0.4–21.7
6–13 5.2 0.9–30.8 2.7* 0.5–15.8 2.5 0.7–9.7 1.5 0.1–15.6
Social support
No 1.0 1.0 1.0 1.0
Yes 1.6 0.4–6.0 1.9 0.4–9.5 0.9 0.4–1.7 1.5 0.5–4.6
Intention for pregnancy
No 1.0 1.0 1.0 1.0
Yes 0.9 0.3–3.3 2.2 0.8–6.4 1.4 0.7–2.6 0.7 0.2–1.9
Prenatal depression diagnosis
No 1.0 1.0 1.0 1.0
Yes 29.4*** 8.5–101.4 52.1*** 16.4–166.0 15.3*** 7.6–30.9 8.1*** 2.9–22.8
Discussion about mood
No 1.0 1.0 1.0 1.0
Yes 1.7 0.6–4.8 9.1** 2.5–33.4 1.3 0.7–2.6 5.8** 2.1–15.9
Only adjusted odds ratios are presented because race/ethnic stratified analyses did not converge when including unadjusted factors in the model.
This was due to zero to small sample sizes in race 9 sociodemographic contingency tables � p \ 0.1; * p \ .05; ** p \ .01; *** p \ .001
Matern Child Health J (2013) 17:1599–1610 1607
123
with them about prenatal depression and PPD at a higher
rate [48]. Mistrust and perceived discrimination within the
medical care setting may prevent disclosure about depres-
sion [22, 49]. In particular, some studies have found that
among those with depressive mood accompanied with
diabetes, African Americans were less likely to be recog-
nized as depressed and to receive depression treatment
[49–51]. Given our initial findings, the association between
gestational diabetes and PPD may not be generalizable,
although further research is needed to fully understand the
relationship. Studies that do not stratify by race may
overlook differences in the effect of gestational diabetes on
depression by race/ethnicity. Maternal and Child Nursing Discussion
Interpretation of results should be made with caution in
light of our limitations. As with any self-report, inaccura-
cies in this data are possible given recall problems. In
addition, prenatal and PPD diagnoses were used in our
study. It would have been far preferable to obtain corrob-
orating information from medical records; however, this
information was unavailable within this survey study. It is
possible that providers employed different standards for
diagnoses, which may be reflected in this data, for instance,
the consideration of ‘‘baby blues’’ or the inclusion of dif-
ferent methods to assess depression (e.g., questionnaire,
verbal report). Furthermore, these diagnoses may not nec-
essarily reflect actual depression rates, but as discussed,
may be more of a reflection of provider sensitivity to
detecting symptoms in a particular group. Finally, the race/
ethnic categories are a proxy for a culture, and are com-
prised of heterogeneous subgroups. For instance, the
unique experiences of Chinese, Japanese or Filipino groups
may have been overlooked since they were combined into
one race/ethnic category.
Conclusion
Our results highlight racial/ethnic disparities in PPD and its
diagnosis, inviting a more nuanced approach in the con-
sideration of PPD risk factors. Although we relied on broad
race/ethnic categories, these findings demonstrate at a basic
level, the possibility of differential effects in the risk fac-
tors associated with PPD. Explanations for racial/ethnic
disparities in diagnosis compared to Whites differ by group
and are not necessarily due to sociodemographic status or
stress, factors that usually explain racial/ethnic disparities.
While prenatal depression seems to be a major risk factor
for PPD across all groups, the extent to which a factor is a
‘‘risk’’ for a particular racial/ethnic group needs to be
evaluated. These associations point to the possibility of
group-specific mechanisms leading to a PPD diagnosis.
Universal postpartum depression screening as a single
approach may not be adequate given the role that provider-
patient interactions might have as suggested by these study
findings. Rather, this study broadly reveals a need to con-
sider the diagnostic process between provider-patient by
race/ethnicity to better understand the source of treatment
disparities.
Acknowledgments The authors would like to acknowledge the NYC Department of Health and Mental Hygiene Bureau of Maternal,
Infant and Reproductive Health PRAMS Team, Bureau of Vital
Statistics, and the CDC PRAMS Team, Program Services and
Development Branch, Division of Reproductive Health. Support
during the preparation of this manuscript was provided through a
grant from the Sackler Foundation for Psychobiological Research and
through the Stuart T. Hauser Clinical Research Training Fellowship
(2T32MH016259-30).
References
1. O’Hara, M. W., & Swain, A. M. (1996). Rates and risk of
postpartum depression-A meta-analysis. International Review of
Psychiatry, 8, 37–54.
2. Gavin, N. I., Gaynes, B. N., Lohr, K. N., Meltzer-Brody, S.,
Gartlehner, G., & Swinson, T. (2005). Perinatal depression: A
systematic review of prevalence and incidence. Obstetrics and
Gynecology, 106, 1071–1083.
3. Leigh, B., & Milgrom, J. (2008). Risk factors for antenatal
depression, postnatal depression and parenting stress. BMC Psy-
chiatry, 8, 24. Maternal and Child Nursing Discussion
4. O’Hara, M. W. (2009). Postpartum depression: What we know.
Journal of Clinical Psychology, 65, 1258–1269.
5. Robertson, E., Grace, S., Wallington, T., & Stewart, D. E. (2004).
Antenatal risk factors for postpartum depression: A synthesis of
recent literature. General Hospital Psychiatry, 26, 289–295.
6. Kleinman, A. (2004). Culture and depression. New England
Journal of Medicine, 351, 951–953.
7. Chentsova-Dutton, Y. E., & Tsai, J. L. (2007). Cultural factors
influence the expression of psychopathology. In S. O. Lilienfeld
& W. T. O’Donohue (Eds.), The great ideas of clinical science:
17 principles that every mental health professional should
understand (pp. 375–396). New York: Routledge/Taylor &
Francis Group.
8. United States. Agency for Healthcare Research and Quality.
(2005). Perinatal depression: Prevalence, screening accuracy, and
screening outcomes. In B. N. Gaynes, N. Gavin, S. Meltzer-
Brody, K. N. Lohr, T. Swinson, G. Gartlehner, S. Brody, W.
Miller Evidence Report/Technology Assessment No. 119. Con-
tract No. 290-02-0016.
9. Howell, E. A., Mora, P. A., Horowitz, C. R., & Levanthal, H.
(2005). Racial and ethnic differences in factors associated with
early postpartum depressive symptoms. Obstetrics and Gyne-
cology, 105, 1442–1450.
10. Wei, G., Greaver, L. B., Marson, S. M., Herndon, C. H., Rogers,
J., & Robeson Healthcare Corporation. (2008). Postpartum
depression: racial differences and ethnic disparities in a tri-racial
and bi-ethnic population. Maternal and Child Health Journal, 12,
699–707.
11. Yonkers, K. A., Ramin, S. M., Rush, J., Navarrete, M. A., Car-
mody, T., March, D., et al. (2001). Onset and persistence of
postpartum depression in an inner-city maternal health clinic
system. American Journal of Psychiatry, 158, 1856–1863.
12. Beeghly, M., Olson, K. L., Weinberg, M. K., Pierre, S. C.,
Downey, N., & Tronick, E. Z. (2003). Prevalence, stability, and
socio-demographic correlates of depressive symptoms in black
1608 Matern Child Health J (2013) 17:1599–1610
123
mothers during the first 18 months postpartum. Maternal and
Child Health Journal, 7, 157–168.
13. Hobfoll, S. E., Ritter, C., Lavin, J., Hulsizer, M. R., & Cameron,
R. P. (1995). Depression prevalence and incidence among inner-
city pregnant and postpartum women. Journal of Consulting and
Clinical Psychology, 63, 445–453. Maternal and Child Nursing Discussion
14. Rich-Edwards, J. W., Kleinman, K., Abrams, A., Harlow, B. L.,
McLaughlin, T. J., Joffe, H., et al. (2006). Sociodemographic
predictors of antenatal and postpartum depressive symptoms
among women in a medical group practice. Journal of Epide-
miology and Community Health, 60, 221–227.
15. Huang, Z. J., Wong, F. Y., Ronzio, C. R., & Yu, S. M. (2007).
Depressive symptomatology and mental health help-seeking
patterns of U.S.- and foreign-born mothers. Maternal and Child
Health Journal, 11, 257–267.
16. Hsu, L. K. G., Wan, Y. M., Chang, H., Summergrad, P., Tsang, B.
Y. P., & Chen, H. (2008). Stigma of depression is more severe in
Chinese Americans than Caucasian Americans. Psychiatry:
Interpersonal and Biological Processes, 71, 210–218.
17. U.S. Census Bureau. (2010). National population projections.
Washington, DC.
18. United States. Census Bureau, Population Division. (2008).
Projections of the population by sex, race and Hispanic origin for
the United States: 2010 to 2050.
19. Centers for Disease Control and Prevention. (2003). Deaths:
Leading causes for 2001. National Vital Statistics Reports, vol.
52.
20. United States. Public Health Service, National Center for Health
Statistics. (2003). Health, United States, 2003.
21. Duldulao, A. A., Takeuchi, D. T., & Hong, S. (2009). Correlates
of suicidal behaviors among Asian Americans. Archives of Sui-
cide Research, 13, 277–290.
22. Hayes, D., Ta, V., Hurwitz, E., Mitchell-Box, K., & Fuddy, L.
(2010). Disparities in self-reported postpartum depression among
Asian, Hawaiian, and Pacific Islander Women in Hawaii: Preg-
nancy Risk assessment monitoring system (PRAMS), 2004–2007.
Maternal and Child Health Journal, 14, 765–773.
23. New York City Department of Health and Mental Hygiene,
Bureau of Maternal, Infant and Reproductive Hygiene. (2004).
Number and percent of women diagnosed with postpartum
depression by select sociodemographic characteristics: NYC
PRAMS, 2004–2005. Maternal and Child Nursing Discussion
24. New York City Department of Health and Mental Hygiene,
Bureau of Maternal, Infant and Reproductive Hygiene. (2006).
Number and percent of women diagnosed with postpartum
depression by select sociodemographic characteristics: NYC
PRAMS, 2006.
25. New York City Department of Health and Mental Hygiene,
Bureau of Maternal, Infant and Reproductive Hygiene. (2007).
Number and percent of women diagnosed with postpartum
depression by select sociodemographic characteristics: NYC
PRAMS, 2007.
26. New York City Department of Health and Mental Hygiene,
Bureau of Maternal, Infant and Reproductive Hygiene (2010).
Number and percent of women diagnosed with postpartum
depression.
27. Segre, L. S., O’Hara, M. W., Arndt, S., & Stuart, S. (2007). The
prevalence of postpartum depression: The relative significance of
three social status indices. Social Psychiatry and Psychiatric
Epidemiology, 42, 316–321.
28. Dennis, C. L., & Letourneau, N. (2007). Global and relationship-
specific perceptions of support and the development of post-
partum depressive symptomatology. Social Psychiatry and Psy-
chiatric Epidemiology, 42, 389–395.
29. Bernazzani, O., Marks, M. N., Bifulco, A., Siddle, K., Asten, P.,
& Conroy, S. (2005). Assessing psychosocial risk in pregnant/
postpartum women using the contextual assessment of maternity
experience (CAME): Recent life adversity, social support and
maternal feelings. Social Psychiatry and Psychiatric Epidemiol-
ogy, 40, 497–508.
30. Boyce, P., & Hickey, A. (2005). Psychosocial risk factors to
major depression after childbirth. Social Psychiatry and Psychi-
atric Epidemiology, 40, 605–612.
31. Wolf, A. W., De Andraca, I., & Lozoff, B. (2002). Maternal
depression in three Latin American samples. Social Psychiatry
and Psychiatric Epidemiology, 37, 169–176.
32. Noh, E. (2007). Asian American women and suicide: Problems of
responsibility and healing. Women & Therapy, 30, 87–107.
33. Kumar, R. (1994). Postnatal mental illness: A transcultural per-
spective. Social Psychiatry and Psychiatric Epidemiology, 29,
250–264.
34. Morsbach, G., Sawaragi, I., Riddell, C., & Carswell, A. (1983). The
occurrence of ‘maternity blues’ in Scottish and Japanese mothers.
Journal of Reproductive and Infant Psychology, 1, 29–35. Maternal and Child Nursing Discussion
ORDER ORIGINAL, PLAGIARISM-FREE ESSAY PAPERS HERE
35. Xie, R. H., He, G., Liu, A., Bradwejn, J., Walker, M., & Wen, S.
W. (2007). Fetal gender and postpartum depression in a cohort of
Chinese women. Social Science and Medicine, 65, 680–684.
36. Xie, R. H., He, G., Koszycki, D., Walker, M., & Wen, S. W.
(2009). Prenatal Social Support, Postnatal Social Support, and
Postpartum Depression. Annals of Epidemiology, 19, 637–643.
37. Patel, V., Rodrigues, M., & DeSouza, N. (2002). Gender, poverty,
and postnatal depression: A study of mothers in Goa, India. The
American Journal of Psychiatry, 159, 43–47.
38. Chu, S. Y., Abe, K., Hall, L. R., Kim, S. Y., Njoroge, T., & Qin,
C. (2009). Gestational diabetes mellitus: All Asians are not alike.
Preventive Medicine, 49, 265–268.
39. Kozhimannil, K. B., Pereira, M. A., & Harlow, B. L. (2009).
Association between diabetes and perinatal depression among
low-income mothers. JAMA: Journal of the American Medical
Association, 301, 842–847.
40. Pedula, K., Hillier, T., Schmidt, M., Mullen, J., Charles, M., &
Pettitt, D. (2009). Ethnic differences in gestational oral glucose
screening in a large US population. Ethnicity and Disease, 19,
414–419.
41. Way, B. M., & Lieberman, M. D. (2010). Is there a genetic
contribution to cultural differences? Collectivism, individualism
and genetic markers of social sensitivity. Social Cognitive and
Affective Neuroscience, 5, 203–211.
42. Wong, S. L. (2001). Depression level in inner-city Asian Amer-
ican adolescents: The contributions of cultural orientation and
interpersonal relationships. Journal of Human Behavior in the
Social Environment, 3, 49–64.
43. Ryder, A. G., Yang, J., & Heini, S. (2002). Somatization versus
psychologization of emotional distress: A paradigmatic example
for cultural psychopathology. In W. J. Lonner, D. L. Dinnel, S.
A. Hayes, & D. N. Sattler (eds) Online readings in psychology
and culture, Unit 9. Center for Cross-Cultural Research, Western
Washington University: Washington. Maternal and Child Nursing Discussion
44. Ryder, A. G., Yang, J., Zhu, X., Yao, S., Yi, J., Heine, S. J., et al.
(2008). The cultural shaping of depression: Somatic symptoms in
China, psychological symptoms in North America? Journal of
Abnormal Psychology, 117, 300–313.
45. Cho, J., Holditch-Davis, D., & Miles, M. (2008). Effects of
maternal depressive symptoms and infant gender on the interac-
tions between mothers and their medically at-risk infants. Journal
of Obstetric, Gynecologic, and Neonatal Nursing, 37, 58–70.
46. Beebe, B., Jaffe, J., Buck, K., Chen, H., Cohen, P., Feldstein, S.,
et al. (2008). Six-week postpartum maternal depressive symp-
toms and 4-month mother-infant self-and-interactive contin-
gency. Infant Mental Health Journal, 29, 442–471.
47. Shea, E., & Tronick, E. (1988). The Maternal Self-Report
Inventory: A research and clinical instrument for assessing
Matern Child Health J (2013) 17:1599–1610 1609
123
maternal self-esteem. In H. E. Fitzgerald, B. M. Lester, & M.
W. Yogman (Eds.), Theory and research in behavioral pediatrics
(Vol. 4, pp. 101–141). New York: Plenum Publishing
Corporation. Maternal and Child Nursing Discussion
48. Sussman, L. K., Robins, L. N., & Earls, F. (1987). Treatment-
seeking for depression by Black and White Americans. Social
Science and Medicine, 24, 187–196.
49. Wagner, J., Tsimikas, J., Abbott, G., de Groot, M., & Heapy, A.
(2007). Racial and ethnic differences in diabetic patient-reported
depression symptoms, diagnosis, and treatment. Diabetes
Research and Clinical Practice, 75, 119–122.
50. Wagner, J. A., Perkins, D. W., Piette, J. D., Lipton, B., & Aikens,
J. E. (2009). Racial differences in the discussion and treatment of
depressive symptoms accompanying type 2 diabetes. Diabetes
Research and Clinical Practice, 86, 111–116.
51. Tiwari, A., Rajan, M., Miller, D., Pogach, L., Olfson, M., &
Sambamoorthi, U. (2008). Guideline-consistent antidepressant
treatment patterns among veterans with diabetes and major
depressive disorder. Psychiatric Services, 59, 1139–1147.
1610 Matern Child Health J (2013) 17:1599–1610
Copyright of Maternal & Child Health Journal is the property of Springer Science & Business Media B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder’s express written permission. However, users may print, download, or email articles for individual use. Maternal and Child Nursing Discussion
- Rates and Predictors of Postpartum Depression by Race and Ethnicity: Results from the 2004 to 2007 New York City PRAMS Survey (Pregnancy Risk Assessment Monitoring System)
- Abstract
- Introduction
- Methods
- Sample
- Measures
- Variables
- Statistical Analyses
- Results
- Discussion
- Conclusion
- Acknowledgments
- References Maternal and Child Nursing Discussion