By Marilynn Larkin

NEW YORK (Reuters Health) – Structural racism and the
COVID-19 pandemic combined to form a “syndemic” that was
associated with negative postpartum mental health among Black
birthing individuals, researchers say.

A syndemic is defined as the aggregation of two or more
endemic and epidemic conditions leading to adverse repercussions
for health.

“Too often, we ignore how impactful a crisis is on a
community that has been historically underserved and
marginalized,” Dr. Wanjikũ F. M. Njoroge of the Perelman School
of Medicine at the University of Pennsylvania told Reuters
Health by email. “This article joins the literature both in the
US and around the world that is interrogating the devastation
these additive crises may have on the lives of birthing
individuals and their developing children.”

“As a health equities researcher and a Black woman, I was
saddened, but unsurprised by the experiences or our Black
participants,” she said. “The same communities who have been
historically underserved and marginalized, who have historically
had less access and less resources, are the same communities
that have been hardest hit by this pandemic. In the US,
secondary to structural racism, those communities are often
communities of color.”

As reported in JAMA Psychiatry, Dr. Njoroge and colleagues
followed 151 Black birthing individuals (mean age, 31) from
pregnancy (April 17 to July 8, 2020) through the early
postpartum period (August 11, 2020, to March 2, 2021).

The main outcomes were associations between composite
variables capturing negative experiences of the COVID-19
pandemic and various types of racism (general structural,
neighborhood structural and interpersonal), with postpartum
depression (Edinburgh Postnatal Depression Scale) and anxiety
(Generalized Anxiety Disorder 7-item scale).

Overall, 44 participants (29%) screened positive for
postpartum depression. Logistic regression revealed that more
negative COVID-19 pandemic experiences (odds ratio, 1.88) and
higher interpersonal racism (OR, 1.60) were independently
associated with higher likelihood of screening for postpartum
depression.

Further, negative COVID-19 pandemic experiences were
associated with a greater likelihood of screening positive for
depression only at higher levels of systemic racism (OR, 2.52)
and interpersonal racism (OR, 1.90) but not at lower levels of
systemic or interpersonal racism.

Twenty participants (13%) met screening criteria for
postpartum anxiety. As with postpartum depression, negative
COVID-19 experiences were associated with anxiety only at higher
levels of interpersonal racism (OR, 1.85) but not at lower
levels (OR,).94).

Dr. Njoroge said, “Though our study looked specifically at
the experience of our Black patients, other groups have looked
at other minoritized communities and found a similar picture.
What is needed includes: 1) improving access to mental health
treatment for Black individuals during the perinatal period,
especially now during the ongoing pandemic; (2) increasing
vigilance and number of check-ups post-childbirth; and (3)
ensuring that providers recognize that racism represents a
specific and unique stressor for Black birthing individuals,
especially in the time of the pandemic, which shapes their
birthing outcomes and mental health postpartum.”

Dr. Rubiahna Vaughn, Director of Consultation Liaison and
Emergency Psychiatry, Weiler Hospital, Montefiore Health System
in New York City, commented on the study in an email to Reuters
Health. “Sadly, the findings are not surprising at all. In the
population that I treat, which is primarily publicly insured
Black and Brown women, the pandemic has only served to worsen
the chronic stressors that can contribute to poor mental health
outcomes.”

“Much like the women in this study,” she said, “my patients
are struggling with food and housing insecurity, unemployment,
domestic violence and so much more in a society that has chosen
to look the other way.”

“The solution to this issue isn’t about individual
clinicians doing a better job,” she said. “It’s about our
society recognizing that Black mothers and infants matter, that
Black people matter. Mothers and babies are the heart of a
community. Taking care of them is really about committing to
taking care of an entire community. And that starts with equal
rights, safe housing, fresh food, employment, access to
healthcare, and more.”

SOURCE: https://bit.ly/3JNfuRW JAMA Psychiatry, online April
13, 2022.