How Social Determinants Shape Perinatal Mental Health

By Office of the President | Oct 1, 2024

Perinatal mood and anxiety disorders (PMADs) are significant concerns for people during pregnancy and postpartum. However, the powerful influence of a person’s social environment on their mental health during this time is often overlooked.

In the October 2024 issue of Seminars in Perinatology, School of Public Health researchers second-year doctoral student Breanna Watson, MSPH, CHES, CLC, and Aimee Afable, Ph.D., MPH, Associate Dean for Community Engagement, teamed up with medical student Olga Pinkhasov and former Downstate OB/GYN faculty member Christina Pardo, M.D., MPH, to explore how social determinants of health (SDOH) impact mental health during pregnancy and after birth. Their article, “Social Determinants of Perinatal Mental Health,” looks at the unique challenges mothers from diverse backgrounds face and suggests ways to improve care.

Social determinants of health include things like income, housing, and even cultural influences, which can affect mental health long before pregnancy starts. Once pregnancy begins, new stressors—hormonal changes, physical discomfort, and the pressures of motherhood—can increase the risk of developing PMADs, like depression or anxiety. This risk is exceptionally high for marginalized communities, where access to healthcare might be limited. PMADs impact up to one in five pregnant people; however, those from minority and low-income backgrounds are less likely to be diagnosed or treated.

One compelling concept from the research is the “Urban Stress Model,” which proposes that living in urban environments adds unique pressures to perinatal mental health. Crowded living conditions, constant noise, and higher levels of aggression can make pregnancy more difficult for some individuals. These stressors from urban life can take a significant toll on a pregnant person’s mental health, making it harder to manage the challenges of pregnancy.

The research also offers promising solutions. Expanding Medicaid coverage to 12 months postpartum and supporting paid family leave could be game changers in improving perinatal mental health. Additionally, programs incorporating doulas, community health workers, and culturally sensitive care can help close gaps in care, particularly for marginalized communities. Faith-based initiatives may also play a vital role, especially for Black, Hispanic, and Muslim families, where cultural barriers might prevent individuals from accessing traditional mental health services.

The research team also highlights the critical need to prioritize perinatal mental health, especially for mothers from diverse backgrounds. They advocate for more research to ensure that PMAD screening tools are inclusive and effective across different populations. By focusing on culturally sensitive solutions and building strong, supportive communities, the mental health needs of expecting and new mothers can be addressed and met. This approach enhances mothers’ well-being and allows for healthier futures for their families, creating a foundation of care and support beyond the postpartum period.