Women with Sexual Minority Status Show Higher Risk of Postpartum Depression

A new cohort study conducted at an academic medical center shed light on the disparities in perinatal depression screening rates and scores between women with sexual minority status and heterosexual cisgender women.¹

The research, published in the Journal of Obstetrics and Gynecology, revealed that those in a sexual minority are not only at higher risk of postpartum depression (PPD) but also face challenges with their sexual orientation being adequately documented in medical records.

The study conducted was conducted by a team of investigators led by Leiszle Lapping-Carr, PhD, Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, from January - December 2019, included a total of 18,234 female-identified individuals who gave birth at the academic medical center. Among this cohort, only 1.5% identified as having sexual minority status, highlighting a potential underrepresentation of sexual minority individuals in medical records.

The results found those with sexual minority status were significantly more likely to attend prenatal care visits (20%) when compared with heterosexual women (13.7%), and postpartum care visits (18.6% vs. 12.8%, respectively).

However, the most significant disparities were observed in depression screening rates. Women in the sexual minority were more likely to be screened for depression during postpartum care (OR, 1.77).

Similarly, a higher percentage of women in the sexual minority attended at least 1 postpartum care visit compared with heterosexual women (18.6% vs. 12.8%, respectively). These results suggested women in the sexual minority are more engaged in obstetric care.

"These findings suggest that sexual minority women are not only at higher risk of postpartum depression but are also more likely to experience barriers in accessing adequate depression screening," investigators wrote. "Moreover, their sexual orientation is often undocumented in medical records, potentially leading to further disparities in care."

Investigators further expressed the need for healthcare providers to implement strategies for measuring sexual orientation reliably during the perinatal period. Specifically, medical record review alone may not be sufficient to capture the sexual identities of patients.

A significant gap in the literature exists regarding perinatal depression screening rates and symptom endorsement among sexual minority women, despite a substantial number of births in the US being to sexual minority individuals, the study cited. Factors such as intimate partner violence and a history of mental illness further compound the disparities in perinatal depression risk among sexual minority individuals.

The importance of healthcare providers being mindful of the distinct requirements and obstacles that sexual minority women encounter throughout pregnancy and the postpartum phase was emphasized. Depression screening rates and the accurate documentation of sexual orientation need to increase, which could result in more precise and efficient interventions for individuals at risk.

The study's limitations included its retrospective design and data from a single academic medical center. However, the findings provided valuable insights into the disparities in perinatal depression screening and the need for inclusive and comprehensive care for sexual minority women.

Future research and interventions should focus on enhancing the cultural competency of healthcare providers, creating inclusive environments, and developing standardized approaches for assessing and documenting sexual orientation in medical records. The study speculated that by addressing these challenges, healthcare systems can work towards providing equitable and supportive care for all women during the perinatal period, regardless of their sexual orientation.

References:

1. Lapping-Carr L, Dennard A, Wisner KL, Tandon SD. Perinatal Depression Screening Among Sexual Minority Women. JAMA Psychiatry. Published online August 02, 2023. doi:10.1001/jamapsychiatry.2023.2619