In a recent publication by Susan Gennaro, PhD, RN, FAAN, Professor in the William F. Connell School of Nursing at Boston College, and her colleagues in The Nurse Practitioner, it was revealed that Black pregnant individuals often grapple with multiple mental health concerns. The study emphasizes the need for prenatal screening and treatment targeting stress, in addition to addressing depression and anxiety. This research is a significant contribution to the ongoing discourse on maternal mental health, shedding light on the specific challenges faced by Black pregnant individuals.
The research group recommends that interventions during the prenatal period for Black individuals should focus on addressing mental health distress, specifically targeting high levels of depression, anxiety, and stress. The study underscores the importance of adopting a comprehensive approach to mental health care during pregnancy to ensure the well-being of Black pregnant individuals.
Depression, anxiety, and stress commonly co-occur in Black pregnant individuals, as highlighted by the findings of the study. Conducted across three U.S. urban clinics, the research aimed to determine the eligibility of pregnant Black patients for a trial of cognitive–behavioral therapy tailored to racial/ethnic minority populations. At less than 19 weeks of gestation, 452 patients, aged 18 to 40, completed assessments using the Edinburgh Postnatal Depression Scale, the General Anxiety Disorders–7 Scale, and the Perceived Stress Scale.
The results indicated that 43% of the participants screened positive for depression, anxiety, and/or stress. Among these individuals, various combinations of mental health concerns were identified, with 81% reporting depression alone or in conjunction with anxiety or stress, 46% reporting anxiety alone or with depression or stress, and 76% reporting stress alone or with depression or anxiety. These findings underscore the complexity and intersectionality of mental health challenges during pregnancy among Black individuals.
The study’s implications extend to the need for changes in prenatal mental health screening practices. While national prenatal care guidelines recommend screening for depression and anxiety, the study highlights the inconsistency and underutilization of these screenings. According to Dr. Gennaro and her colleagues, screening during pregnancy is less frequent than in the postpartum period, and when conducted, evidence-based care is not consistently provided. Alarmingly, over a third of pregnant individuals, particularly those from minority communities, have never undergone screening.
Additionally, the study advocates for the inclusion of stress screening in prenatal care guidelines. The authors argue that the findings underscore the necessity of incorporating stress screening to ensure a more comprehensive understanding of the mental health status of pregnant individuals. The study suggests that individuals who are younger or attending school may be at higher risk, warranting additional consideration for those with borderline screening scores.
Despite the potential challenges, the study emphasizes that screening for depression, anxiety, and stress during prenatal visits is a feasible and time-efficient practice. On average, the screening process added only 10 minutes to the prenatal visit. The authors recommend the use of validated tools for screening, allowing for focused attention on the full spectrum of symptoms. This approach is deemed essential, given the overlap of some mental health symptoms with normal physiological changes during pregnancy, such as appetite and sleep alterations.
The study’s authors also highlight a critical point regarding individuals who acknowledge self-harm tendencies in their responses. According to the Edinburgh Postnatal Depression Scale, immediate further assessment is recommended, with potential referrals for emergency psychiatric evaluation or social work support.
In conclusion, this study brings attention to the multifaceted mental health challenges faced by Black pregnant individuals and advocates for a more comprehensive approach to prenatal mental health care. The findings underscore the urgency of consistent and inclusive mental health screening practices during pregnancy, with a particular emphasis on addressing stress. As maternal mental health continues to be a critical aspect of overall well-being, initiatives that prioritize mental health support during pregnancy are essential for promoting healthier outcomes for both mothers and their infants.