UC Berkeley

Background: Perinatal mental disorders (PMD), including perinatal mood and anxiety disorders (PMAD) and serious mental illness (SMI) are a major public health issue in the United States. Studies find racial and ethnic disparities in these disorders, including in diagnosis and access to adequate and quality mental healthcare. These disorders are linked to adverse pregnancy outcomes and impaired child development. While racial and ethnic disparities in PMD and access to quality mental healthcare have been documented, evidence on the prevalence of PMD by race is mixed, highlighting the need for further research. Moreover, limited research has empirically investigated the association of structural racism on these disparities.

Methods: This dissertation aims to evaluate the trends and racial and ethnic disparities in PMD and examine and the relationship between structural racism and these outcomes among a diverse cohort in California. The first paper investigates trends and racial disparities in PMD. The second paper incorporates a systematic review of empirical studies on structural racism and mental health/substance use outcomes. The final paper empirically examines the association between structural racism, measured by the index of concentration at the extremes (ICE), and PMD.

Conclusion: Leveraging California state-wide data on over 10 million births spanning 20 years (1997-2018), this dissertation seeks to advance knowledge on the racial disparities and drivers of PMD. Understanding the impact of structural racism on perinatal mental health is crucial for identifying underlying causes and informing effective, multi-sectoral public health interventions and population-level policies aimed at eliminating these inequities and ultimately improving the mental health of birthing populations in this country.