Changes in Experiences With Discrimination Across Pregnancy and Postpartum: Age Differences and Consequences for Mental Health

Objectives. We aimed to contribute to growing research and theory suggesting the importance of examining patterns of change over time and critical life periods to fully understand the effects of discrimination on health, with a focus on the period of pregnancy and postpartum and mental health outcomes.Methods. We used hierarchical linear modeling to examine changes across pregnancy and postpartum in everyday discrimination and the resulting consequences for mental health among predominantly Black and Latina, socioeconomically disadvantaged young women who were receiving prenatal care in New York City.Results. Patterns of change in experiences with discrimination varied according to age. Among the youngest participants, discrimination increased from the second to third trimesters and then decreased to lower than the baseline level by 1 year postpartum; among the oldest participants, discrimination decreased from the second trimester to 6 months postpartum and then returned to the baseline level by 1 year postpartum. Within-subjects changes in discrimination over time predicted changes in depressive and anxiety symptoms at subsequent points. Discrimination more strongly predicted anxiety symptoms among participants reporting food insecurity.Conclusions. Our results support a life course approach to understanding the impact of experiences with discrimination on health and when to intervene.A large and ever-growing body of research has shown that experiences with discrimination are associated with a wide range of adverse mental and physical health outcomes and may help explain socioeconomic and racial/ethnic health disparities in the United States.1,2 Although the majority of this research has been cross-sectional, an increasing number of longitudinal studies have shown that discrimination predicts poorer health.3,4 Some studies have gone further to examine within-person changes over time in discrimination and the resulting health implications.5–7Recently, Gee et al.8 proposed a life course perspective, calling for more research on changes in experiences with discrimination during critical periods to fully understand discrimination’s health effects and inform interventions. We examined changes across pregnancy and 1 year postpartum in experiences with everyday discrimination and consequences in terms of subsequent changes in depressive and anxiety symptoms among predominantly Black and Latina, socioeconomically disadvantaged young women residing in New York City. In their recent theoretical article, Gee et al. asserted:

Exposure to racism can change in nature, importance, and intensity. Similarly, health and the factors that produce health can change. A growing body of research shows that health is not merely the result of risks that occur sporadically at one point in time. Failure to attend to these temporal changes not only shortchanges our knowledge base, but also can lead to missed opportunities for intervention.8^(p967)

Cross-sectional (or even longitudinal) studies examining between-subjects associations of discrimination with health outcomes cannot assess changes in discrimination over time. To advance understanding of the health effects of discrimination, taking a life course perspective and examining changes in discrimination over time are crucial. Gee et al.8 highlighted potential age-patterned exposures to discrimination, with certain critical periods during which changes are more drastic. Some research supports this perspective, with evidence that racial discrimination increases across adolescence5 among African American youths and increases over time6 among African American, Latino, and Asian American youths. Although Gee et al. focused on racism, we suggest that their framework applies to all forms of discrimination.Pregnancy and postpartum may be a critical period to study changes in discrimination, given that women’s experiences with discrimination during pregnancy increase their likelihood of adverse maternal and infant health outcomes such as having a low birth weight infant9,10 and contracting a sexually transmitted infection.11 Also, women experience changes in their bodies, social relationships, and emotions12 during pregnancy and postpartum and come into contact with a variety of new social institutions, including those related to obstetrics and child care; thus, as a result of these life changes, women may experience changes in exposure to discrimination during this time period.8Changes in experiences with discrimination may also vary according to factors such as age, race/ethnicity, nativity, and socioeconomic status. Socioeconomically disadvantaged women, women of color, and women born outside of the United States who may have experienced discrimination regularly throughout their lives might feel that they are treated better or face less discrimination during pregnancy and the postpartum period, when people may extend them courtesies (e.g., giving up a seat on a bus) and institutions may offer added support (e.g., ensuring prenatal and infant care).By contrast, some theories suggest that Black and Latina women in the United States may experience heightened discrimination during pregnancy and postpartum because of group stereotypes related to sexuality and motherhood (e.g., sexual promiscuity, single parenthood) and the societal devaluation of motherhood in women of color.13,14 Some of these negative stereotypes specifically target Black and Latina adolescents and young women14 and so may be particularly relevant for younger age groups. Thus, experiences with discrimination can increase or decrease during pregnancy and postpartum, and the pattern of change may vary on the basis of characteristics such as age, race/ethnicity, nativity, and socioeconomic status. It is therefore important to assess these characteristics as potential moderators of changes in discrimination during this period.Discrimination is an important determinant of mental health across different social groups.1,2 The majority of research on discrimination and mental health is cross sectional; as noted, however, an increasing amount of research has explored this association longitudinally. For example, individual differences in Black Americans’ experiences with racial discrimination have been found to predict depressive and anxiety symptoms at a later time point, but differences in depressive and anxiety symptoms have not been found to predict racial discrimination at a later point.4,15Studies have begun to explore whether experiences with discrimination change over time and whether these changes are associated with changes in mental health. Schulz et al.7 found that changes over 2 time points (spaced 5 years apart) in Black American women’s experiences with discrimination were positively associated with simultaneous changes in depressive symptoms and negatively associated with changes in self-rated health.Greene et al.6 found that changes in experiences with discrimination across 5 time points (over 3 years) were negatively associated with simultaneous changes in self-esteem and positively associated with changes in depressive symptoms among Black, Latino, and Asian American high school students. Similarly, Brody et al.5 found that changes in experiences with racial discrimination across 3 time points (over 5 years) were positively associated with simultaneous changes in conduct problems and depressive symptoms among Black adolescents. To the best of our knowledge, despite this existing research on discrimination and depressive symptoms, no work has examined associations between changes in discrimination and changes in anxiety or assessed these associations during pregnancy.Yet, pregnancy and postpartum may be a particularly important period during which to examine associations of discrimination with depressive and anxiety symptoms. During pregnancy, these symptoms have adverse consequences for birth outcomes (e.g., preterm birth and low birth weight) and infant development (e.g., cognitive and motor development).16 In the postpartum period, these symptoms have adverse consequences with respect to parenting behaviors (e.g., playing with and talking to the infant) and the health of both the mother and the child.17 In addition, although past research suggests that discrimination has adverse mental health consequences across diverse groups, much of this research has focused on specific groups (e.g., Black Americans), and thus it is important to examine whether these associations vary according to factors such as age, race/ethnicity, nativity, and socioeconomic status.The first aim of our study was to examine changes in experiences with discrimination across pregnancy and 1 year postpartum and assess whether age, race/ethnicity, nativity, or socioeconomic status moderated the pattern of change. Our second aim was to explore whether changes in experiences with discrimination over time predicted changes in depressive and anxiety symptoms at subsequent points and whether the sociodemographic factors just described moderated these associations.Given the competing theories described earlier, we did not have a specific expected pattern of change; rather, we hypothesized that experiences with discrimination would change across pregnancy and the postpartum period and that age, race/ethnicity, nativity, or socioeconomic status of participant might moderate that pattern. Also, consistent with past work showing associations between discrimination and mental health across diverse groups, we hypothesized that changes in experiences with discrimination across pregnancy and postpartum would significantly positively predict changes in depressive and anxiety symptoms at subsequent time points and that participants’ age, race/ethnicity, nativity, and socioeconomic status would not moderate those associations.