The role of medical mistrust in racial and ethnic inequities in postpartum mental health care

Among a sample of people with postpartum depressive symptoms, we examine the relationship between medical mistrust and receipt of a perinatal mood and anxiety disorder (PMAD) diagnosis and postpartum mental health care by race and ethnicity. Data are from the 2020 Postpartum Assessment of Health Survey administered at 12-14 mo. postpartum across 7 US jurisdictions. The analytical sample included 454 respondents with a positive screen on the Patient Health Questionnaire-2. Self-reported measures included: medical mistrust (measured with the Group-Based Medical Mistrust Scale), PMAD diagnosis by a provider, postpartum mental health care, and race and ethnicity. Survey-weighted risk ratios (RR) were calculated for the relationship between a 1-unit increase in medical mistrust and PMAD diagnosis and care, overall and by race and ethnicity. Higher levels of medical mistrust were reported among individuals that were single, Black, Hispanic, had lower educational attainment, and public/no insurance. Increasing medical mistrust was associated with a moderately increased likelihood of PMAD diagnosis (RR: 1.2; 95% CI: 0.8-1.0) and a reduced likelihood of receiving postpartum mental health care (RR: 0.9; 95% CI: 0.8-1.1). The latter largely driven by the suspicion subscale (RR: 0.8; 95% CI: 0.7-1.0). The relationship between medical mistrust and a reduced likelihood of care was strongest among Black and American Indian/Alaskan Native (AIAN) postpartum people for both PMAD diagnosis (RR: 0.6; 95% CI: 0.1-6.3) and care (RR: 0.9; 95% CI: 0.4-2), though subgroup CIs overlapped. Medical mistrust specifically related to suspicion may be related to racial and ethnic inequities in postpartum mental health care. • Racism fosters medical mistrust, which can reduce healthcare • First study linking medical mistrust to inequities in postpartum mental health care • Higher mistrust, especially suspicion, potentially linked to reduced care • Effects stronger for Black and Indigenous postpartum people • Improving medical practices may increase trust and equity in care