Racial Disparities in Psychiatric Treatment Among Patients Positive for COVID-19 During Pregnancy

Background: The COVID-19 pandemic has disproportionately devastated Black patients, both in regard to disease incidence and mortality, and COVID-associated mental health burdens (2). This, coupled with research suggesting that pregnant women are vulnerable to COVID-related psychosocial stressors (3), provides imperative to study racial disparities in mental health outcomes among pregnant women during the COVID-19 pandemic. Methods: Retrospective chart review: Patients were eligible if they tested positive for COVID-19 prior to delivery and received obstetric care from a Cleveland Clinic provider between March and December of 2020. We matched for age, race, marital status, and zip code to identify control patients (negative COVID-19 test prior to delivery). Results: 645 charts were reviewed. Of the 129 patients positive for COVID-19 prior to delivery, 28.8% were Black, 63.2% were White, and 8.0% were Other. Ratios approximately were the same for the 516 patients negative for COVID-19. In the COVID positive cohort, 66.7% of Black patients and 75.9% of white patients attended at least one postpartum visit. Among these patients, 20.8% of black patients had a positive brief depression screen, and 11.7% of white patients attending these visits had a positive brief screen. In the COVID negative cohort, black patients also had lower postpartum attendance rate compared to white  patients (70.8% vs 82.6%). Among patients who attended a postpartum visit, black and other patients showed higher positive brief screen rates compared to white patients (29.8% vs 20.6% vs 14.2%, respectively). Prior to pregnancy, a higher rate of white patients received psychotropic treatment compared to black patients (14.6% vs 30.1%). The racial breakdown of patients using pre-pregnancy psychotropic medications was similar for the COVID positive cohort. Discussion: The disproportionate representation of Black patients among positive cases is concerning considering that prior to pregnancy, a higher rate of white patients received psychotropic treatment compared to black patients. This supports past research suggesting that minority women are particularly at risk for under-treatment of psychiatric conditions (1). Poorly managed psychiatric conditions rank highest among risk factors for postpartum depression (4). We speculate that this helps to explain the relationship between lower rates of pre-pregnancy psychiatric medication and higher rates of positive brief screens among black patients.

1. American Psychiatric Association: Mental Health Disparities: African Americans. (2017)


2. Ibrahimi S, et al. COVID-19 Devastation of African American Families: Impact on Mental Health and the Consequence of Systemic Racism.(2020)


3. Liu, Cindy H, et al. Risk factors for depression, anxiety, and PTSD symptoms in perinatal women during the COVID-19 Pandemic (2021)


4. Stewart, DE, et al. Postpartum Depression. (2016)