New survey results find that sociocultural factors may be involved in how likely someone is to report moderate to severe depression symptoms and get a prenatal depression diagnosis.

The differences across racial and ethnic groups and maternal nativity were evident in the cross-sectional study but the authors believe that the observed advantage among non–U.S.-born individuals may not be real when race and ethnicity are considered. They may keep a 'stiff upper lip', like Finland being called the happiest place on earth despite few of them seeming happy and instead being that culturally they believe they need to say they are happy on surveys. Not that they are.

Of the 252,171 pregnant women included in data from Kaiser-Permanente Northern California who attended at least one prenatal care visit and delivered a live birth between January 1, 2013, and December 31, 2019, non–US-born women had fewer prenatal depression diagnoses even though they had a higher risk of moderate to severe depression symptoms. So depression diagnoses could be a sign or privilege or it may be cultural belief that they should just tough it out. 

The 83,566 non-US-born women had fewer prenatal depression diagnoses compared with their US-born counterparts even in the same racial and ethnic subgroups. For example, non–US-born Black pregnant individuals presented lower risk of a depression diagnosis (aRR, 0.30) and depression than US-born Black individuals.


Relative Risk of Prenatal Depression Diagnosis of Non−US-Born Compared With US-Born Pregnant Individuals by Race and Ethnicity. Adjusted for maternal age, education, parity, delivery year, and NDI. aRR indicates adjusted adjusted relative risk.

Confounders are that these were self-reported race, ethnicity, and country of birth plus self-reported symptoms then subjectively categorized by Patient Health Questionnaire-9 scores.

Citation: Kelly-Taylor K, Aghaee S, Nugent J, et al. Country of Birth, Race, Ethnicity, and Prenatal Depression. JAMA Netw Open. 2025;8(9):e2531844.