Background Drawing on the intersectionality theory, emerging research shows that discrimination is a multidimensional risk factor for health. Yet, associations between multiple forms of discrimination (MFD) and postpartum depression (PPD) have not been explored. This study compares relationships between MFD and PPD among Palestinian-Arab indigenous minority, Jewish immigrant, and Jewish non-immigrant mothers citizens of Israel.
Methods We used data from a stratified sample of 1,128 postpartum mothers who were interviewed during visiting maternal and child health clinics in 2014–15. We conducted multivariable logistic regression analysis and generalized estimation equation for PPD (Edinburgh Postnatal Depression Scale with cutoff ≥10) and compared associations with two measure of MFD among the study groups, while considering age, socioeconomic status, anti-depressant use, and single forms of discrimination in different models. The two MFD measures included: cumulative MFD (additive experiences of 0, 1, 2 or ≥3 forms of discrimination based on ethnicity, skin color, religiosity level, gender, age and socioeconomic status), and composite MFD (12 categories resulting from an interactions terms between cumulative 0, 1, 2 and 3≥ MFD and women’s study groups. The reference category was non-immigrant Jewish mothers who reported no MFD.
Results Palestinian-Arab mothers reported highest MFD, followed by Jewish immigrant mothers and non-immigrant Jews (≥3MFD=29.2%, 24.1% and 17.8%, respectively). Composite MFD had stronger dose response associations with PPD among Palestinian-Arab women, followed by immigrant Jews and non-immigrant Jewish women. Compared to non-immigrant Jewish women with no MFD, Palestinian-Arab women reporting ≥3MFD, 2MFD and one MFD were more likely to experience PPD. Adjusted odds ratio and 95% confidence intervals (AOR, 95%CI) were 12.68 (5.29–30.40), 10.08 (3.73–27.20), and 3.98 (1.23–12.86), respectively, among Palestinian-Arab women; 4.44 (1.45–13.61), 5.76 (1.84–17.97), 2.32 (0.59–9.12), respectively, among immigrant Jewish mothers; and 4.68 (1.87–11.71), 3.74 (1.32–10.63) and 2.70 (1.06–6.87) among non-immigrant Jews mothers. Cumulative or additive MFD showed a strong dose response association with PPD among non-immigrant Jews and Palestinian-Arab women who reported ≥3MFD, but not among immigrant Jewish women.
Conclusion The study result sheds light on the importance of studying the facets of MFD in intersection with social identities in maternal mental health research. Using a cumulative or additive measure of MFD might underestimate the association between discrimination and PPD specifically in minority and immigrant mothers who face MFD. Health care providers should consider the effects of MFD on PPD among mothers, especially for women located at more than one marginalized axis of identity.
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