A Legacy of Division: The Toll of Segregation on Black Prenatal Mental Health
By Lauren DeSouza- Master of Public Health, Simon Fraser Public Research University – Canada
https://empathymh.org/our-team/
Staff Research and Content Writer
© Copyright – Empathy Mental Health – A Division of Genesis Behavioral Services, Inc., Milwaukee, Wisconsin – January 2025 – All rights reserved.
The US has a long and troubled history of racial residential segregation. While laws permitting or promoting segregation have been repealed, their legacy remains. Segregation has profound and long-lasting impacts on income and wealth gaps, health, and longevity. The social, physical, and socioeconomic contexts of living in a segregated neighborhood negatively impact many facets of health for Black people.
In a new study, researchers demonstrate the impact of racial residential segregation on the mental health of pregnant people. The findings reveal that living in a highly segregated residential neighborhood leads to an increased risk of prenatal depression and anxiety for Black pregnant people.
What is racial residential segregation?
Racial residential segregation is the degree to which two or more racial groups live apart from one another. Racial residential segregation is a dimension of structural racism and a fundamental cause of health disparities among Black Americans.
Racial residential segregation negatively impacts health by:
- Limiting investment in economic infrastructure in communities of color, predominantly Black communities,
- Limiting access to good quality social and built environments,
- Restricting access to healthcare,
- Limiting education and employment opportunities, and
- Increasing psychological stress
Racial residential segregation between Black and White communities was the result of explicit government policies such as Jim Crow laws and redlining policies from the Federal Housing Administration implemented from the 1930s-1960s. The US has made tremendous progress in abolishing serration in public spaces, but residential segregation has thus far proven more difficult to eradicate.
The experience of residential segregation is vastly different for Black Americans compared to other racial groups. For some communities, racial residential segregation can be protective for health because it can lead to stronger social connections within one’s community and reduce instances of discrimination. Hispanic and Asian communities have lower odds of depression and anxiety when they live among others of their race. However, there seems to be a threshold for Black communities, wherein a certain degree of segregation tips the scale toward poor mental health. This is likely because of the structural racism that underpins racial residential segregation, which has led to a lack of investment into the social and economic fabric of these communities for decades.
Photo by Kelly on Pexels
How did this study work?
This cross-sectional study used medical records from Kaiser Permanente Northern California (KPNC) from pregnant people who gave birth between January 1, 2014, and December 31, 2019, and met the following criteria:
- Were enrolled in the KPNC health plan during pregnancy
- Attended at least one prenatal care visit
- Self-reported their racial and ethnic group as Asian, Hispanic, Black, or White.
Overall, the study included over 20,000 pregnant people in Northern California.
The study aimed to understand better how racial residential segregation impacts prenatal mental health to inform policy and clinical interventions to improve the health of new mothers and their children. The primary outcomes of interest were depression and anxiety scores as documented in the patients’ Electronic Health Records.
This study quantified segregation using the Gi* statistic. The Gi* statistic measures clustering and quantifies the extent to which racially and ethnically similar neighborhoods group together in space.
- A positive Gi* score indicates an overrepresentation of the racial group relative to the surrounding area (segregation)
- A Gi* statistic near zero indicates a similar representation of the racial and ethnic group in the index census tract and neighboring tracts compared with the larger surrounding geographic area.
- A negative Gi* statistic indicates underrepresentation of the racial and ethnic group in the index census tract and neighboring tracts compared with the larger surrounding geographic area.
The researchers determined that a Gi* statistic of 1.96 indicated statistically significant racial segregation. They categorized each patient in the study into high, medium, or low racial residential segregation based on their Gi* statistic:
- High segregation (Gi* >1.96)
- Medium segregation (Gi*= 0-1.90)
- Low segregation (Gi* <0)
The researchers used patients’ medical records to determine mental health in the prenatal period. Each patient enrolled with KPNC was screened for depression and anxiety using validated screening measures. These scores formed the basis of the researchers’ statistical analysis.
What were the results?
In this study, the researchers were primarily interested in rates of prenatal depression and anxiety among pregnant people of different races. They found that Black people had the highest prevalence of depression (18.3%) and anxiety (18.4%) during pregnancy of all racial groups. Living in a neighborhood with high residential racial segregation was associated with a 25% higher risk of depression and a 14% higher risk of anxiety for Black pregnant people.
Black and Asian pregnant people were most likely to live in neighborhoods with high racial segregation. In contrast, White pregnant people were more likely to live in areas with less racial segregation. Though Asian people lived in areas with high racial segregation, this served as a protective factor for prenatal mental health. Asian pregnant people had the lowest rates of prenatal depression (5.7%) and anxiety (6.4%) but some of the highest levels of racial residential segregation.
Of note, the researchers did not find a dose-response relationship between higher racial residential segregation and the severity of depression symptoms. That is, a higher Gi* score was not correlated with more severe symptoms of depression or anxiety.
What are the consequences of this research?
This study found that higher segregation was associated with lower socioeconomic status, lower educational attainment, and higher neighborhood deprivation for Black pregnant people. These factors may contribute to greater difficulty accessing healthcare and a higher likelihood of experiencing stressful life events, both of which significantly increase the likelihood of experiencing a mental health condition during pregnancy. Compared with White, Hispanic, and Asian people, Black people in the US may experience more detrimental impacts from segregated neighborhoods.
Photo by Andrea Piacquadio on Pexels
The impact of racial residential segregation on mental health is also generational. Poor mental health can have long-term deleterious effects on child development. Children born to parents experiencing the detrimental effects of segregation are more likely to face challenges such as impaired emotional regulation, behavioral issues, and lower educational attainment. Additionally, living in segregated neighborhoods often means limited access to quality schools, safe environments, and economic opportunities, which can further hinder a child’s development. These cumulative disadvantages perpetuate cycles of inequality, ensuring that the negative impacts of segregation persist across generations, deepening systemic inequities in health, education, and socioeconomic outcomes.
What are the key takeaways?
This cross-sectional study provides evidence of an association between residential segregation and prenatal mental health conditions that differs by racial and ethnic groups. The findings suggest that Black people experience worse prenatal mental health as a result of segregation, while Asian, Hispanic, and White individuals experience better mental health.
This study sheds light on the ongoing consequences of racial segregation on mental health, particularly for Black communities. It underscores the need for further research on residential segregation, race and ethnicity, and health to understand the mechanisms that continue to exacerbate disparities for Black communities. Moreover, these findings emphasize the need for social and public health policies in neighborhoods with high racial segregation to improve prenatal mental health outcomes and reduce racial disparities, in particular for Black pregnant people and future generations of children born into these neighborhoods.
Key Points
– There is an association between residential segregation and prenatal mental health conditions that differs by racial and ethnic group.
– For some racial groups, living with members of your racial community can be a protective factor; for Black people, the structural racism upheld with continued segregation has a deleterious impact on mental health.
– Racial residential segregation negatively impacts the mental health of Black pregnant people, leading to increased risks of prenatal depression and anxiety.
– There is a need for policy and public health interventions to address prenatal mental health in Black communities and to address the ongoing consequences of racial segregation.