Perinatal Social Support in Underserved and Minority Populations

Over half a million childbearing individuals in the United States (US) each year experience perinatal (pre- and postpartum) depression. When combined with other perinatal mood and anxiety disorders, this illness costs society upwards of $14.2 billion in productivity losses, healthcare expenditures, and other costs. Some key risk factors for perinatal depression include a history of depression and low levels of social support. Sexual and gender minorities (SGM) are a growing population disproportionally affected by depression and social isolation due to the discrimination that stems from having a marginalized identity. Discrimination may similarly increase the risk for perinatal depressive symptoms and other adverse outcomes among SGM gestational parents; however, little is known about their perinatal health as they are an understudied perinatal population. SGM gestational parents include pregnant or postpartum individuals assigned female at birth who identify as a sexual minority (e.g., a lesbian or bisexual woman), a transmasculine individual (e.g., a self-identified man, transgender man, or non-binary person), or both (e.g., a gay, transgender man). Approximately 2.6-8.7 million SGMs have biological children, and population estimates of SGM gestational parents continue to rise. The scant studies on SGM gestational parents have been primarily limited to small, cross-sectional samples of lesbian or bisexual woman outside the US, yet preliminary findings indicate profound loneliness and social isolation, as well as postpartum depression at rates twice as high as heterosexual women. Social support has been a promising modifiable target for intervention to prevent or reduce the length and intensity of perinatal depression. Yet, the specific sources, settings, and types of social support that protect heterosexual women from perinatal depression are often not available to or inclusive of SGMs due to high rates of estrangement from biological families and anticipatory fear of experiencing rejection and discrimination in public settings. To address these gaps, the specific aims of this longitudinal, qualitative study are to: (1) describe multidimensional social support among SGM gestational parents across the perinatal period, and (2) characterize SGM gestational parents' perceptions of gaps in and assets of perinatal social support through photos. We will achieve these aims through three online, descriptive, semi-structured interviews across six months complemented with modified photovoice methods, an established visual elicitation method that allows participants to capture and share their experiences through photos. Findings may provide valuable insights on how discrimination influences the multidimensional aspects of perinatal social support SGMs experience at multiple levels of their social environment. This research aligns with the NINR wellness area of scientific focus and will lay the foundation for this predoctoral applicant's program of research by generating foundational knowledge for developing and testing future culturally-competent, community-based social support intervention studies to prevent illness (reduce the risk for perinatal depressive symptoms) in a health disparity population.