Mind the Gap: Worsening Black Maternal Mental Health Outcomes During the Pandemic

Lediya Dumessa, PhD

Dr. Lediya Dumessa earned her Ph.D. in Clinical Psychology from Mississippi State University, her M.A in Clinical Psychology from Western Carolina University, and her B.A. in Psychology from University of Tennessee. She completed her pre-doctoral internship training at Johns Hopkins University Counseling Center. Prior to that, she trained in various settings including specialty outpatient clinics, residential treatment programs, substance use units, and inpatient hospital. Prior to joining the Washington Anxiety Center of Capitol Hill, Dr. Dumessa worked as a staff psychologist at Johns Hopkins University Counseling Center providing brief therapy, group therapy, and workshops to undergraduate and graduate students. She has experience treating varied presenting concerns, such as depression, anxiety, adjustment issues, disruptive behavior in children, grief, trauma, acculturation issues, interpersonal difficulties, and substance use disorders.

Dr. Dumessa utilizes a wide range of interventions including, Cognitive Behavioral Therapy (CBT), Exposure Therapy, Dialectical Behavior Therapy (DBT), Mindfulness, Parent Management Training (PMT), Trauma Focused CBT, and Motivational Interviewing (MI). She provides treatment in various modalities including individual, couples, group, and family coaching.

Johanna Kaplan, PhD

Dr. Johanna Kaplan is the director of the Washington Anxiety Center of Capitol Hill. She is a licensed clinical psychologist in Washington, DC, Maryland, Virginia, and Delaware. She is also a PSYPact provider. She earned her Ph.D. in Clinical Psychology from The Catholic University of America and her undergraduate degree in Psychology and Communications from American University in Washington, D.C.

Prior to opening the Washington Anxiety Center, she worked for four years at the Center for Anxiety and Behavior Change in Rockville MD. She also completed 18 months of post-doctoral training at the Institute of Living/Hartford Hospital at the Anxiety Disorders Center/Center for Cognitive Behavioral Therapy under the direct supervision of David Tolin, Ph.D.

Additionally, she completed a 2-year post-baccalaureate fellowship and a 6-year pre-doctoral fellowship in the Mood and Anxiety Disorders Program at the National Institute of Mental Health. Dr. Kaplan has received extensive clinical and clinical-research training in anxiety, mood, and obsessive-compulsive spectrum disorders and has completed clinical and research work in private practice, community, counseling center, and hospital-based settings.

Together, she has over 60 presentations/publications in the domain of clinical anxiety in adult, adolescent, and child populations. She has been interviewed for several articles in Parent magazine, parent.com, Romper.com, klicknews.com, the Hillrag.com, www.livestrong.com and has been interviewed by several local television media outlets. She continues to actively pursue her education in evidence-based treatments for anxiety in these populations.

March 15, 2022

Mind the Gap: Worsening Black Maternal Mental Health Outcomes During the Pandemic

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Pregnancy and childbirth can be a joyous time in a woman’s life but can also be a challenging one. Besides the physical changes that occur during pregnancy and postpartum, about 20% of women may experience mental health challenges. While increasing awareness of maternal mental health needs has led to various national efforts to improve maternal health care, Black mothers disproportionately face disparities in accessing and receiving appropriate health services. In the United States, Black women are three times more likely to die from childbirth, and Black infants are two times more likely to die before their first birthday.

Regardless of socioeconomic status, Black women have historically experienced higher rates of medical complications (e.g., hypertension, pelvic floor issues, hemorrhaging), poorer practitioner-patient advocacy and communication, and fewer postpartum mental and physical healthcare supports. Awareness of these risks puts black mothers at a higher risk for perinatal and postnatal mood and anxiety disorders (PMADs) such as depression, anxiety, obsessive compulsive disorder, and posttraumatic stress disorder.

It is estimated that Black mothers' risks for PMADs is double that of the general population. Unsurprisingly, the inadequate access to quality and culturally sensitive physical and mental health care discourages Black mothers from seeking appropriate prenatal care which in turn is associated with higher infant mortality as well as lower levels of postnatal care for both the mother and baby. Unfortunately, the rates worsened during the COVID-19 pandemic as Black communities, including pregnant women, became disproportionately impacted by the disease. Further decreased access to care during the pandemic due to reallocation of resources to acute care meant even wider health care inequalities. Restriction surrounding in person medical appointments also contributed to the under-detection of mental health concerns in Black women for whom face to face connection aids in building trust with health care providers.

Conventionally, the role of psychologists in addressing perinatal and postnatal mood and anxiety disorders has largely been limited to clinical work within offices. The intricate cultural, systemic, educational, and now pandemic-related barriers, however, call for the expansion of this role beyond that of reduction of anxiety and depressive symptoms, to include patient advocacy and effective communication, mother and infant health education, and psychosocial support (e.g., breastfeeding and community resource identification). While cognitive-behavioral strategies such as cognitive restructuring, gradual exposure, problem-solving, and communication strategies are effective ways of decreasing PMADs long term, comprehensive standards of care involve integration of professional support and advocacy into treatment. Psychologists are faced with a unique privilege and responsibility of minding the gap when it comes to treating PMADs in Black women.