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Abstract
Significant racial disparities in maternal health in the United States have persisted, with the highest mortality and morbidity among Black women. Mental health problems are the most common pregnancy-related complications. This study explored the perceptions of the Strong Black Woman, or Superwoman role, stress, and anxiety and the cultural equivalence of the Perceived Stress Scale (PSS) and the State-Trait Anxiety Inventory (STAI) among Black perinatal women. The study consisted of three phases. Phase 1 analyzed data from a survey of 134 Black perinatal women to assess how their experiences as Black women impacted their stress and anxiety levels. Phase 2 consisted of semi-structured interviews and responses to the PSS and STAI of 18 Black perinatal women. Using the sample from Phase 2, Phase 3 combined the qualitative and quantitative data to examine how participants conceptualize stress and anxiety and interpret items in the PSS and STAI using the Rasch model.In Phase 1, the SWS, PSS, and STAI correlations were moderate. Higher education, but not socioeconomic status, was associated with lower stress and anxiety. Only 50% of the PSS and 30% of the STAI items were in the expected range. However, in Phase 3, the number of items in the expected range was much lower. Three themes emerged from the participant interviews: 1) Black Women had strong, diverse, and polarizing opinions of the Strong Black Woman and Superwoman roles. 2) American history, culture, and lived experience impacted the mental health of Black perinatal women. 3) Perinatal Black women fear losing their lives while navigating the healthcare system in the United States. Women emphasized how stress and anxiety frequently manifest physically first. However, the PSS and STAI do not include physical items. Many indicated rephrasing the items to improve clarity and specificity.
This study addresses critical gaps in current knowledge about maternal mental health measurement and assessment among Black perinatal populations. Findings extend previous research in documenting the significance of understanding Black maternal mental health and the need for developing culturally competent measures, the quality of the assessment process, and healthcare modifications for Black perinatal women.