Lived experiences of interpersonal and perceived racism can increase symptoms of psychological distress and mental health symptoms [1], [2], [3], [4]. These experiences can increase allostatic load, or the cumulative burden of chronic stress, which increases the likelihood of depression and other mental health conditions [5], [6], [7]. The frequency and magnitude of these experiences and their impact on mental health may be partially determined by one’s neighborhood, specifically residential segregation. But, findings on the impact of segregation and mental health outcomes are not clear. Some studies have found that individuals residing among a high concentration of individuals of similar race or ethnicity experience fewer depressive symptoms than their counterparts.[8], [9], [10], [11], [12] Specifically among Hispanic populations, living among an increasing number of Hispanic individuals has been shown to be associated with decreased depressive symptoms [8], [9], [10], hypothesized in part to be related to a shared culture, language, or physical appearance [9]. Strong social and family support structures present in ‘ethnic enclaves’ may buffer the effects of low socioeconomic status or neighborhood deprivation [13]. Similar mechanisms may be relevant among Black populations as a separate study found that non-Hispanic (NH) Black adults living among higher proportions of Black individuals experience lower rates of depression [11]. The hypothesized mechanism behind these findings are that NH Black and Hispanic individuals living among majority NH white may experience greater race-related stress, linguistic isolation, discrimination, and social exclusion, which in turn, could increase the risk of depressive symptoms [12], [14], [15]. On the other hand, numerous studies have found no association between residential segregation and depressive symptoms after controlling for individual- and neighborhood-level factors [10], [16], [17], [18], [19]. Differences may be explained by inconsistencies in the measurement of segregation and depression, as well as varying geographic contexts.

A notable gap in the research is a lack of empirical data depicting these relationships specifically among women or during pregnancy. This gap is of concern as approximately 7-20% of pregnant people experience depression [20], which can increase the risk of adverse outcomes, such as preterm birth [21], [22], low birthweight, preeclampsia [23], cesarean section, poor maternal-fetal attachment [24], impaired child development [25], and postpartum and future depression [26]. Experiences of discrimination during pregnancy have been shown to increase the risk of prenatal depression [27], [28], [29]. However, only one study has investigated the impact of residential segregation on prenatal depression [30], conducted among low-income Mexican American mothers, finding that those living among higher Latinx concentrations experienced fewer maternal depressive symptoms than their counterparts [30]. In this study, we investigated the relationship between a nuanced measure of residential racial and economic segregation and prenatal depressive symptoms among NH Black and Hispanic pregnant persons in North Carolina (NC). We hypothesized that living among a higher concentration of NH white and/or high-income individuals will be independently associated with increased prenatal depressive symptoms for NH Black and Hispanic pregnant people.