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Detection and treatment rates for perinatal depression in a state Medicaid population

Published online by Cambridge University Press:  13 October 2014

Michelle L. Geier ,
Nancy Hills ,
Marco Gonzales ,
Karoline Tum  and
Patrick R. Finley
Michelle L. Geier
Affiliation:
Department of Behavioral Health Services, San Francisco Department of Public Health, San Francisco, California, USA
Nancy Hills
Affiliation:
Department of Neurology and Department of Epidemiology and Biostatistics, University of California San Francisco School of Medicine San Francisco, California, USA
Marco Gonzales
Affiliation:
Department of California Health eQuality, University of California Davis Medical Center, Sacramento, California, USA
Karoline Tum
Affiliation:
University of California at San Francisco School of Pharmacy, San Francisco, California, USA
Patrick R. Finley*
Affiliation:
Department of Clinical Pharmacy, University of California at San Francisco, San Francisco, California, USA
*
*Address for correspondence: Patrick R. Finley, PharmD BCPP, Department of Clinical Pharmacy, University of California at San Francisco, 3333 California Street, Box 0613, San Francisco, CA 94143-0613, USA. (Email: [email protected])
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Abstract

Background

The purpose of this investigation was to assess detection and treatment rates for perinatal depression among women enrolled in the California State Medicaid (Medi-Cal) program in comparison to female beneficiaries of reproductive age who did not give birth during the same study period.

Methods

Investigators conducted a retrospective longitudinal cohort analysis of women between the ages of 18 and 39 years old who were continuously enrolled in the Medi-Cal fee-for-service program between January 2006 and December 2009. The perinatal cohort consisted of women with evidence of a live birth occurring between October 2007 and March 2009. The control cohort consisted of women in the same age group and health plan without evidence of pregnancy during this time frame. The primary outcome of this investigation was diagnosis of depression during 3 contiguous 9-month time frames: immediately prior to presumed conception, during pregnancy, and throughout the postpartum period. Secondary outcomes included within-group and cohort comparisons of treatment patterns (antidepressant or psychotherapy). A multivariable analysis of demographic factors predicting depression diagnosis or treatment was conducted as well.

Results

A total of 6030 women was identified in the perinatal cohort, and 56,709 women were included in the control group. The perinatal cohort was significantly less likely than nonpregnant controls to receive a diagnosis of depression both during pregnancy (prevalence=1.6% vs 3.5%; OR=0.45; 95% CI=0.35–0.55) and postpartum (2.2% vs 3.6%; OR=0.59; 95% CI=0.50–0.71). Similar differences were noted in antidepressant prescribing patterns apparent during these 2 time frames. A subgroup analysis of women who received a depression diagnosis revealed that only 48% of the perinatal cohort was provided any treatment during pregnancy (vs 72% of the control group; p<0.0001) or postpartum (57% vs 73%; p<0.0001). Specific demographic factors predicting a lower prevalence of depression detection or treatment included Hispanic descent, age <25 years, or primary residence in an rural setting.

Conclusions

Depression was often overlooked and undertreated among women who are pregnant or postpartum in comparison to services delivered to similar nonpregnant controls. Significant disparities in the healthcare received by certain subpopulations of perinatal women suggest that research into barriers to care and subsequent interventions are warranted.

Keywords

antidepressantsMedicaid populationperinatal depression
Type
Original Research
Information
CNS Spectrums , Volume 20 , Issue 1 , February 2015 , pp. 11 - 19
Copyright
© Cambridge University Press 2014 

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References

1. Kessler, RC, Berglund, P, Demler, O, et al. The epidemiology of major depressive disorder—results from the national comorbidity survey replication. JAMA. 2003; 289(23): 3095–3105.Google Scholar
2. Murray, CJL, Lopez, AD. The Global Burden of Disease: A Comprehensive Assessment of Mortality and Disability from Diseases, Injuries and Risk Factors in 1990 and Projected to 2020. Geneva, Switzerland: World Health Organization; 1996.Google Scholar
3. Gavin, NI, Gaynes, BN, Lohr, KN, Meltzer-Brody, S, Gartlehner, G, Swinson, T. Perinatal depression—a systematic review of prevalence and incidence. Obstet Gynecol. 2005; 106(5 Pt 1): 1071–1083.Google Scholar
4. Banti, S, Mauri, M, Oppo, A, et al. From the third month of pregnancy to 1 year postpartum: prevalence, incidence, recurrence, and new onset of depression. Results from the perinatal depression-research and screening unit study. Compr Psychiatry. 2011; 52(4): 343–351.CrossRefGoogle ScholarPubMed
5. Le Strat, Y, Dubertret, C, Le Foll, B. Prevalence and correlates of major depressive episode in pregnant and postpartum women in the United States. J Affect Disord. 2011; 135(1–3): 128–138.Google Scholar
6. Silva, R, Jansen, K, Souza, L, et al. Sociodemographic risk factors of perinatal depression: a cohort study in the public health care system. Rev Bras Psiquiatr. 2012; 34(2): 143–148.Google Scholar
7. Zuckerman, B, Amaro, H, Bauchner, H, et al. Depressive symptoms during pregnancy: relationship to poor health behaviors. Am J Obstet Gynecol. 1989; 160(5 Pt 1): 1107–1111.Google Scholar
8. Chung, TK, Lau, TK, Yip, AS, Chiu, HF, Lee, DT. Antepartum depressive symptomatology is associated with adverse obstetric and neonatal outcomes. Psychosom Med. 2001; 63(5): 830–834.Google Scholar
9. Orr, ST, James, SA, Blackmore Prince, C. Maternal prenatal depressive symptoms and spontaneous preterm births among African-American women in Baltimore, Maryland. Am J Epidemiol. 2002; 156(9): 797–802.CrossRefGoogle ScholarPubMed
10. Field, T, Hernandez-Reif, M, Diego, M, et al. Still-face and separation effects on depressed mother-infant interactions. Infant Mental Health Journal. 2007; 28(3): 314–323.Google Scholar
11. Whisman, MA, Uebelacker, LA, Weinstock, LM. Psychopathology and marital satisfaction: the importance of evaluating both partners. J Consult Clin Psychol. 2004; 72(5): 830–838.Google Scholar
12. Kurstjens, S, Wolke, D. Effects of maternal depression on cognitive development of children over the first seven years of life. J Child Psychol Psychiatry. 2001; 42(5): 623–636.Google Scholar
13. Murray, L, Woolgar, M, Cooper, P, Hipwell, A. Cognitive vulnerability to depression in 5-year-old children of depressed mothers. J Child Psychol Psychiatry. 2001; 42(7): 891–899.Google Scholar
14. Zahn-Waxler, C, Iannotti, RJ, Cummings, EM, Denham, S. Antecedents of problem behaviors in children of depressed mothers. Dev Psychopathol. 1990; 2(3): 271–291.Google Scholar
15. Yonkers, KA, Wisner, KL, Stewart, DE, et al. The management of depression during pregnancy: a report from the American Psychiatric Association and the American College of Obstetricians and Gynecologists. Gen Hosp Psychiatry. 2009; 31(5): 403–413.Google Scholar
16. Revicki, DA, Siddique, MS, Frank, L, et al. Cost-effectiveness of evidence-based pharmacotherapy or cognitive behavior therapy compared with community referral for major depression in predominantly low-income minority women. Arch Gen Psychiatry. 2005; 62(8): 868–875.Google Scholar
17. Freeman, MP. Antenatal depression: navigating the treatment dilemmas. Am J Psychiatry. 2007; 164(8): 1162–1165.Google Scholar
18. Ko, JY, Farr, SL, Dietz, PM, Robbins, CL. Depression and treatment among U.S. pregnant and nonpregnant women of reproductive age, 2005–2009. J Womens Health (Larchmt). 2012; 21(8): 830–836.Google Scholar
19. Ng, RC, Hirata, CK, Yeung, W, Haller, E, Finley, PR. Pharmacological treatments for the management of postpartum depression: a systematic review. Pharmacotherapy. 2010; 30(9): 928–941.CrossRefGoogle Scholar
20. Domar, AD, Moragianni, VA, Ryley, DA, Urato, AC. The risks of selective serotonin reuptake inhibitor use in infertile women: a review of the impact on fertility, pregnancy, neonatal health and beyond. Hum Reprod. 2013; 28(1): 160–171.CrossRefGoogle ScholarPubMed
21. National Research Council and Institute of Medicine. Depression in Parents, Parenting and Children: Opportunities to Improve Identification, Treatment, and Prevention. Washington, DC: The National Academies Press; 2009.Google Scholar
22. Marcus, SM, Flynn, HA, Blow, FC, et al. Depressive symptoms among pregnant women screened in obstetric settings. J Womens Health (Larchmt). 2003; 12(4): 373–380.CrossRefGoogle Scholar
23. Bennett, IM, Marcus, SC, Palmer, SC, Coyne, JC. Pregnancy related discontinuation of antidepressants and depression care visits among Medicaid recipients. Psychiatr Serv. 2010; 61(4): 386–391.CrossRefGoogle ScholarPubMed
24. Witt, WP, Keller, A, Gottlieb, C, et al. Access to adequate outpatient depression care for mothers in the USA: a nationally representative population-based study. J Behav Health Serv Res. 2011; 38(2): 191–204.Google Scholar
25. Flynn, HA, Blow, FC, Marcus, SM. Rates and predictors of depression treatment among pregnant women in hospital-affiliated obstetrics practices. Gen Hosp Psychiatry. 2006; 28(4): 289–295.CrossRefGoogle ScholarPubMed
26. Goodman, JH, Tyer-Viola, L. Detection, treatment, and referral of perinatal depression and anxiety by obstetrical providers. J Womens Health (Larchmt). 2010; 19(3): 477–490.Google Scholar
27. Spettell, CM, Wall, TC, Allison, J, et al. Identifying physician-recognized depression from administrative data: consequences for quality measurement. Health Serv Res. 2003; 38(4): 1081–1102.Google Scholar
28. Walkup, JT, Boyer, CA, Kellermann, SL. Reliability of Medicaid claims files for use in psychiatric diagnoses and service delivery. Adm Policy Ment Health. 2000; 27(3): 129–139.Google Scholar
29. Gjerdingen, D, Katon, W, Rich, DE. Stepped care treatment of postpartum depression: a primary care-based management model. Womens Health Issues. 2008; 18(1): 44–52.CrossRefGoogle ScholarPubMed
30. Bonari, L, Koren, G, Einarson, TR, Jasper, JD, Taddio, A, Einarson, A. Use of antidepressants by pregnant women: evaluation of perception of risk, efficacy of evidence based counseling and determinants of decision making. Arch Womens Ment Health. 2005; 8(4): 214–220.Google Scholar
31. Leddy, M, Haaga, D, Gray, J, Schulkin, J. Postpartum mental health screening and diagnosis by obstetrician-gynecologists. J Psychosom Obstet Gynaecol. 2011; 32(1): 27–34.Google Scholar
32. Dietrich, AJ, Williams, JW Jr, Ciotti, MC, et al. Depression care attitudes and practices of newer obstetrician-gynecologists: a national survey. Am J Obstet Gynecol. 2003; 189(1): 267–273.Google Scholar
33. LaRocco-Cockburn, A, Melville, J, Bell, M, Katon, W. Depression screening attitudes and practices among obstetrician-gynecologists. Obstet Gynecol. 2003; 101(5 Pt 1): 892–898.Google Scholar
34. Thomas, N, Sleath, BL, Jackson, E, West, S, Gaynes, B. Survey of characteristics and treatment preferences for physicians treating postpartum depression in the general medical setting. Community Ment Health J. 2008; 44(1): 47–56.Google Scholar
35. Coleman, VH, Carter, MM, Morgan, MA, Schulkin, J. Obstetrician-gynecologists’ screening patterns for anxiety during pregnancy. Depress Anxiety. 2008; 25(2): 114–123.Google Scholar
36. Palladino, CL, Fedock, GL, Forman, JH, Davis, MM, Henshaw, E, Flynn, HA. OB Cares—the obstetric clinics and resources study: providers’ perceptions of addressing perinatal depression—a qualitative study. Gen Hosp Psychiatry. 2011; 33(3): 267–278.Google Scholar
37. Centers for Disease Control and Prevention (CDC). Adequacy of prenatal-care utilization—California, 1989–1994. MMWR Morb Mortal Wkly Rep. 1996; 45(30): 653–656.Google Scholar
38. Johnson, KA. Public finance policy strategies to increase access to preconception care. Matern Child Health J. 2006; 10(5 Suppl): 85–91.Google Scholar
39. Dietz, PM, Williams, SB, Callaghan, WM, Bachman, DJ, Whitlock, EP, Hornbook, MC. Clinically identified maternal depression before, during, and after pregnancies ending in live births. Am J Psychiatry. 2007; 164(10): 1515–1520.Google Scholar
40. Gonzalez, HM, Vega, WA, Williams, DR, Tarraf, W, West, BT, Neighbors, HW. Depression care in the United States—too little too few. Arch Gen Psychiatry. 2010; 67(1): 37–46.CrossRefGoogle ScholarPubMed
41. Kozhimannil, KB, Trinacty, CM, Busch, AB, Huskamp, HA, Adams, AS. Racial and ethnic disparities in postpartum depression care among low income women. Psychiatr Serv. 2011; 62(6): 619–625.Google Scholar
42. Borowsky, SJ, Rubenstein, LV, Meredith, LS, et al. Who is at risk of nondetection of mental health problems in primary care? J Gen Intern Med. 2000; 15(6): 381–388.Google Scholar
43. Kimerling, R, Baumrind, N. Access to specialty mental health services among women in California. Psychiatr Serv. 2005; 56(6): 729–734.Google Scholar
44. H.R. 3590 (111th): Patient Protection and Affordable Care Act. http://www.govtrack.us/congress/bills/111/hr3590/text [accessed February 5, 2013].Google Scholar
45. Screening for Depression in Adults, Topic Page. December 2009. U.S. Preventive Services Task Force. http://www.uspreventiveservicestaskforce.org/uspstf/uspsaddepr.htm [accessed February 5, 2013].Google Scholar
46. World Health Organization. Integrated management of pregnancy and childbirth: WHO recommended interventions for improving maternal and newborn health. WHO/MPSO7.05 (2nd ed.) Geneva, Switzerland; 2009.http://www.who.int/maternal_child_adolescent/topics/maternal/impac/en/ [accessed February 5, 2013].Google Scholar
47. American College of Obstetricians and Gynecologists: Committee opinion no. 453. Screening for depression during and after pregnancy. Obstet Gynecol. 2010; 115(2 Pt 1): 394–395.Google Scholar
48. LaRocco-Cockburn, A, Reed, SD, Melville, J, et al. Improving depression treatment for women: integrating a collaborative care depression intervention into OB-GYN care. Contemp Clin Trials. 2013; 36(2): 362–370.Google Scholar