Racial and Ethnic Disparities in Postpartum Depression Care Among Low-Income Women

Abstract

Objective-The goal of this study was to characterize racial-ethnic differences in mental health care utilization associated with postpartum depression in a multiethnic cohort of Medicaid recipients.Methods-In a retrospective cohort study, administrative claims data from New Jersey's Medicaid program were obtained for 29,601 women (13,001 whites, 13,416 blacks, and 3,184 Latinas) who delivered babies between July 2004 and October 2007. Racial-ethnic differences were estimated with logistic regression for initiation of antidepressant medication or outpatient mental health visits within six months of delivery, follow-up (a prescription refill or second visit), and continued mental health care (at least three visits or three filled antidepressant prescriptions within 120 days).Results-Nine percent (N=1,120) of white women initiated postpartum mental health care, compared with 4% (N=568) of black women and 5% (N=162) of Latinas. With analyses controlling for clinical factors, the odds of initiating treatment after delivery were significantly (p<.001) lower for blacks (adjusted odds ratio [AOR]=.43) and Latinas (AOR=.59) compared with whites. Among those who initiated treatment, blacks and Latinas were less likely than whites to receive follow-up treatment (blacks, AOR=.66, p<.001; Latinas, AOR=.67, p<.05) or continued care (blacks, AOR=.81, marginal difference at p<.10; Latinas, AOR=.67, p<.05). Among those who initiated antidepressant treatment, black women and Latinas were less likely than whites to refill a prescription.Conclusions-There were significant racial-ethnic differences in depression-related mental health care after delivery. Suboptimal treatment was prevalent among all low-income women in the study. However, racial and ethnic disparities in the initiation and continuation of postpartum depression care were particularly troubling and warrant clinical and policy attention.Postpartum depression is a serious and debilitating illness that affects appproximately 10%-20% of women who give birth (1). Available evidence suggests that rates of postpartum disclosures The authors report no competing interests. NIH Public Access NIH-PA Author ManuscriptNIH-PA Author Manuscript NIH-PA Author Manuscript depression do not differ by race and ethnicity, but it does not conclusively demonstrate equal rates of illness across groups. Studies in which low-income mothers were systematically screened for clinical criteria indicate that rates of depression during the postpartum period are similar among Latinas, black women, and white women-8% for major depressive disorder and 23% for all depressive disorders in the first three months after delivery (2,3). Effective screening tools and treatment strategies for combating postpartum depression have been developed (4,5). However, detection and treatment rates for this condition are low (6-8), particularly among high-risk women (9). Untreated postpartum depression can have severe impacts on the health and well-being of the affected woman and her family, including long-term ...

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“…In particular, clinicians can increase use of the postpartum visit as gateway to interconception care, identify women who had adverse outcome in pregnancy and enhance care plans, and use evidence-based and best practices with a particular focus on effective contraceptive methods, 48 managing diabetes 49,30 reducing weight 50,51 smoking cessation 52,53 and psychosocial risk factors. [54][55][56][57] r e f e r e n c e s…”