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.

Mental Health Disorders Subsequent to Gestational Diabetes Mellitus Differ by Race/Ethnicity

“…[7,8,27] One study of women with GDM enrolled in Medicaid observed a higher incidence of depression as defined by ICD-9 coding or prescription drug claims. [7] This relationship was confirmed in studies of women with GDM who were examined using the Edinburgh Postnatal Depression Scale (EPDS) between 6 and 10 weeks postpartum [8] ; or the Center for Epidemiologic Studies-Depression Scale (CES-D) at 8 weeks postpartum. [27] However, in contrast to our study, these investigations did not document a clinical diagnosis of depression rather they evaluated depressive symptoms briefly postpartum.…”

Depression and Posttraumatic Stress Symptoms After Perinatal Loss in a Population-Based Sample

“…In general, African American women report being less likely to seek treatment in formal mental health institutions and have much lower rates of treatment for postpartum depression and posttraumatic stress disorder in the perinatal period despite similar rates of illness. [21][22][23] Since African Americans have dramatically higher rates of perinatal loss than Caucasian women, it is critical that we identify culturally acceptable approaches to address unmet treatment needs in this population.…”

Mental Health Utilization Among Diverse Parenting Young Couples

“…Postpartum depression affects 10–20 % of women (Kozhimannil et al 2011). Evidence has shown that African American women are more susceptible to postpartum depression due to factors such as financial hardship, chronic medical conditions, and stigma associated with mental illness (Boyd et al 2009).…”

“…Adolescent mothers are at higher risk for postpartum depression compared to their adult counterparts, with estimates in adolescents ranging from 26 to 50 % (Nunes and Phipps 2013). Because detection and treatment rates are low among low-income minority women young minority mothers may be more vulnerable to underdiagnosis and inadequate mental health services (Kozhimannil et al 2011). …”