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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: finleyp@pharmacy.ucsf.edu)
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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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