Advertisement

Healthcare Utilization and Costs Associated With Perinatal Depression Among Medicaid Enrollees

  • Lisa M. Pollack
    Correspondence
    Address correspondence to: Lisa M. Pollack, PhD, MPH, MPT, Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, 4770 Buford Highway, Atlanta GA 30341.
    Affiliations
    Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
    Search for articles by this author
  • Jiajia Chen
    Affiliations
    Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
    Search for articles by this author
  • Shanna Cox
    Affiliations
    Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
    Search for articles by this author
  • Feijun Luo
    Affiliations
    Division of Heart Disease and Stroke Prevention, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
    Search for articles by this author
  • Cheryl L. Robbins
    Affiliations
    Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
    Search for articles by this author
  • Heather D. Tevendale
    Affiliations
    Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
    Search for articles by this author
  • Rui Li
    Affiliations
    Division of Research, Office of Epidemiology and Research, Health Resources & Services Administration, Maternal & Child Health, Rockville, Maryland
    Search for articles by this author
  • Jean Y. Ko
    Affiliations
    Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia

    Commissioned Corps, U.S. Public Health Service, HHS, Rockville, Maryland
    Search for articles by this author
Published:February 25, 2022DOI:https://doi.org/10.1016/j.amepre.2021.12.008

      Introduction

      Differences in healthcare utilization and medical expenditures associated with perinatal depression are estimated.

      Methods

      Using the MarketScan Multi-State Medicaid Database, the analytic cohort included individuals aged 15–44 years who had an inpatient live birth delivery hospitalization between January 1, 2017 and December 31, 2018. Multivariable negative binomial regression models were used to estimate the differences in utilization associated with perinatal depression, and multivariable generalized linear models were used to estimate the differences in expenditures associated with perinatal depression. Analyses were conducted in 2021.

      Results

      The cohort included 330,593 individuals. Nearly 17% had perinatal depression. Compared with individuals without perinatal depression individuals with perinatal depression had a larger number of inpatient admissions (0.19, 95% CI=0.18, 0.20), total inpatient days (0.95, 95% CI=0.92, 0.97), outpatient visits (14.02, 95% CI=13.81, 14.22), emergency department visits (1.70, 95% CI=1.66, 1.74), and weeks of drug therapy covered by a prescription (28.70, 95% CI=28.12, 29.28) and larger total expenditures ($5,078, 95% CI=$4,816, $5,340). Non-Hispanic Black individuals had larger differences in utilization and expenditures for inpatient services and outpatient visits but smaller differences in utilization for pharmaceutical services associated with perinatal depression than non-Hispanic White individuals. Hispanic individuals had larger differences in utilization for outpatient visits but smaller differences in utilization for pharmaceutical services associated with perinatal depression than non-Hispanic White individuals.

      Conclusions

      Individuals with perinatal depression had more healthcare utilization and medical expenditures than individuals without perinatal depression, and differences varied by race/ethnicity. The findings highlight the need to ensure comprehensive and equitable mental health care to address perinatal depression.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to American Journal of Preventive Medicine
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      REFERENCES

        • Gaynes BN
        • Gavin N
        • Meltzer-Brody S
        • et al.
        Perinatal depression: prevalence, screening accuracy, and screening outcomes.
        Evid Rep Technol Assess (Summ). 2005; : 1-8https://doi.org/10.1037/e439372005-001
        • 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: 1071-1083https://doi.org/10.1097/01.AOG.0000183597.31630.db
        • Postpartum Depression: Action Towards Causes and Treatment (PACT) Consortium
        Heterogeneity of postpartum depression: a latent class analysis.
        Lancet Psychiatry. 2015; 2: 59-67https://doi.org/10.1016/S2215-0366(14)00055-8
        • McKee K
        • Admon LK
        • Winkelman TNA
        • et al.
        Perinatal mood and anxiety disorders, serious mental illness, and delivery-related health outcomes, United States, 2006-2015.
        BMC Womens Health. 2020; 20: 150https://doi.org/10.1186/s12905-020-00996-6
        • Center on the Developing Child at Harvard University
        Maternal Depression Can Undermine the Development of Young Children: working paper no. 8.
        Center on the Developing Child at Harvard University, Cambridge, MA2009 (https://developingchild.harvard.edu/resources/maternal-depression-can-undermine-the-development-of-young-children/. Accessed December 17, 2021)
        • Grote NK
        • Bridge JA
        • Gavin AR
        • Melville JL
        • Iyengar S
        • Katon WJ.
        A meta-analysis of depression during pregnancy and the risk of preterm birth, low birth weight, and intrauterine growth restriction.
        Arch Gen Psychiatry. 2010; 67: 1012-1024https://doi.org/10.1001/archgenpsychiatry.2010.111
        • Deave T
        • Heron J
        • Evans J
        • Emond A.
        The impact of maternal depression in pregnancy on early child development.
        BJOG. 2008; 115: 1043-1051https://doi.org/10.1111/j.1471-0528.2008.01752.x
        • Mogos MF
        • Jones LM
        • Robinson NS
        • Whitehead AO
        • Piscotty R
        • Goba GK.
        Prevalence, correlates, and outcomes of co-occurring depression and hypertensive disorders of pregnancy.
        J Womens Health (Larchmt). 2019; 28: 1460-1467https://doi.org/10.1089/jwh.2018.7144
        • Mukherjee S
        • Trepka MJ
        • Pierre-Victor D
        • Bahelah R
        • Avent T.
        Racial/ethnic disparities in antenatal depression in the United States: a systematic review.
        Matern Child Health J. 2016; 20: 1780-1797https://doi.org/10.1007/s10995-016-1989-x
        • Bauman BL
        • Ko JY
        • Cox S
        • et al.
        Vital signs: postpartum depressive symptoms and provider discussions about perinatal depression - United States, 2018.
        MMWR Morb Mortal Wkly Rep. 2020; 69: 575-581https://doi.org/10.15585/mmwr.mm6919a2
        • Haight SC
        • Byatt N
        • Moore Simas TA
        • Robbins CL
        • Ko JY
        Recorded diagnoses of depression during delivery hospitalizations in the United States, 2000-2015.
        Obstet Gynecol. 2019; 133: 1216-1223https://doi.org/10.1097/AOG.0000000000003291
        • Salameh TN
        • Hall LA
        • Crawford TN
        • Staten RR
        • Hall MT.
        Racial/ethnic differences in mental health treatment among a national sample of pregnant women with mental health and/or substance use disorders in the United States.
        J Psychosom Res. 2019; 121: 74-80https://doi.org/10.1016/j.jpsychores.2019.03.015
        • Brody DJ
        • Gu Q.
        Antidepressant use among adults: United States, 2015–2018.
        NCHS Data Brief. 2020; (Accessed March 14, 2021): 1-8
        • Abrams LS
        • Dornig K
        • Curran L.
        Barriers to service use for postpartum depression symptoms among low-income ethnic minority mothers in the United States.
        Qual Health Res. 2009; 19: 535-551https://doi.org/10.1177/1049732309332794
        • Song D
        • Sands RG
        • Wong YL.
        Utilization of mental health services by low-income pregnant and postpartum women on medical assistance.
        Women Health. 2004; 39: 1-24https://doi.org/10.1300/J013v39n01_01
        • Chang JJ
        • Tabet M
        • Elder K
        • Kiel DW
        • Flick LH.
        Racial/ethnic differences in the correlates of mental health services use among pregnant women with depressive symptoms.
        Matern Child Health J. 2016; 20: 1911-1922https://doi.org/10.1007/s10995-016-2005-1
        • Alegría M
        • Chatterji P
        • Wells K
        • et al.
        Disparity in depression treatment among racial and ethnic minority populations in the United States.
        Psychiatr Serv. 2008; 59: 1264-1272https://doi.org/10.1176/appi.ps.59.11.1264
        • Farr SL
        • Bitsko RH
        • Hayes DK
        • Dietz PM.
        Mental health and access to services among U.S. women of reproductive age.
        Am J Obstet Gynecol. 2010; 203 (542.e1‒542.e5429)https://doi.org/10.1016/j.ajog.2010.07.007
        • Ta VM
        • Juon HS
        • Gielen AC
        • Steinwachs D
        • Duggan A.
        Disparities in use of mental health and substance abuse services by Asian and Native Hawaiian/other Pacific Islander women.
        J Behav Health Serv Res. 2008; 35: 20-36https://doi.org/10.1007/s11414-007-9078-y
        • Luca DL
        • Margiotta C
        • Staatz C
        • Garlow E
        • Christensen A
        • Zivin K.
        Financial toll of untreated perinatal mood and anxiety disorders among 2017 births in the United States.
        Am J Public Health. 2020; 110: 888-896https://doi.org/10.2105/AJPH.2020.305619
        • Chambers GM
        • Randall S
        • Mihalopoulos C
        • et al.
        Mental health consultations in the perinatal period: a cost-analysis of Medicare services provided to women during a period of intense mental health reform in Australia.
        Aust Health Rev. 2018; 42: 514-521https://doi.org/10.1071/AH17118
        • Bauer A
        • Knapp M
        • Parsonage M.
        Lifetime costs of perinatal anxiety and depression.
        J Affect Disord. 2016; 192: 83-90https://doi.org/10.1016/j.jad.2015.12.005
        • Bauer A
        • Pawlby S
        • Plant DT
        • King D
        • Pariante CM
        • Knapp M.
        Perinatal depression and child development: exploring the economic consequences from a South London cohort.
        Psychol Med. 2015; 45: 51-61https://doi.org/10.1017/S0033291714001044
        • Dagher RK
        • McGovern PM
        • Dowd BE
        • Gjerdingen DK.
        Postpartum depression and health services expenditures among employed women.
        J Occup Environ Med. 2012; 54: 210-215https://doi.org/10.1097/JOM.0b013e31823fdf85
        • Martin JA
        • Hamilton BE
        • Osterman MJK
        • Driscoll AK.
        Births: final data for 2018.
        Natl Vital Stat Rep. 2019; 68 (https://www.ncbi.nlm.nih.gov/pubmed/32501202. Accessed October 22, 2021): 1-47
      1. IBM MarketScan research databases for health services researchers. IBM. https://www.ibm.com/products/marketscan-research-databases/databases. Accessed January 15, 2021.

        • Shrestha SS
        • Zhang P
        • Li R
        • Thompson TJ
        • Chapman DP
        • Barker L.
        Medical expenditures associated with major depressive disorder among privately insured working-age adults with diagnosed diabetes in the United States, 2008.
        Diabetes Res Clin Pract. 2013; 100: 102-110https://doi.org/10.1016/j.diabres.2013.02.002
      2. IBM MarketScan research databases user guide multi-state Medicaid database.
        IBM Watson Health, 2018 (Accessed January 10, 2021)
      3. Databases, tables & calculators by subject. U.S. Bureau of Labor Statistics. https://www.bls.gov/data/#prices. Accessed January 15, 2021.

        • Elixhauser A
        • Steiner C
        • Harris DR
        • Coffey RM.
        Comorbidity measures for use with administrative data.
        Med Care. 1998; 36: 8-27https://doi.org/10.1097/00005650-199801000-00004
      4. Elixhauser comorbidity software refined for ICD-10-CM. Agency for Healthcare Research and Quality.https://www.hcup-us.ahrq.gov/toolssoftware/comorbidityicd10/comorbidity_icd10.jsp. Updated October 29, 2021. Accessed January 29, 2021.

      5. Chronic Conditions Data Warehouse. https://www2.ccwdata.org/web/guest/condition-categories. Accessed December 17, 2021.

        • Johnston EM
        • McMorrow S
        • Alvarez Caraveo C
        • Dubay L
        Post-ACA, more than one-third of women with prenatal Medicaid remained uninsured before or after pregnancy.
        Health Aff (Millwood). 2021; 40: 571-578https://doi.org/10.1377/hlthaff.2020.01678
        • Rafferty J
        • Mattson G
        • Earls MF
        • Yogman MW
        • Committee on Psychosocial Aspects of Child and Family Health
        Incorporating recognition and management of perinatal depression into pediatric practice.
        Pediatrics. 2019; 143e20183260https://doi.org/10.1542/peds.2018-3260
        • Byatt N
        • Carter D
        • Deligiannidis KM
        • et al.
        Position Statement on Screening and Treatment of Mood and Anxiety Disorders During Pregnancy and Postpartum.
        American Psychiatric Association, Washington, DC2018 (https://www.psychiatry.org/File%20Library/About-APA/Organization-Documents-Policies/Policies/Position-Screening-and-Treatment-Mood-Anxiety-Disorders-During-Pregnancy-Postpartum.pdf. Accessed January 1, 2021)
      6. ACOG committee opinion no. 757. Screening for perinatal depression.
        Obstet Gynecol. 2018; 132: e208-e212https://doi.org/10.1097/AOG.0000000000002927
        • Cawthorpe D
        • Wilkes TC
        • Guyn L
        • Li B
        • Lu M.
        Association of mental health with health care use and cost: a population study.
        Can J Psychiatry. 2011; 56: 490-494https://doi.org/10.1177/070674371105600807
        • Chojenta C
        • William J
        • Martin MA
        • Byles J
        • Loxton D.
        The impact of a history of poor mental health on health care costs in the perinatal period.
        Arch Womens Ment Health. 2019; 22: 467-473https://doi.org/10.1007/s00737-018-0912-4
        • Gautam S
        • Jain A
        • Gautam M
        • Vahia VN
        • Grover S.
        Clinical practice guidelines for the management of depression.
        Indian J Psychiatry. 2017; 59: S34-S50https://doi.org/10.4103/0019-5545.196973
        • O'Mahen HA
        • Flynn HA.
        Preferences and perceived barriers to treatment for depression during the perinatal period.
        J Womens Health (Larchmt). 2008; 17: 1301-1309https://doi.org/10.1089/jwh.2007.0631
        • Bailey ZD
        • Feldman JM
        • Bassett MT.
        How structural racism works - racist policies as a root cause of U.S. racial health inequities.
        N Engl J Med. 2021; 384: 768-773https://doi.org/10.1056/NEJMms2025396
        • Sarayani A
        • Wang X
        • Thai TN
        • Albogami Y
        • Jeon N
        • Winterstein AG.
        Impact of the transition from ICD-9-CM to ICD-10-CM on the identification of pregnancy episodes in U.S. health insurance claims data.
        Clin Epidemiol. 2020; 12: 1129-1138https://doi.org/10.2147/CLEP.S269400
      7. National Health Interview Survey: tables of summary health statistics.
        Centers for Disease Control and Prevention, 2019 (https://www.cdc.gov/nchs/nhis/shs/tables.htm. Accessed March 24, 2021)
        • MacDorman MF
        • Declercq E.
        Trends and state variations in out-of-hospital births in the United States, 2004-2017.
        Birth. 2019; 46: 279-288https://doi.org/10.1111/birt.12411