Senior Research Investigator Pregnancy and Child Health Research Center, HealthPartners Institute Minneapolis, United States
Background: In the United States (US), fewer than half of pregnant persons with a new episode of depression initiate antidepressants or psychotherapy. There are limited data on predictors of treatment initiation among persons with new depression episodes during pregnancy.
Objectives: We describe antidepressant and psychotherapy initiation and identify predictors of treatment initiation among patients with a new depression episode during pregnancy.
Methods: Using electronic health data from 5 US healthcare systems, we identified pregnancies ending in livebirth or stillbirth from 2011-2021 among patients ages 16-49 years who had ≥1 prenatal visit during the first 6 months of pregnancy, continuous health insurance coverage (6 months before pregnancy through delivery), a new depression episode (i.e., a depression diagnosis during pregnancy with no depression diagnosis, no antidepressant dispensings, and no psychotherapy in the 6 months before pregnancy), and no antidepressant or psychotherapy initiation before their first depression diagnosis during pregnancy. Treatment initiation was defined as an antidepressant dispensing or psychotherapy visit within 90 days of the first depression diagnosis during pregnancy. We used Modified Poisson regression to estimate bivariable associations between predictors (delivery year, race and ethnicity, age, public insurance, primiparity, mental health diagnosis other than depression in the 3 years before pregnancy, and depression diagnosis, antidepressant dispensing, and psychotherapy between 3 years and 6 months before pregnancy) and any versus no treatment initiation.
Results: Using data from 1 healthcare system, we identified 1,263 pregnant individuals with a new depression episode. The mean age was 29 years (SD: 6), 39% had public insurance, 60% were non-Hispanic White; 12% initiated antidepressants only, 30% initiated psychotherapy only, 5% initiated both treatments, and 52% did not initiate either treatment within 90 days of diagnosis. Among treatment initiators, 76% initiated treatment on the date of their first depression diagnosis during pregnancy. Delivery in 2016 or later was predictive of treatment initiation (risk ratio (RR): 1.1, 95% CI: 1.0, 1.3). A depression diagnosis between 3 years and 6 months before pregnancy was associated with not initiating treatment (RR: 0.8, 95% CI: 0.7, 0.9), as was other mental health diagnosis in the 3 years before pregnancy (RR: 0.9, 95% CI: 0.8, 0.9).
Conclusions: Among individuals with new depression episodes during pregnancy, treatment initiation was less likely in those with a previous mental health diagnosis versus none. Analyses will be updated with data from all 5 healthcare systems and with data on depression severity.
