Predisposing, Enabling, and Need Factors Associated with Postpartum Depression Treatment Among Women Enrolled in...

To determine which of the available predisposing, enabling, and need factors are related to receipt of postpartum depression (PPD) treatment among postpartum women with Texas Medicaid.

This retrospective database analysis used Texas Medicaid claims (1/1/2018-6/30/2022) and included women 12-55 years, continuously enrolled 84 days pre- to 12 months post-delivery, with a PPD diagnosis. The outcome was receipt of PPD treatment (psychotherapy and/or antidepressant medication) within 12 months post-delivery. Independent variables were guided by the Andersen Behavioral Model and included predisposing (age, race/ethnicity), enabling (urbanicity, prenatal care), and need (depression/anxiety, substance use disorder [SUD], cesarean delivery, preterm birth, pregnancy complications) factors. Multivariable logistic regression was used.

Included women (N = 25,976) were 26.7 ± 5.9 years and 42.1% were Hispanic. Most women resided in urban counties (80.6%) and had 6.2 ± 3.4 prenatal visits, 3.3 ± 2.8 postpartum visits, and 1.4 ± 0.9 pregnancy complications. Nearly half (44.7%) had baseline depression/anxiety, 17.4% had baseline SUD, 35.8% had cesarean delivery, and 13.5% had preterm birth. Approximately, three-fourths (76.2%) received treatment within 12 months after delivery. Logistic regression (p < 0.0001) revealed that the likelihood of treatment receipt was significantly associated with age (25-29:odds ratio [OR] = 1.155, 95% confidence interval 1.039-1.284, 30-34: OR = 1.186;1.058-1.330, > 34: OR = 1.295;1.134-1.479; reference:<20), race (White: OR = 1.700;1.556-1.857; Hispanic: OR = 1.179;1.087-1.277; reference: Black), urbanicity (OR = 0.869;0.799-0.944), prenatal care (4-6 visits: OR = 1.178;1.039-1.336, 7-9 visits: OR = 1.156;1.020-1.311, > 9 visits: OR = 1.406;1.217-1.625; reference:0 visits), and cesarean delivery (OR = 1.099;1.031-1.173).

While over 75% of women with PPD received treatment, additional efforts to mitigate disparate consequences of untreated PPD should be focused on younger, Black, and urban women.