Perinatal depression screening and diagnosis: Identifying opportunities to improve optimal care

Perinatal depression (PND), occurring during pregnancy or within the first year after childbirth, is a common medical complication with serious consequences when left untreated, including hospitalizations, increased morbidity, and suicide. This study examined the intersection among racial, ethnic, and sociodemographic disparities in PND screening and diagnosis within a Midwestern health system.

We performed a multilevel analysis of individual heterogeneity and discriminatory accuracy (MAIHDA) using electronic health record data for 79,992 deliveries. The study included women aged 15-50 who delivered live-born infants between 22 and 44 weeks of gestation. PND screening was identified by the presence of a PHQ-9 or EPDS score, and ICD9/10 codes were used to define depression diagnosis within one year before or after delivery.

Across groups older women (≥ 36 years) were less likely to be screened for PND (OR = 0.65; 95%CI = 0.56-0.75) but not less likely to be diagnosed. Non-Hispanic Black, Hispanic, and Asian women were more likely to receive PND screening (ORs = 1.23-1.31) but less likely to be diagnosed (ORs = 0.16-0.60) compared to Non-Hispanic White women. Enrollment in public insurance was not associated with PND screening but was linked to a higher likelihood of diagnosis (OR = 1.41, CI = 1.24-1.61). Women in rural areas were less likely to be screened for PND (OR = 0.66, CI = 0.58-0.75), with no significant association with diagnosis.

Significant disparities exist in PND screening and diagnosis. Groups facing historic structural inequities are more likely to be screened but less likely to receive a diagnosis, highlighting the need for targeted interventions to address these inequities.