Prevalence of and Risk Factors for Postpartum Anxiety in a U.S. Cohort With Commercial Insurance

The primary objective of this study was to estimate the prevalence of new-onset anxiety diagnoses in the postpartum period. We also aimed to estimate the prevalence of psychiatric comorbidities, explore changes by year, and identify risk factors for new-onset postpartum anxiety.

This retrospective cohort study used the Merative™ MarketScan ® Commercial Database and included adult women with commercial insurance who were at least 18 years of age, delivered a singleton or multiple gestation between 2008 and 2021, and did not have a preexisting or prepregnancy diagnosis of depression, anxiety, or posttraumatic stress disorder (PTSD). The primary outcome was a new-onset anxiety diagnosis, based on International Classification of Diseases, Ninth and Tenth Revision, Clinical Modification codes, during the postpartum period (up to 12 months after childbirth). Secondary outcomes were comorbid anxiety with depression and PTSD. We also estimated the prevalence of each psychiatric condition by year and identified risk factors associated with postpartum anxiety. Univariable and multivariable regression models were constructed to identify risk factors.

From the 1,469,121 individuals identified without prenatal mental health disorders, 84,984 individuals (5.8%; 95% CI, 5.7-5.8%) were diagnosed with new-onset postpartum anxiety within 12 months of childbirth, with 9,490 diagnosed in the first month and 75,494 diagnosed between 1 month and 1 year postpartum. Comorbid anxiety and depression occurred in 18.0 per 1,000 individuals in the study cohort (95% CI, 17.8-18.2), and comorbid anxiety and PTSD occurred in 0.9 per 1,000 individuals (95% CI, 0.9-1.0). The prevalence of postpartum anxiety increased from 30.8 per 1,000 individuals in 2008 to 122.9 per 1,000 individuals in 2021 ( P for trend<.001). Independent risk factors for new-onset postpartum anxiety diagnosed 1-12 months postpartum included younger age, North Central U.S. residence, earlier gestational age at delivery, cesarean delivery, antenatal or early postpartum sleep disorders, severe maternal morbidity (including transfusion), neglected medical conditions, and neonatal complications.

Postpartum anxiety was estimated to affect nearly 6% of patients with commercial insurance in the United States and has increased fourfold since 2008. Risk factors associated with postpartum anxiety may help to identify at-risk individuals who could benefit from early intervention.