Racial differences in diagnosis of perinatal mood and anxiety disorders

Perinatal mood and anxiety disorders (PMADs) represent a common comorbidity of pregnancy and postpartum with serious consequences. Despite high disease prevalence and burden, PMADs often remain undiagnosed. In recent years, universal screening for perinatal mental health disorders has become standard care and most patients are screened at least once during pregnancy or postpartum. Whether racial differences in PMAD diagnosis persist remains unknown. We aimed to measure and assess temporal trends in racial differences in PMAD diagnosis among symptomatic pregnant and postpartum Medicaid enrollees in Michigan.

This serial cross-sectional observational study analyzed data from the Michigan Pregnancy Risk Assessment Monitoring System (MI-PRAMS) and Michigan Medicaid administrative claims for deliveries spanning 2016-2020. We linked MI-PRAMS responses to Medicaid claims from one year before through one year after delivery to determine whether enrollees who reported PMAD symptoms to MI-PRAMS received a PMAD diagnosis in Medicaid claims. We used weighted logistic regression to determine the association between race and PMAD diagnosis among Michigan Medicaid enrollees who reported PMAD symptoms.

Out of 60,583 Medicaid enrollees with a live birth in Michigan from 2016-2020, 33% were Black and 61% were White. About 70% were between 19-29 years old and 18% were between 30-34 years old. During the perinatal period, 39% had 2 or more co-morbid conditions, and 60% had 2 or more major life stressors. In unadjusted weighted logistic regression, White enrollees had 2.146 times greater odds of PMAD diagnosis than Black enrollees (95% CI: 1.570-2.933). This association remained significant after adjusting for age, ethnicity, co-morbidities, major life stressors, and delivery year. Adjusted weighted logistic regression found that White enrollees had 2.326 times greater odds of PMAD diagnosis than Black enrollees (95% CI: 1.669-3.236).

White enrollees who reported PMAD symptoms were more than twice as likely to receive a PMAD diagnosis as Black enrollees reporting PMAD symptoms. The magnitude of racial difference in PMAD diagnosis did not improve over the course of the study period. These persistent racial differences are consistent with structural barriers, provider biases, and cultural stigmas that differentially and disproportionately impact non-White patients. Tailored interventions to improve mental health care among Black Medicaid enrollees may be needed to improve PMAD diagnosis, a critical first step in mental health management.

Not applicable.