The probability of receiving a postpartum mood or anxiety disorder diagnosis is three times higher for White patients with symptoms than for Black patients with symptoms, according to a study published yesterday in Psychiatric Services. In addition, regardless of race, only 1 in 5 women received a diagnosis.
“Despite their high prevalence and disease burden, [postpartum mood and anxiety disorders] often remain underdiagnosed,” wrote Stephanie V. Hall, Ph.D., M.P.H., of the University of Michigan, Ann Arbor, and colleagues. “Low diagnosis rates contribute to even lower treatment rates and exacerbate poor outcomes. Untreated [postpartum mood and anxiety disorders] are associated with worse maternal and infant health outcomes.”
Hall and colleagues linked Medicaid claims data in Michigan with results from the Michigan Pregnancy Risk Assessment Monitoring System (MI-PRAMS), an ongoing representative survey of childbearing people conducted at two to six months after childbirth. All participants gave birth between 2012 and 2015 and were continuously enrolled in Medicaid from nine months before delivery through three months after delivery.
Participants self-reported their postpartum mood and anxiety disorder symptoms using an adapted version of the two-item Patient Health Questionnaire. The questions asked how often the participants had little interest or pleasure in doing things since their babies were born and how often they felt down, depressed, or hopeless. Participants were considered to have screened positive for postpartum mood and anxiety disorder symptoms if they responded “often” or “always” to either question.
A total of 2,781 participants were included in the study, 542 (19.5%) of whom screened positive for postpartum mood or anxiety disorder symptoms. More White participants received a diagnosis for postpartum mood and anxiety disorder compared with Black participants (23.8% vs. 8.9%) in the weighted sample. No covariates were significantly associated with having a diagnosis among White participants. Among Black participants, however, more comorbid conditions (such as diabetes or hypertension) and life stressors were significantly associated with receiving a diagnosis for postpartum mood and anxiety disorder.
“Measuring the factors associated with underdiagnosis is a first step in improving [postpartum mood and anxiety disorder] detection and treatment,” the authors wrote. “Implementing culturally sensitive care, including strategies such as using nonstigmatizing language to describe mental health, ensuring that providers reflect patients’ identities, and fostering patient-provider relationships, may mitigate underdiagnosis.”
For related information, see the Psychiatric News article “Addressing Maternal Mental Health: Progress, Challenges, and Potential Solutions.”
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