Thursday, April 11, 2024

Nonemergency ED Use Higher Among Infants of Mothers With Perinatal Depression, Study Finds

Compared with infants of mothers with no perinatal depression symptoms, those born to mothers with mild or moderate/severe symptoms were significantly more likely to have emergency department (ED) visits for nonemergency reasons, according to a study published in Health Affairs.

“Perinatal mental health conditions affect 20% of birthing people and are associated with a range of adverse child outcomes, including increased ED use,” wrote Slawa Rokicki, Ph.D., M.S., of Rutgers University. “This may be a result of increased illness or injury due to biological effects of depression on infant health or inadequate infant care practices associated with parental depression. Alternatively, increased ED use may be due to overuse resulting from a lack of social support at home or low health literacy.”

Rokicki used data from the hospital records of 207,428 mothers who gave birth to non-twins in New Jersey between 2016 and 2018; New Jersey implemented universal depression screening for new mothers before hospital discharge in 2006. Most hospitals screened with the Edinburgh Postnatal Depression Scale. Rokicki categorized perinatal depression symptom severity as none (scores of zero to six), mild (scores of seven to 13), and moderate/severe (scores of 14 or greater).

She linked these data with infants’ ED discharge records during the first year of life. Infants’ primary diagnosis codes when discharged from the ED were used to determine if the visits were nonemergent or emergent.

A little over 10% of infants were born to mothers who had mild depressive symptoms at delivery, and just under 1% were born to mothers with moderate/severe depressive symptoms. Additional findings included the following:

  • In total, 68.4% of ED visits among infants were classified as nonemergent.
  • Infants born to mothers with moderate/severe depressive symptoms had an average of 1.05 ED visits, both emergent and nonemergent, during the first year, compared with 0.82 among those born to mothers with mild symptoms and 0.70 among those born to mothers with no symptoms.
  • Similarly, infants born to mothers with moderate/severe depressive symptoms had an average of 0.6 nonemergent ED visits during their first year, compared with 0.48 among those born to mothers with mild symptoms and 0.41 among those born to mothers with no symptoms.
  • Infants whose deliveries were paid for by Medicaid had an average of 1.24 ED visits in the first year compared with 0.41 visits among those with commercial insurance.

After adjusting for demographic, economic, and birthing (for example, preterm birth or need for a C-section) differences among the groups, there remained a significant association between perinatal depressive symptoms and increased nonemergent infant ED visits, but not emergent visits.

“Medicaid is the primary payer for more than 60 percent of pediatric ED visits, and this proportion has been steadily rising,” Rokicki concluded. “Implementing policies that interrupt the relationship between perinatal depression and nonemergent ED use is therefore an important priority with potential for cost savings.”

For related information, see the Psychiatric News article “In Addressing Maternal Mortality, Mental Health Often Left Out.”

(Image: Getty Images/iStock/Rawpixel)

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