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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Risk of Suicide Higher Among Women Diagnosed With Perinatal Depression

Women who experience perinatal depression (depression during pregnancy or in the year following delivery) are at an elevated risk of suicide compared with women who do not experience depression during this time, according to a report published today in JAMA Network Open. The cohort study, based on analysis of records of nearly 1 million women in Sweden, found that this risk was highest during the first year after a diagnosis, though the risk remained elevated up to 18 years later.

“The findings highlight the pressing need for vigilant clinical monitoring and prompt intervention for this vulnerable population to prevent such devastating outcomes, regardless of prepregnancy history of psychiatric disorders,” wrote Han Yu, M.Sc., of Karolinska Institutet and colleagues.

For the study, Yu and colleagues analyzed data from multiple Swedish registers, including those containing records of prenatal care and delivery, diagnoses, filled prescriptions, and death. Women were categorized as having perinatal depression if they had a depression diagnosis recorded during pregnancy or within one year after delivery, or filled prescriptions for antidepressant medication during either period.

The researchers focused on women who gave birth between 2001 and 2017, including 86,551 women with perinatal depression. The researchers matched each woman with perinatal depression with 10 women who did not have perinatal depression (matched on age and year of delivery). Women were followed up from the matching date until the first suicide attempt and/or completion, death, emigration, or December 31, 2018, whichever occurred first.

Compared with the women who did not have perinatal depression, those with perinatal depression had a three times higher risk of suicidal behavior (hazard ratio [HR], 3.15). “Notably, the association was greater among women without a history of psychiatric disorders,” Yu and colleagues wrote.

Women with perinatal depression had a seven times higher risk of suicidal behavior during the first year after being diagnosed with perinatal depression, they continued. “Although declining over time, the risk remained doubled 5 or more years later (HR, 2.34).”

The authors concluded, “[T]he sustained risk over 18 years necessitates a paradigm shift in how we should approach [perinatal depression], advocating for extended monitoring and support beyond the perinatal period. Most importantly, the striking risk elevation of suicidal behavior within 1 year after [perinatal depression] reinforces the necessity of strategies that effectively detect early signs and act in a timely manner for suicide prevention.”

For related information, see the American Journal of Psychiatry article “Perinatal Mental Health: Advances and Opportunities.”

(Image: Getty Images/iStock/globalmoments)

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Future of NIMH, Goldwater Rule, and More From APA's 2017 Annual Meeting

Highlights of day three coverage from APA’s Annual Meeting include an address by the NIMH director on the future of the institute, the naming of the winners of APA’s Psychiatry Innovation Lab, the importance of partnerships when caring for the military, and how mental illness played a major role in the musical genius of Robert Schumann.

From now through May 24, Psychiatric News will deliver an evening digest of some of the day’s highlights—from the lecture halls to the exhibit floor. Whether you are here in San Diego or at home, these reports will convey the excitement and outstanding scientific program being presented at this year’s meeting.

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In tomorrow’s Psychiatric News Alert: A report on ABC News journalist Elizabeth Vargas’s lecture and discussion with NIDA Director Nora Volkow, M.D., at the Convocation of Distinguished Fellows.