Department of Obstetrics & Gynaecology, University of British Columbia, Suite 930, 1125 Howe Street, Vancouver, BC, V6Z 2K8, Canada.
BC Children's Hospital Research Institute, University of British Columbia, 950 West 28th Ave., Vancouver, BC, V5Z 4H4, Canada.
Arch Womens Ment Health. 2020 Oct;23(5):689-697. doi: 10.1007/s00737-020-01034-y. Epub 2020 May 15.
Women at the lower end of the socioeconomic distribution have higher rates of depression in pregnancy and lower rates of treatment. In this study, we investigate relationships between income and the use of psychotropic mediciness in pregnancy. This retrospective cohort study using population-based administrative datasets included all women who delivered a live infant in the province of British Columbia, Canada (population of 4.6 million), between April 1, 2000, and December 31, 2009. We compared the socioeconomic distribution in use of psychotropic mediciness in pregnancy. We included 305,984 deliveries among 217,721 women. Women at the low end of the income distribution were significantly more likely to have a diagnosis for all mental health conditions, except anxiety, which was more common in women of highest socioeconomic status. The adjusted odds ratios for psychotropic medicine use indicate that women in the lowest income quintile have lower odds of filling a prescription for a psychotropic medicine after controlling for covariates and diagnoses of mental health conditions. However, they were more likely to fill a prescription for an antipsychotic and were more likely to fill psychotropic medicines from three or more different drug categories during pregnancy. Our findings suggest that women of lower socioeconomic status are less likely to fill a prescription for a psychotropic medicine in pregnancy, a finding largely driven by their decreased likelihood of filling an antidepressant. This is despite overall higher rates of mental illness among women of lower socioeconomic status, suggesting a gap in treatment by socioeconomic status.
处于社会经济分布低端的女性在怀孕期间抑郁的发生率更高，治疗率更低。在这项研究中，我们调查了收入与怀孕期间使用精神药物之间的关系。这是一项使用基于人群的行政数据集的回顾性队列研究，纳入了 2000 年 4 月 1 日至 2009 年 12 月 31 日期间在加拿大不列颠哥伦比亚省分娩的所有活产婴儿的女性（人口 460 万）。我们比较了怀孕期间使用精神药物的社会经济分布。我们纳入了 305984 次分娩，涉及 217721 名女性。处于收入分配低端的女性更有可能被诊断出患有所有心理健康状况，但焦虑除外，焦虑在社会经济地位最高的女性中更为常见。精神药物使用的调整后优势比表明，在控制了协变量和心理健康状况的诊断后，收入最低五分位的女性使用精神药物处方的可能性较低。然而，她们更有可能开抗精神病药物处方，并且在怀孕期间更有可能从三个或更多不同的药物类别开精神药物处方。我们的研究结果表明，社会经济地位较低的女性在怀孕期间更不可能开精神药物处方，这一发现主要归因于她们开抗抑郁药的可能性降低。尽管社会经济地位较低的女性整体上更有可能患有精神疾病，但这表明治疗存在社会经济地位差距。
