Kornstein Susan G, Joseph Anny-Claude, Graves Whitney C, Wallenborn Jordyn T
Department of Psychiatry, School of Medicine, Virginia Commonwealth University, Richmond, Virginia, USA.
Institute for Women's Health, Virginia Commonwealth University, Richmond, Virginia, USA.
Womens Health Rep (New Rochelle). 2020 Oct 8;1(1):468-473. doi: 10.1089/whr.2020.0079. eCollection 2020.
Postpartum visits are a necessary continuum of medical care for women who are diagnosed with depression during pregnancy. However, postpartum care utilization is typically lower in populations who face adverse events and it is unclear to what extent having depression during pregnancy may compromise postpartum visit follow-up. Our study examined the association between severity of prenatal depression and postpartum care utilization among women on Medicaid. Data from a university-based, nonprofit managed care organization (2008-2012) were analyzed ( = 846). Prenatal depression severity and postpartum care utilization were determined using the International Classification of Diseases, Ninth Revision (ICD-9) codes, from medical claims records. Bivariate and multivariable logistic regression was conducted. Odds ratios and 95% confidence intervals (CIs) were calculated. The majority (64.2%) of women received a mild/moderate prenatal depression diagnosis and 52.5% of the total sample attended their postpartum care visit. After adjusting for confounders, we found decreased odds of postpartum care utilization among women with less severe diagnoses. Women with a mild/moderate prenatal depression diagnosis were 12% less likely to attend the postpartum care visit compared with women with a severe prenatal depression diagnosis (adjusted odds ratio = 0.88, 95% CI = 0.65-1.19). However, this finding was not statistically significant. Our study did not yield evidence of a statistically significant relationship between prenatal depression severity and postpartum visit attendance among a sample of Medicaid beneficiaries. Additional research is needed to assess the association between prenatal depression severity and postpartum care use to enhance continuity of services for Medicaid-insured women into the postpartum period.
产后访视对于孕期被诊断为抑郁症的女性来说是医疗护理中必要的连续环节。然而，在面临不良事件的人群中，产后护理的利用率通常较低，而且孕期患抑郁症在多大程度上可能会影响产后访视的后续跟进尚不清楚。我们的研究调查了医疗补助计划女性中产前抑郁症严重程度与产后护理利用率之间的关联。分析了来自一家大学非营利性管理式医疗组织（2008 - 2012年）的数据（n = 846）。产前抑郁症严重程度和产后护理利用率通过医疗理赔记录中的国际疾病分类第九版（ICD - 9）编码来确定。进行了双变量和多变量逻辑回归分析。计算了比值比和95%置信区间（CIs）。大多数（64.2%）女性被诊断为轻度/中度产前抑郁症，总样本中有52.5%的人进行了产后护理访视。在对混杂因素进行调整后，我们发现诊断较轻的女性产后护理利用率的比值降低。与产前抑郁症严重诊断的女性相比，产前抑郁症诊断为轻度/中度的女性进行产后护理访视的可能性低12%（调整后的比值比 = 0.88，95% CI = 0.65 - 1.19）。然而，这一发现没有统计学意义。我们的研究没有得出在医疗补助计划受益人群样本中，产前抑郁症严重程度与产后访视出勤率之间存在统计学显著关系的证据。需要进一步研究来评估产前抑郁症严重程度与产后护理使用之间的关联，以加强为医疗补助参保女性提供的产后服务连续性。
