Pennington Emma L, Barner Jamie C, Brown Carolyn M, Moczygemba Leticia R, Patel Divya A
Health Outcomes Division, The University of Texas at Austin College of Pharmacy, Austin, TX, USA.
Health Outcomes Division, The University of Texas at Austin College of Pharmacy, 2409 University Avenue, STOP A1930, Austin, Texas, TX 78712-1120, USA.
Matern Child Health J. 2025 Jul 17. doi: 10.1007/s10995-025-04145-z.
To determine which of the available predisposing, enabling, and need factors are related to receipt of postpartum depression (PPD) treatment among postpartum women with Texas Medicaid.
This retrospective database analysis used Texas Medicaid claims (1/1/2018-6/30/2022) and included women 12-55 years, continuously enrolled 84 days pre- to 12 months post-delivery, with a PPD diagnosis. The outcome was receipt of PPD treatment (psychotherapy and/or antidepressant medication) within 12 months post-delivery. Independent variables were guided by the Andersen Behavioral Model and included predisposing (age, race/ethnicity), enabling (urbanicity, prenatal care), and need (depression/anxiety, substance use disorder [SUD], cesarean delivery, preterm birth, pregnancy complications) factors. Multivariable logistic regression was used.
Included women (N = 25,976) were 26.7 ± 5.9 years and 42.1% were Hispanic. Most women resided in urban counties (80.6%) and had 6.2 ± 3.4 prenatal visits, 3.3 ± 2.8 postpartum visits, and 1.4 ± 0.9 pregnancy complications. Nearly half (44.7%) had baseline depression/anxiety, 17.4% had baseline SUD, 35.8% had cesarean delivery, and 13.5% had preterm birth. Approximately, three-fourths (76.2%) received treatment within 12 months after delivery. Logistic regression (p < 0.0001) revealed that the likelihood of treatment receipt was significantly associated with age (25-29:odds ratio [OR] = 1.155, 95% confidence interval 1.039-1.284, 30-34: OR = 1.186;1.058-1.330, > 34: OR = 1.295;1.134-1.479; reference:<20), race (White: OR = 1.700;1.556-1.857; Hispanic: OR = 1.179;1.087-1.277; reference: Black), urbanicity (OR = 0.869;0.799-0.944), prenatal care (4-6 visits: OR = 1.178;1.039-1.336, 7-9 visits: OR = 1.156;1.020-1.311, > 9 visits: OR = 1.406;1.217-1.625; reference:0 visits), and cesarean delivery (OR = 1.099;1.031-1.173).
While over 75% of women with PPD received treatment, additional efforts to mitigate disparate consequences of untreated PPD should be focused on younger, Black, and urban women.
确定在参加德克萨斯医疗补助计划的产后妇女中，哪些现有的诱发因素、促成因素和需求因素与产后抑郁症（PPD）治疗的接受情况相关。
这项回顾性数据库分析使用了德克萨斯医疗补助计划的索赔数据（2018年1月1日至2022年6月30日），纳入了年龄在12 - 55岁之间、分娩前84天至产后12个月持续参保且被诊断为产后抑郁症的妇女。结局指标是产后12个月内接受产后抑郁症治疗（心理治疗和/或抗抑郁药物治疗）情况。自变量以安德森行为模型为指导，包括诱发因素（年龄、种族/族裔）、促成因素（城市化程度、产前护理）和需求因素（抑郁/焦虑、物质使用障碍[SUD]、剖宫产、早产、妊娠并发症）。采用多变量逻辑回归分析。
纳入的妇女（N = 25976）年龄为26.7±5.9岁，42.1%为西班牙裔。大多数妇女居住在城市县（80.6%），产前检查次数为6.2±3.4次，产后检查次数为3.3±2.8次，妊娠并发症1.4±0.9次。近一半（44.7%）有基线抑郁/焦虑，17.4%有基线物质使用障碍，35.8%进行了剖宫产，13.5%发生了早产。大约四分之三（76.2%）在分娩后12个月内接受了治疗。逻辑回归分析（p < 0.0001）显示，接受治疗可能性与年龄（25 - 29岁：比值比[OR] = 1.155,95%置信区间1.039 - 1.284,30 - 34岁：OR = 1.186；1.058 - 1.330, > 34岁：OR = 1.295；1.134 - 1.479；参照组：<20岁）、种族（白人：OR = 1.700；1.556 - 1.857；西班牙裔：OR = 1.179；1.087 - 1.277；参照组：黑人）、城市化程度（OR = 0.869；0.799 - 0.944）、产前护理（4 - 6次检查：OR = 1.178；1.039 - 1.336,7 - 9次检查：OR = 1.156；1.02[此处疑似有误，应为1.020] - 1.311, > 9次检查：OR = 1.406；1.217 - 1.625；参照组：0次检查）和剖宫产（OR = 1.099；1.031 - 1.173）显著相关。
虽然超过75%的产后抑郁症妇女接受了治疗，但为减轻未治疗的产后抑郁症的不同后果而做出的额外努力应集中在年轻、黑人及城市妇女身上。
