Racial and ethnic disparities in postpartum depression care among low-income women

Psychiatr Serv. 2011 Jun;62(6):619-25. doi: 10.1176/ps.62.6.pss6206_0619.

Abstract

Objective: The goal of this study was to characterize racial-ethnic differences in mental health care utilization associated with postpartum depression in a multiethnic cohort of Medicaid recipients.

Methods: In a retrospective cohort study, administrative claims data from New Jersey's Medicaid program were obtained for 29,601 women (13,001 whites, 13,416 blacks, and 3,184 Latinas) who delivered babies between July 2004 and October 2007. Racial-ethnic differences were estimated with logistic regression for initiation of antidepressant medication or outpatient mental health visits within six months of delivery, follow-up (a prescription refill or second visit), and continued mental health care (at least three visits or three filled antidepressant prescriptions within 120 days).

Results: Nine percent (N=1,120) of white women initiated postpartum mental health care, compared with 4% (N=568) of black women and 5% (N=162) of Latinas. With analyses controlling for clinical factors, the odds of initiating treatment after delivery were significantly (p<.001) lower for blacks (adjusted odds ratio [AOR]=.43) and Latinas (AOR=.59) compared with whites. Among those who initiated treatment, blacks and Latinas were less likely than whites to receive follow-up treatment (blacks, AOR=.66, p<.001; Latinas, AOR=.67, p<.05) or continued care (blacks, AOR=.81, p=.069; Latinas, AOR=.67, p<.05). Among those who initiated antidepressant treatment, black women and Latinas were less likely than whites to refill a prescription.

Conclusions: There were significant racial-ethnic differences in depression-related mental health care after delivery. Suboptimal treatment was prevalent among all low-income women in the study. However, racial and ethnic disparities in the initiation and continuation of postpartum depression care were particularly troubling and warrant clinical and policy attention.

Publication types

  • Comparative Study
  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Adolescent
  • Adult
  • African Continental Ancestry Group / psychology*
  • African Continental Ancestry Group / statistics & numerical data*
  • Aftercare / psychology
  • Aftercare / statistics & numerical data
  • Antidepressive Agents / therapeutic use*
  • Cohort Studies
  • Community Mental Health Services / statistics & numerical data*
  • Depression, Postpartum / epidemiology
  • Depression, Postpartum / ethnology*
  • Drug Utilization / statistics & numerical data
  • European Continental Ancestry Group / psychology*
  • European Continental Ancestry Group / statistics & numerical data*
  • Female
  • Healthcare Disparities / statistics & numerical data*
  • Hispanic Americans / psychology*
  • Hispanic Americans / statistics & numerical data*
  • Humans
  • Medicaid / statistics & numerical data
  • Medication Adherence / ethnology
  • Medication Adherence / psychology
  • Medication Adherence / statistics & numerical data
  • New Jersey
  • Odds Ratio
  • Probability
  • Regression Analysis
  • Retrospective Studies
  • United States
  • Utilization Review / statistics & numerical data
  • Young Adult

Substances

  • Antidepressive Agents