IMPACT OF TIME OF DIAGNOSIS ON PREVALENCE OF POSTPARTUM DEPRESSION IN WOMEN WITH COMMERCIAL AND MEDICAID HEALTH INSURANCE – A RETROSPECTIVE STUDY

• Published in: Value in health Vol. 20; no. 5; p. A349
• Main Authors: Bonthapally, V, Broder, MS, Tieu, RS, Gannu, L, Meltzer-Brody, S, Chang, E
• Format: Journal Article
• Language: English
• Published: Lawrenceville Elsevier Science Ltd 01.05.2017
• Subjects: Adjustment disorder; Childbirth & labor; Claims; Depressive personality disorders; Diagnostic and Statistical Manual; Diagnostic tests; Health insurance; Inpatient care; Medicaid; Medical diagnosis; Medical screening; Mental depression; Mental disorders; Patients; Postpartum; Postpartum depression; Postpartum women; Pregnancy; Prevalence
• ISSN: 1098-3015; 1524-4733
• DOI: 10.1016/j.jval.2017.05.005

OBJECTIVES: Postpartum depression (PPD) has multiple definitions. The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition defines PPD as a subtype of major depressive disorder with onset during pregnancy and up to 4 weeks postpartum-i.e. "peripartum onset." Due to differing time-based definitions of PPD, we sought to determine the impact of time of PPD onset on prevalence estimates of PPD. METHODS: We used the Truven Commercial Claims database (>70 million patients), the Medicaid Multi-State database, (>30 million patients; 11 states), and ICD-9 coding to retrospectively study women between the ages of 15 and 50 years at childbirth from 2011-2014. For the commercial database, women had to be continuously enrolled in health insurance for one year before and after delivery. Since Medicaid has limited coverage, continuous enrollment for 6 months before and 60 days after delivery was required. PPD was denned based on inpatient and outpatient claims for PPD, MDD, adjustment disorder, or depression not otherwise specified, or claims for treatment. Subjects with MDD prior to the last trimester of pregnancy were excluded. RESULTS: There were 230,927 deliveries in the commercial database and 351,533 deliveries in the Medicaid database. In months 0-2 postpartum, the prevalence estimates for PPD were 1.7% in the commercial database and 1.9% in Medicaid. The prevalence in the commercial database was 2.7% for 0-4 months postpartum. (Medicaid prevalence could not be determined due to enrollment restrictions.) The prevalence estimates for PPD at 8, 10, and 12 months were 3.4%, 4.0%, and 4.9%, respectively. CONCLUSIONS: Of the total PPD cases identified by the algorithm over 12 months postpartum, only one third were identified in only the first two months postpartum, suggesting that restrictive, time-based PPD definitions and the limited duration of postpartum screening may contribute to underestimates of PPD prevalence.