Predisposing, Enabling, and Need Factors Associated with Postpartum Depression Treatment Among Women Enrolled in Texas Medicaid.

IF 1.7 4区医学 Q3 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Maternal and Child Health Journal Pub Date : 2025-07-17 DOI:10.1007/s10995-025-04145-z

Emma L Pennington, Jamie C Barner, Carolyn M Brown, Leticia R Moczygemba, Divya A Patel

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引用次数: 0

Abstract

Objectives: 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.

Methods: 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.

Results: 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).

Conclusions for practice: 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.

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参与德州医疗补助计划的妇女产后抑郁症治疗的易感因素、促成因素和需求因素

目的：确定哪些可用的易感因素，使能因素和需要因素与接受产后抑郁症（PPD）治疗有关。方法：该回顾性数据库分析使用德克萨斯州医疗补助索赔（2018年1月1日至2022年6月30日），包括12-55岁的女性，分娩前84天至产后12个月连续登记，诊断为PPD。结果是产后12个月内接受PPD治疗（心理治疗和/或抗抑郁药物）。独立变量以Andersen行为模型为指导，包括易感因素（年龄、种族/民族）、使能因素（城市化、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logistic回归。结果：纳入的女性（N = 25,976）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6.2±3.4次，产后检查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SUD， 35.8%有剖腹产，13.5%有早产。大约四分之三（76.2%）的患者在分娩后12个月内接受了治疗。Logistic回归(p 34: OR = 1.295;1.134-1.479；参考：9次访问：OR = 1.406;1.217-1.625；参考文献：0次就诊)和剖宫产（OR = 1.099;1.031-1.173）。实践结论：虽然超过75%的PPD女性患者接受了治疗，但为减轻未经治疗的PPD的不同后果，应将更多的努力集中在年轻、黑人和城市女性身上。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Maternal and Child Health Journal PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH-

CiteScore

3.20

自引率

4.30%

发文量

271

期刊介绍： Maternal and Child Health Journal is the first exclusive forum to advance the scientific and professional knowledge base of the maternal and child health (MCH) field. This bimonthly provides peer-reviewed papers addressing the following areas of MCH practice, policy, and research: MCH epidemiology, demography, and health status assessment Innovative MCH service initiatives Implementation of MCH programs MCH policy analysis and advocacy MCH professional development. Exploring the full spectrum of the MCH field, Maternal and Child Health Journal is an important tool for practitioners as well as academics in public health, obstetrics, gynecology, prenatal medicine, pediatrics, and neonatology. Sponsors include the Association of Maternal and Child Health Programs (AMCHP), the Association of Teachers of Maternal and Child Health (ATMCH), and CityMatCH.