title: Detection and treatment rates for perinatal depression in a state Medicaid population.
abstract: BACKGROUND
  The purpose of this investigation was to assess detection and treatment rates for perinatal depression among women enrolled in the California State Medicaid (Medi-Cal) program in comparison to female beneficiaries of reproductive age who did not give birth during the same study period.
  
  
  METHODS
  Investigators conducted a retrospective longitudinal cohort analysis of women between the ages of 18 and 39 years old who were continuously enrolled in the Medi-Cal fee-for-service program between January 2006 and December 2009. The perinatal cohort consisted of women with evidence of a live birth occurring between October 2007 and March 2009. The control cohort consisted of women in the same age group and health plan without evidence of pregnancy during this time frame. The primary outcome of this investigation was diagnosis of depression during 3 contiguous 9-month time frames: immediately prior to presumed conception, during pregnancy, and throughout the postpartum period. Secondary outcomes included within-group and cohort comparisons of treatment patterns (antidepressant or psychotherapy). A multivariable analysis of demographic factors predicting depression diagnosis or treatment was conducted as well.
  
  
  RESULTS
  A total of 6030 women was identified in the perinatal cohort, and 56,709 women were included in the control group. The perinatal cohort was significantly less likely than nonpregnant controls to receive a diagnosis of depression both during pregnancy (prevalence=1.6% vs 3.5%; OR=0.45; 95% CI=0.35-0.55) and postpartum (2.2% vs 3.6%; OR=0.59; 95% CI=0.50-0.71). Similar differences were noted in antidepressant prescribing patterns apparent during these 2 time frames. A subgroup analysis of women who received a depression diagnosis revealed that only 48% of the perinatal cohort was provided any treatment during pregnancy (vs 72% of the control group; p<0.0001) or postpartum (57% vs 73%; p<0.0001). Specific demographic factors predicting a lower prevalence of depression detection or treatment included Hispanic descent, age <25 years, or primary residence in an rural setting.
  
  
  CONCLUSIONS
  Depression was often overlooked and undertreated among women who are pregnant or postpartum in comparison to services delivered to similar nonpregnant controls. Significant disparities in the healthcare received by certain subpopulations of perinatal women suggest that research into barriers to care and subsequent interventions are warranted.
authors.affiliation: 1Department of Behavioral Health Services,San Francisco Department of Public Health,San Francisco,California,USA.
authors.forename: Michelle L
authors.initials: ML
authors.lastname: Geier
authors.affiliation: 2Department of Neurology and Department of Epidemiology and Biostatistics,University of California San Francisco School of Medicine San Francisco,California,USA.
authors.forename: Nancy
authors.initials: N
authors.lastname: Hills
authors.affiliation: 3Department of California Health eQuality,University of California Davis Medical Center,Sacramento,California,USA.
authors.forename: Marco
authors.initials: M
authors.lastname: Gonzales
authors.affiliation: 4University of California at San Francisco School of Pharmacy,San Francisco,California,USA.
authors.forename: Karoline
authors.initials: K
authors.lastname: Tum
authors.affiliation: 5Department of Clinical Pharmacy,University of California at San Francisco,San Francisco,California,USA.
authors.forename: Patrick R
authors.initials: PR
authors.lastname: Finley
mesh_terms: D000293:Adolescent; D000328:Adult; D000928:Antidepressive Agents / Q000627:therapeutic use; D002140:California; D016022:Case-Control Studies; D019052:Depression, Postpartum / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology*; D005260:Female; D006801:Humans; D008484:Medicaid; D011247:Pregnancy; D014481:United States
chemical_list: D000928:Antidepressive Agents
keywords: perinatal depression