title: The pregnancy "super-utilizer": how does a high-risk depression screen affect medical utilization?
abstract: OBJECTIVE
  Our objective was to determine whether a score of  >11 on the Edinburgh postnatal depression scale (EPDS) at the initial prenatal visit was associated with an increased use of acute medical visits when compared to pregnant women with an initial EPDS score of ≤11.
  
  
  METHODS
  This was a retrospective cohort study comparing the utilization of acute medical care during pregnancy and the first eight weeks after delivery amongst 200 women with an EPDS score >11 at their initial prenatal visit compared with 200 women with an EPDS score ≤11. "Super-utilization" was defined as ≥4 acute or unscheduled medical visits during pregnancy and the first eight weeks after delivery (90th percentile). Logistic regression was used to control for confounders.
  
  
  RESULTS
  Women with an initial EPDS score >11 were significantly more likely to engage in super-utilization of acute medical care compared with those women scoring ≤11 (adjusted odds ratio [aOR], 2.12; 95% confidence interval [CI], 1.53-3.90).
  
  
  CONCLUSIONS
  Pregnant women scoring >11 on the EPDS at their initial prenatal visit are more likely to super-utilize acute medical care in the perinatal period. This subset of patients at-risk for increased utilization can be identified early during prenatal care. Interventions to better meet the medical and psychosocial needs of these women warrant future research.
authors.affiliation: a Department of Obstetrics and Gynecology , ATTN: MCHJ-CLG, Madigan Army Medical Center, 9040 Fitzsimmons Dr , Tacoma , WA , USA.
authors.forename: Alison M
authors.initials: AM
authors.lastname: Grajkowski
authors.affiliation: a Department of Obstetrics and Gynecology , ATTN: MCHJ-CLG, Madigan Army Medical Center, 9040 Fitzsimmons Dr , Tacoma , WA , USA.
authors.forename: Brad M
authors.initials: BM
authors.lastname: Dolinsky
authors.affiliation: a Department of Obstetrics and Gynecology , ATTN: MCHJ-CLG, Madigan Army Medical Center, 9040 Fitzsimmons Dr , Tacoma , WA , USA.
authors.forename: Jonathan L
authors.initials: JL
authors.lastname: Abbott
authors.affiliation: a Department of Obstetrics and Gynecology , ATTN: MCHJ-CLG, Madigan Army Medical Center, 9040 Fitzsimmons Dr , Tacoma , WA , USA.
authors.forename: Alison L
authors.initials: AL
authors.lastname: Batig
mesh_terms: D000328:Adult; D019052:Depression, Postpartum / Q000175:diagnosis* / Q000523:psychology; D005260:Female; D006801:Humans; D016015:Logistic Models; D008403:Mass Screening / Q000379:methods / Q000706:statistics & numerical data*; D008427:Maternal Health Services / Q000706:statistics & numerical data*; D000069342:Medical Overuse / Q000517:prevention & control* / Q000706:statistics & numerical data; D049590:Postpartum Period; D011247:Pregnancy; D011569:Psychiatric Status Rating Scales; D012189:Retrospective Studies; D055815:Young Adult
keywords: Depression; postpartum depression; prenatal care