Recorded Diagnoses of Depression During Delivery Hospitalizations in the United States, 2000-2015

Abstract

Objective: To describe national, state-specific, and sociodemographic trends in diagnoses of depressive disorders recorded during delivery hospitalizations.

Methods: Data were analyzed from the National Inpatient Sample (2000-2015) and 31 publicly available State Inpatient Databases (2000-2015) of the Healthcare Cost and Utilization Project. Delivery hospitalizations were identified by using International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) diagnostic and procedure codes for obstetric delivery. Depressive disorders were identified from ICD-9-CM diagnoses codes classified as depressive disorders in the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (291.89, 292.84, 293.83, 296.2-296.26, 296.3-296.36, 300.4, and 311). Prevalence rates and average annual rate change were calculated nationally and across 28 states with at least 3 years of data and age, payer source, and race or ethnicity.

Results: The U.S. rate of depressive disorders recorded during delivery hospitalizations increased from 4.1 diagnoses per 1,000 hospitalizations in 2000 to 28.7 in 2015. Rates significantly increased in 27 of the 28 states. Recent (2014-2015) rates were lowest in Hawaii and Nevada (less than 14/1,000) and highest in Vermont, Minnesota, Oregon, and Wisconsin (greater than 49/1,000). Rates in 2015 were highest among those aged 35 years or older, public insurance recipients, and non-Hispanic white women (greater than 31/1,000). The highest annual rate increases were in Vermont and Maine (3.8/1,000 or greater). Non-Hispanic white women, those 35 years of age or older, and public insurance recipients showed the highest annual rate increases during 2000-2015 (1.7/1,000 or greater).

Conclusion: During 2000-2015, rates of depressive disorders recorded during delivery hospitalizations increased nationally, in 27 states with available data, and across all sociodemographic categories.

Figure 1.

U.S. national prevalence rate* and 95% confidence interval^† of depressive disorders recorded per 1,000 hospitalizations Nationwide Inpatient Sample, Healthcare Cost and Utilization Project, 2000–−2015.^‡ The solid blue line represents the prevalence rate and the dotted blue lines represent the 95% confidence intervals. *Prevalence rate numerator consisted of depressive disorder International Classification of Diseases-9-Clinical Modification codes (291.89, 292.84, 293.83, 296.2–296.26, 296.3–296.36, 300.4, and 311), prevalence rate denominator consisted of delivery hospitalization discharges. ^†Confidence intervals are based on unweighted data. ^‡Rates are for 2000 through the third quarter of 2015.

Figure 2.

A state-specific comparison of depressive disorders recorded per 1,000 delivery hospitalizations: (A) prevalence rate*, 2014–2015^† and (B) average annual rate change, 2000–2015. Data from state inpatient databases, Healthcare Cost and Utilization Project. Red line notes national value. *Prevalence rate numerator consisted of depressive disorder International Classification of Diseases-9-Clinical Modification codes (291.89, 292.84, 293.83, 296.2–296.26, 296.3–296.36, 300.4, and 311), prevalence rate denominator consisted of delivery hospitalization discharges. ^†Rates for Arizona, Colorado, Iowa, Kentucky, Minnesota, Nebraska, North Carolina, and Wisconsin are 2015, the remainder are 2014. ^‡Significant at P<.05.

Figure 3.

Prevalence rates,* 95% confidence intervals,^† and average annual percent change in the rate of depressive disorders recorded during delivery hospitalizations by sociodemographic characteristics: (A) age at admission, (B) payer source, and (C) race–ethnicity. Data from the Nationwide Inpatient Sample, Healthcare Cost and Utilization Project, 2000–2015.^‡ Light blue bars indicate the year 2000; dark blue bars indicate the year 2015. *Prevalence rate numerator consisted of depressive disorder ICD-9-CM codes (291.89, 292.84, 293.83, 296.2–296.26, 296.3–296.36, 300.4, and 311), prevalence rate denominator consisted of delivery hospitalization discharges. †Confidence intervals are based off of unweighted data. ^‡Rates are for 2000 through the third quarter of 2015. ^§Includes Worker’s Compensation, Tricare, Title V, and other government programs. ^¶Includes Medicaid and Medicare (<2%).