Utilization of Health Care Among Perinatal Women in the United States: The Role of Depression

Abstract

Background: Individuals with depression have increased nonpsychiatric health care utilization. Associations between depression and utilization have not been studied in perinatal women, despite their heightened depression risk. We examined patterns of nonpsychiatric health care utilization by symptoms of perinatal depression, expecting more frequent use of acute services while being less likely to have routine medical care. Materials and Methods: We identified 1,103 perinatal participants from the 2005 to 2016 National Health and Nutrition Examination Surveys. The Patient Health Questionnaire was used to identify depression (score ≥10). We evaluated associations between perinatal depressive symptoms and health care utilization using logistic models and relative excess risk due to interaction (RERI) using adjusted models with appropriate weighting to provide national estimates. Results: Among perinatal U.S. women, 7.3% had depressive symptoms. Relative to those without these symptoms, women experiencing depressive symptoms were younger, more impoverished, and uninsured (p < 0.05). Women with depressive symptoms, compared with those without them, had twice the odds of being without routine medical care (21.6% vs. 12.5%, adjusted odds ratio [aOR]: 2.1, 95% confidence interval [CI]: 1.1 to 4.1) and of using urgent care more frequently (26.5% vs. 15.1%, aOR: 1.9, 95% CI: 1.0 to 3.9). Depressive symptoms combined with lack of insurance generally increased the odds of not having routine care (RERI: 8.4, 95% CI: -0.5 to 17.3) and more frequent use of urgent care (RERI: 7.1, 95% CI: -2.7 to 17.0). Conclusions: Perinatal depression is a prevalent, high-risk illness that requires more nonpsychiatric services and increased psychiatric care. Approaches that facilitate establishing a place for routine care and decreasing acute care use are necessary.

Keywords: NHANES; depression; health care utilization; perinatal.

FIG. 1.

The interaction between depression and insurance status on perinatal women's having no place to go for routine care. Data presented in figure were generated by using weighted data. Scale is in adjusted odds ratios, adjusted for age, education level, poverty-to-income ratio, marital status, race/ethnicity, and substance use. aOR represents the likelihood that a woman will not have a place for routine care. Non-depressed and insured are used as the reference, with these women having a 1.0 aOR of not having a routine place for care. The black bar and light grey bars represent the main effects of depression and lack of insurance, respectively, on the aOR. Expected joint effects are the sum of the independent contributions of depression and lack of insurance, and equate to the total anticipated aOR, should no biological interaction be present. RERI is the additional effects to the total aOR due to the interaction between depression and lack of insurance. RERI = 8.4 (95% CI: −0.5 to 17.3). aOR, adjusted odds ratio; CI, confidence interval; RERI, relative excess risk due to interaction.