The impact of the 2015 ACOG screening guidelines on the diagnosis of postpartum depression among privately insured women

Abstract

Background: Postpartum depression (PPD), is underdiagnosed and undertreated. In 2015, the American College of Obstetricians and Gynecologists (ACOG) recommended that women be screened for PPD at least once during the perinatal period. The effect of the recommendation on PPD diagnosis is unknown.

Methods: Using the MerativeTM MarketScan® database, PPD prevalence was identified in privately insured women ages 13-45 with a live birth between 2013 and 2016. Postpartum depression was defined as an ICD diagnosis code for PPD or other depression, or a new pharmacy claim for an antidepressant medication during the first 12 months following delivery. Multivariable logistic regression was used to estimate the likelihood of PPD both before and after the ACOG PPD Committee Opinion.

Results: The study included 244,624 women ages 13-45 who had a live birth in 2013 through 2016. PPD prevalence before and after the 2015 ACOG Committee Opinion was 15.1 % and 17.2 %, respectively. The likelihood of PPD was not statistically different following the 2015 Committee Opinion (adjusted OR, 1.00, 95 % CI, 0.97-1.03) when controlling for age, year, delivery complications, and geographic region.

Limitations: Sociodemographic variables are not included in the MarketScan database and therefore could not be analyzed as covariates. Re-defining a PPD diagnosis as above interfered with the ability to measure a prior history of mood disorders as a covariate.

Conclusion: Implementation of the ACOG recommendations was not associated with a significant increase in PPD diagnosis. This suggests that physician organization recommendations alone are not sufficient to increase detection of PPD.

Keywords: ACOG Committee opinion; Depression; Postpartum depression; Postpartum depression screening.