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Diagnoses of postpartum depression (PPD) increased significantly across all racial and ethnic groups and pre-pregnancy body mass index (BMI) categories over the past decade, according to a California-based cross-sectional study.
An analysis of more than 400,000 pregnancies found that prevalence of PPD doubled from 2010 to 2021 (9.4% vs 19%), according to Darios Getahun, MD, PhD, MPH, of Kaiser Permanente Southern California in Pasadena, and co-authors.
While rates increased across all groups, the largest increases were seen in those who identified as Asian and Pacific Islander (280% increase) and non-Hispanic Black (140% increase), they reported in JAMA Network Open.
Overall increases were found in the rates of PPD among individuals of all pre-pregnancy weight groups, but the largest increases were in those with obesity and morbid obesity:
- 6.4% to 13.4% among those with underweight (P<0.001)
- 8.5% to 17% among those with normal weight (P<0.001)
- 9.5% to 19.8% among those with overweight (P<0.001)
- 11% to 21.2% among those with class I obesity (P<0.001)
- 14.9% to 24.4% among those with class II/III obesity (P<0.001)
Getahun and co-authors noted that increases in PPD diagnoses may be a result of improved screening and diagnostic practices, but they also noted these findings highlight a major need for the development and implementation of interventions for preventing PPD as well.
“Targeted efforts to address racial and ethnic disparities and the mental health needs of high-risk groups, including women with elevated pre-pregnancy BMI, may help mitigate the impact of PPD on maternal and child well-being,” they wrote.
Ludmila De Faria, MD, the chair for the American Psychiatric Association’s (APA) Council on Women’s Mental Health and an associate professor of psychiatry at the University of Florida in Gainesville, said these findings are a huge positive and also a call to action.
“It confirms what we know, that all of the emphasis on early detection and screening has paid off, and now more people are definitely being identified that struggle with postpartum depression,” she told MedPage Today. “The issue is, do they all have access to care?”
With increased diagnoses of PPD, De Faria emphasized that there is also a shortage of mental health care professionals who can provide the needed care. The challenge moving forward, she added, will be understanding where access to appropriate mental health services might be lacking around the country and making efforts to improve resources in those areas.
She also noted that it is not necessary for every individual diagnosed with PPD to see a psychiatrist, and highlighted that the APA has a perinatal mental health toolkit to help guide mental health care.
To conduct the study, the authors analyzed data from 442,308 pregnancies from Kaiser Permanente Southern California (KPSC) electronic health records, including all live and stillbirths at 20 weeks’ gestation or more between January 2010 and December 2021.
Among those pregnancies, the median maternal age at delivery was 31 years. The majority of mothers identified as Hispanic (52.4%), followed by non-Hispanic white (24.5%), Asian and Pacific Islander (14.2%), and non-Hispanic Black (7.5%).
PPD was defined as the presence of a depressive disorder diagnosis based on ICD-9 and ICD-10 diagnostic codes provided by a mental health specialist or the use of antidepressants prescribed for PPD within 12 months following childbirth.
The largest relative increases of PPD overall were observed in 2013 (22% increase from 2012), 2018 (30% increase from 2017), and 2019 (20% increase from 2018). The authors noted that some of these increases were likely due to new California laws that required obstetric clinicians to provide universal screening for maternal mental health conditions by the middle of 2019.
Limitations included that the study may have underestimated the prevalence of PPD since some cases were likely not captured through clinical screening or postpartum visits. Also, any mental healthcare services received outside of KPSC facilities were not accounted for. And the results may not be generalizable since the study cohort was based in one area and received healthcare services from one health system.
The study was partly supported by Kaiser Permanente Direct Community Benefit Funds.
The authors reported no conflicts of interest.
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