Arch Womens Ment Health DOI 10.1007/s00737-015-0524-1
SHORT COMMUNICATION
Mental health care use in relation to depressive symptoms among pregnant women in the USA Nancy Byatt 1 & Rui S. Xiao 3 & Kate H. Dinh 4 & Molly E. Waring 5
Received: 22 October 2014 / Accepted: 17 March 2015 # Springer-Verlag Wien 2015
Abstract We examined mental health care use in relation to depressive symptoms (Patient Health Questionnaire (PHQ-9) ≥10) among a nationally representative sample of pregnant women using data from the National Health and Nutrition Examination Survey 2005–2012. Logistic regression models estimated crude and adjusted odds ratios for mental health care use in the past year in relation to depressive symptoms. While 8.2 % (95 % CI 4.6–11.8) of pregnant women were depressed, only 12 % (95 % CI 1.8–22.1) of these women reported mental health care use in the past year.
Keywords Pregnancy . Depression . Mental health care . Treatment . Access
* Nancy Byatt [email protected] 1
Departments of Psychiatry and Obstetrics and Gynecology, University of Massachusetts Medical School/UMass Memorial Health Care, Worcester, MA, USA
2
Clinical and Population Health Research Program, Division of Epidemiology of Chronic Diseases and Vulnerable Populations, Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA
3
Department of Surgery, University of Massachusetts Medical School, Worcester, MA, USA
4
Division of Epidemiology of Chronic Diseases and Vulnerable Populations, Departments of Quantitative Health Sciences and Obstetrics and Gynecology, University of Massachusetts Medical School, Worcester, MA, USA
Introduction Major depressive disorder is the leading cause of disability among women of reproductive age (World Health Organization 2008) and a major public health concern. One in eight women experience perinatal depression (Gavin et al. 2005) which is associated with negative birth (Grote et al. 2010), infant (Britton et al. 2001), and child outcomes (Deave et al. 2008). Perinatal depression is also under-diagnosed and undertreated (Byatt et al. 2012). Despite legislation and numerous recommendations to screen for perinatal depression, screening remains controversial because screening alone does not translate into improved outcomes (Thombs et al. 2014). While much of the legislation and recommendations have focused on detection and treatment of postpartum depression, more than 50 % of women with postpartum depression enter pregnancy depressed or have an onset during pregnancy (Wisner et al. 2013). Thus, it is critical to detect and treat depression during pregnancy. There is a dearth of studies examining mental health care use among pregnant women as it relates to symptoms of depression. Thus, the purpose of this study is to examine mental health care use in relation to depressive symptoms among pregnant women.
Methods We analyzed data from the National Health and Nutrition Examination Survey (NHANES) 2005–2012, a nationally representative survey of the civilian non-institutionalized population in the USA. NHANES first asked about mental health care use in 2005–2006. NHANES includes a household interview and a physical examination in a mobile examination center (MEC) that includes laboratory tests, physiological
N. Byatt et al.
measurements, and additional interviews (Curtin et al. 2012). Additional information about NHANES can be found at www.cdc.gov/nhanes. All participants provided written informed consent. The University of Massachusetts Medical School Institutional Review Board determined that this study did not require their oversight because analyses included only publically available de-identified data. Women were included in the analytic sample if they were aged 20–44 years and pregnant as determined by a positive urine or serum hCG test, Table 1 Characteristics of pregnant women in relation to depressive symptoms: NHANES 2005–2012, mean (SE) or % (95 % CI)
and had information available about depressive symptoms and mental health care use. During the home interview, women were asked, “During the past 12 months, have you seen or talked to a mental health professional such as a psychologist, psychiatrist, psychiatric nurse, or clinical social worker about your health?” Respondents that answered “yes” to this question were defined as having used mental health care, and those that answered “no” were defined as not having used mental health
Sample N Weighted N Age (years) Race/ethnicity Non-Hispanic White Non-Hispanic Black Mexican American/other Hispanic Other race/multiracial Poverty-to-income ratio (PIR) 0–199 % 200–399 % 400+ % Missing Education Less than high school High school graduate/GED or equivalent Some college or AA degree
Depressed
Non-depressed
45 211,584 27.7 (1.1)
418 2,370,249 28.8 (0.4)
26.3 (5.0, 47.5) 23.6 (7.7, 39.4) 41.1 (21.9, 60.2) 9.1 (0.0, 22.1)
55.4 (47.2, 63.7) 13.1 (8.6, 17.6) 21.3 (16.0, 26.5) 10.2 (5.5, 14.9)
65.6 (48.6, 82.5) 20.5 (4.0, 37.0) 3.0 (0.0, 6.7) 11.0 (0.3, 21.6)
30.7 (25.1, 36.3) 25.3 (18.7, 32.0) 39.0 (31.1, 46.8) 5.0 (2.4, 7.6)
47.7 (26.1, 69.3) 17.0 (1.4, 32.6) 25.3 (10.8, 39.8)
16.1 (12.2, 20.0) 16.1 (11.5, 20.8) 32.8 (27.3, 38.3)
10.0 (0.0, 23.6)
35.0 (28.1, 41.9)
41.9 (23.0, 60.8) 29.6 (11.6, 47.7) 28.4 (12.8, 44.0) 5.0 (0.4)
71.3 (65.2, 77.5) 10.5 (6.6, 14.3) 18.2 (12.7, 23.7) 5.5 (0.2)
College graduate or above Marital status Married Living with partner Widowed, divorced, separated, never married Mean month of pregnancy Gravidity One pregnancy Two pregnancies Three pregnancies Four or more pregnancies Health insurance status Currently uninsured Current coverage but time without coverage in past 12 months Continuous insurance coverage for past 12 months Alcohol use in past 12 months Ever used marijuana Ever used methamphetamines
13.7 (0.0, 28.2) 18.9 (5.4, 32.5) 12.9 (1.6, 24.2) 54.4 (35.6, 73.2)
22.4 (15.2, 29.6) 27.9 (21.7, 34.0) 25.5 (20.3, 30.8) 24.2 (17.7, 30.8)
29.3 (8.9, 49.7) 25.7 (10.2, 41.3) 44.9 (26.0, 63.9) 59.7 (44.5, 74.9) 60.5 (44.5, 76.5) 2.6 (1.1, 4.2)
14.2 (10.2, 18.3) 17.3 (12.5, 22.1) 68.4 (61.6, 75.2) 56.7 (49.7, 63.7) 45.4 (37.0, 53.9) 0.8 (0, 2.4)
Ever used heroin Ever used cocaine
0.7 (0, 1.9) 9.9 (5.0, 14.8)
0.6 (0, 2.0) 6.2 (0, 13.6)
Adjusted for poverty-to-income ratio (PIR) and race/ethnicity OR odds ratio, CI confidence interval
Mental health care use in relation to depressive symptoms
care. Participants who refused to answer or who answered “don’t know” were excluded from the analysis. At the Mobile Examination Center, depressive symptoms were assessed using the Patient Health Questionnaire (PHQ9), a nine-item self-report questionnaire that has been widely validated for use in primary care settings (Kroenke et al. 2001). Interviewers asked participants nine items about the frequency of symptoms of depression over the past 2 weeks. Response categories of “not at all,” “several days,” “more than half the days,” and “nearly every day” were scored from 0 to 3. We summed these nine items for a total PHQ-9 score. The total PHQ-9 scores were categorized into not depressed (score of
SHORT COMMUNICATION
Mental health care use in relation to depressive symptoms among pregnant women in the USA Nancy Byatt 1 & Rui S. Xiao 3 & Kate H. Dinh 4 & Molly E. Waring 5
Received: 22 October 2014 / Accepted: 17 March 2015 # Springer-Verlag Wien 2015
Abstract We examined mental health care use in relation to depressive symptoms (Patient Health Questionnaire (PHQ-9) ≥10) among a nationally representative sample of pregnant women using data from the National Health and Nutrition Examination Survey 2005–2012. Logistic regression models estimated crude and adjusted odds ratios for mental health care use in the past year in relation to depressive symptoms. While 8.2 % (95 % CI 4.6–11.8) of pregnant women were depressed, only 12 % (95 % CI 1.8–22.1) of these women reported mental health care use in the past year.
Keywords Pregnancy . Depression . Mental health care . Treatment . Access
* Nancy Byatt [email protected] 1
Departments of Psychiatry and Obstetrics and Gynecology, University of Massachusetts Medical School/UMass Memorial Health Care, Worcester, MA, USA
2
Clinical and Population Health Research Program, Division of Epidemiology of Chronic Diseases and Vulnerable Populations, Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA
3
Department of Surgery, University of Massachusetts Medical School, Worcester, MA, USA
4
Division of Epidemiology of Chronic Diseases and Vulnerable Populations, Departments of Quantitative Health Sciences and Obstetrics and Gynecology, University of Massachusetts Medical School, Worcester, MA, USA
Introduction Major depressive disorder is the leading cause of disability among women of reproductive age (World Health Organization 2008) and a major public health concern. One in eight women experience perinatal depression (Gavin et al. 2005) which is associated with negative birth (Grote et al. 2010), infant (Britton et al. 2001), and child outcomes (Deave et al. 2008). Perinatal depression is also under-diagnosed and undertreated (Byatt et al. 2012). Despite legislation and numerous recommendations to screen for perinatal depression, screening remains controversial because screening alone does not translate into improved outcomes (Thombs et al. 2014). While much of the legislation and recommendations have focused on detection and treatment of postpartum depression, more than 50 % of women with postpartum depression enter pregnancy depressed or have an onset during pregnancy (Wisner et al. 2013). Thus, it is critical to detect and treat depression during pregnancy. There is a dearth of studies examining mental health care use among pregnant women as it relates to symptoms of depression. Thus, the purpose of this study is to examine mental health care use in relation to depressive symptoms among pregnant women.
Methods We analyzed data from the National Health and Nutrition Examination Survey (NHANES) 2005–2012, a nationally representative survey of the civilian non-institutionalized population in the USA. NHANES first asked about mental health care use in 2005–2006. NHANES includes a household interview and a physical examination in a mobile examination center (MEC) that includes laboratory tests, physiological
N. Byatt et al.
measurements, and additional interviews (Curtin et al. 2012). Additional information about NHANES can be found at www.cdc.gov/nhanes. All participants provided written informed consent. The University of Massachusetts Medical School Institutional Review Board determined that this study did not require their oversight because analyses included only publically available de-identified data. Women were included in the analytic sample if they were aged 20–44 years and pregnant as determined by a positive urine or serum hCG test, Table 1 Characteristics of pregnant women in relation to depressive symptoms: NHANES 2005–2012, mean (SE) or % (95 % CI)
and had information available about depressive symptoms and mental health care use. During the home interview, women were asked, “During the past 12 months, have you seen or talked to a mental health professional such as a psychologist, psychiatrist, psychiatric nurse, or clinical social worker about your health?” Respondents that answered “yes” to this question were defined as having used mental health care, and those that answered “no” were defined as not having used mental health
Sample N Weighted N Age (years) Race/ethnicity Non-Hispanic White Non-Hispanic Black Mexican American/other Hispanic Other race/multiracial Poverty-to-income ratio (PIR) 0–199 % 200–399 % 400+ % Missing Education Less than high school High school graduate/GED or equivalent Some college or AA degree
Depressed
Non-depressed
45 211,584 27.7 (1.1)
418 2,370,249 28.8 (0.4)
26.3 (5.0, 47.5) 23.6 (7.7, 39.4) 41.1 (21.9, 60.2) 9.1 (0.0, 22.1)
55.4 (47.2, 63.7) 13.1 (8.6, 17.6) 21.3 (16.0, 26.5) 10.2 (5.5, 14.9)
65.6 (48.6, 82.5) 20.5 (4.0, 37.0) 3.0 (0.0, 6.7) 11.0 (0.3, 21.6)
30.7 (25.1, 36.3) 25.3 (18.7, 32.0) 39.0 (31.1, 46.8) 5.0 (2.4, 7.6)
47.7 (26.1, 69.3) 17.0 (1.4, 32.6) 25.3 (10.8, 39.8)
16.1 (12.2, 20.0) 16.1 (11.5, 20.8) 32.8 (27.3, 38.3)
10.0 (0.0, 23.6)
35.0 (28.1, 41.9)
41.9 (23.0, 60.8) 29.6 (11.6, 47.7) 28.4 (12.8, 44.0) 5.0 (0.4)
71.3 (65.2, 77.5) 10.5 (6.6, 14.3) 18.2 (12.7, 23.7) 5.5 (0.2)
College graduate or above Marital status Married Living with partner Widowed, divorced, separated, never married Mean month of pregnancy Gravidity One pregnancy Two pregnancies Three pregnancies Four or more pregnancies Health insurance status Currently uninsured Current coverage but time without coverage in past 12 months Continuous insurance coverage for past 12 months Alcohol use in past 12 months Ever used marijuana Ever used methamphetamines
13.7 (0.0, 28.2) 18.9 (5.4, 32.5) 12.9 (1.6, 24.2) 54.4 (35.6, 73.2)
22.4 (15.2, 29.6) 27.9 (21.7, 34.0) 25.5 (20.3, 30.8) 24.2 (17.7, 30.8)
29.3 (8.9, 49.7) 25.7 (10.2, 41.3) 44.9 (26.0, 63.9) 59.7 (44.5, 74.9) 60.5 (44.5, 76.5) 2.6 (1.1, 4.2)
14.2 (10.2, 18.3) 17.3 (12.5, 22.1) 68.4 (61.6, 75.2) 56.7 (49.7, 63.7) 45.4 (37.0, 53.9) 0.8 (0, 2.4)
Ever used heroin Ever used cocaine
0.7 (0, 1.9) 9.9 (5.0, 14.8)
0.6 (0, 2.0) 6.2 (0, 13.6)
Adjusted for poverty-to-income ratio (PIR) and race/ethnicity OR odds ratio, CI confidence interval
Mental health care use in relation to depressive symptoms
care. Participants who refused to answer or who answered “don’t know” were excluded from the analysis. At the Mobile Examination Center, depressive symptoms were assessed using the Patient Health Questionnaire (PHQ9), a nine-item self-report questionnaire that has been widely validated for use in primary care settings (Kroenke et al. 2001). Interviewers asked participants nine items about the frequency of symptoms of depression over the past 2 weeks. Response categories of “not at all,” “several days,” “more than half the days,” and “nearly every day” were scored from 0 to 3. We summed these nine items for a total PHQ-9 score. The total PHQ-9 scores were categorized into not depressed (score of
