Depressive Disorders

Change in the Trends in Mental Healthcare Utilization During Pregnancy, Postpartum

Jessica Nye, PhD
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Pregnant-Therapy
In this study, women who had an outpatient visit for depression/anxiety with an antidepressant distribution in the 6 months prior to pregnancy were evaluated for mental healthcare utilization during pregnancy and the postpartum period.

Mental healthcare utilization was reduced during pregnancy among all women who were using antidepressants during prepregnancy, according to findings of a study published in the Journal of Affective Disorders.

This nationwide cohort study was conducted between 2009 and 2018 using data from the Medical Birth Registry of Norway (MBRN), the Norwegian Prescription Database (NorPD), the Norway Control and Payment of Health Reimbursement (KUHR), and the Norwegian Patient Registry (NPR). Women (N=8460) who had an outpatient visit for depression/anxiety with an antidepressant distribution in the 6 months prior to pregnancy were evaluated for mental healthcare utilization during pregnancy and the postpartum period.

The study population comprised mostly women aged 25 to 29 years (30.6%) and 30 to 34 years (29.8%), 84.7% were married or cohabitating, 53.7% were employed, 72.5% had not had a previous miscarriage or stillbirth, 55.5% had a high severity of depression/anxiety before pregnancy, and 68.1% had used a selective serotonin reuptake inhibitor in the 6 months before pregnancy.

The study population was stratified into late discontinuation (discontinuing antidepressants near the end of pregnancy; 33.8%), early discontinuation (discontinuing around the start of pregnancy; 30.4%), continuation (20.6%), and interruption (discontinuing near the end of pregnancy and resuming in postpartum; 15.2%) of antidepressant use group groups.

Consultation for depression/anxiety in the outpatient setting had been increasing in the 6 months before pregnancy (slope, 0.46).

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At the start of pregnancy, consultation in outpatient clinics (slope, -1.18), with public-contracted psychiatrists (slope, -0.26), and with public-contracted psychologists (slope, -1.18) decreased. At delivery, consultation dropped immediately and remained stable for outpatient clinics (slope, 0.07), and increased for public-contracted specialists (slope, 0.11).

Stratified by antidepressant discontinuation groups, the decrease in consultation in outpatient clinics was most pronounced among early discontinuers (slope, -1.50) and least for interrupters (slope, -0.20). In the postpartum period, interrupters had the greatest increase in consultation (slope, 0.54) and early discontinuers, the least (slope, -0.002).

This study may have been limited by not evaluating whether antidepressants were stopped due to patient choice of physician recommendation.

The study authors concluded, “Pregnancy was associated with reduced mental healthcare utilization regardless of whether antidepressant treatment was maintained during pregnancy or not. An increase in mental healthcare utilization in the postpartum year was observed among those pregnancies within women who discontinued their antidepressant treatment during pregnancy then resumed after delivery.”

Reference

Trinh NTH, Nordeng HME, Bandoli G, Eberhard-Gran M, Lupattelli A. Antidepressant and mental health care utilization in pregnant women with depression and/or anxiety: An interrupted time-series analysis. J Affect Disord. 2022;308:458-465. doi:10.1016/j.jad.2022.04.101