OBJECTIVES: Mental health conditions are a leading cause of maternal death, but postpartum depression (PPD) screening is inconsistent, and barriers hinder the receipt of treatment. The objective of this study was to determine the relationship between sociodemographic factors and PPD screening and treatment.

METHODS: Women continuously enrolled in a self-insured health plan of a large health system with a delivery between 9/2019 and 4/2021 were followed from the start of pregnancy until 12 months after delivery. Medical and prescription claims identified PPD screening and treatment. Race, ethnicity, and social vulnerability index (SVI) were collected from enrollment data. Age, preterm birth, previous depression screening, and previous depression diagnosis were covariates. The study objectives were addressed with multivariable logistic regression.

RESULTS: The sample (N=2,418) was 31.0+/-5.0 years old, primarily White (77.9%) and non-Hispanic (77.2%). About 25% had a documented PPD screening. Patients residing in moderate and highly vulnerable communities based on SVI household composition and disability (moderate odds ratio=0.7, 95% confidence interval 0.52-0.99; high 0.5, 0.29-0.92) and housing type and transportation (moderate 0.8, 0.62-1.00; high 0.34, 0.15-0.71) had lower odds of receiving screening than patients in less vulnerable communities. The odds of receiving PPD screening were higher for patients in moderate and highly vulnerable communities based on SVI minority status and language (moderate 1.5, 1.19-1.91; high 2.4, 1.65-3.52), and those screened during pregnancy (6.1, 3.86-9.70), compared to their counterparts. Nearly 95% (93.5%) of patients diagnosed with PPD received treatment. The odds of receiving treatment were lower for Black patients (0.2, 0.09-0.64) and higher for patients who had depression during pregnancy (2.1, 1.02-4.14).

CONCLUSIONS: PPD screening was suboptimal, however, most patients diagnosed with PPD received treatment. Outreach efforts should be made to improve screening rates among vulnerable populations and PPD treatment for Black patients should be prioritized.