OBJECTIVES: The objective of this study was to determine what predisposing, enabling, and need factors are significantly related to receipt of postpartum depression (PPD) treatment among postpartum women with Texas Medicaid.

METHODS: This retrospective database analysis used Texas Medicaid enrollment, medical, and pharmacy claims from 1/1/2018 to 6/30/2022. Inclusion criteria were at least one delivery, age 12-55 years, continuous enrollment for 84 days pre- and 12 months post-delivery, and a diagnosis of PPD. The index date was the date of delivery. The dependent variable was receipt of PPD treatment (i.e., psychotherapy and/or antidepressant medication) within 12 months after delivery. The independent variables included predisposing (age, race/ethnicity), enabling (urbanicity, prenatal care), and need (baseline depression/anxiety, baseline substance use disorder [SUD], cesarean delivery, preterm birth, pregnancy complications) factors. Multivariable logistic regression was used to examine the relationships between these factors and receipt of depression treatment.

RESULTS: Included women (N=25,976) were 26.7±5.9 years old and 42.1% were Hispanic. Most patients resided in urban counties (80.6%) and had 6.2±3.4 prenatal visits, 3.3±2.8 postpartum visits, and 1.4±0.9 pregnancy complications. Nearly half (44.7%) had baseline depression/anxiety, 17.4% had baseline SUD, 35.8% had cesarean delivery, and 13.5% had preterm birth. Three-fourths (76.2%) received treatment (41.6% antidepressant only, 21.8% psychotherapy and antidepressant, 12.8% psychotherapy only) within 12 months after delivery. Logistic regression (p<0.0001) revealed that the likelihood of receipt of treatment was significantly associated with age at delivery (odds ratio [OR]=1.015, 95% confidence interval 1.010-1.021), race (White: OR=1.694,1.551-1.850; Hispanic: OR=1.179,1.088-1.278; reference-Black), urbanicity (OR=0.871,0.802-0.946), prenatal care visits (OR=1.019,1.010-1.028), baseline SUD (OR=1.304,1.194-1.424), and cesarean delivery (OR=1.098,1.030-1.172).

CONCLUSIONS: While over 75% of women with PPD received treatment, additional efforts to mitigate disparate consequences of untreated PPD should be focused on younger, Black, and urban women, as well as those with SUD and who had a cesarean delivery.