Perinatal Risk Factors and Postpartum Depression: A Comparison of Publicly and Privately Insured Women

Abstract

Postpartum depression affects approximately 13% of women and is considered a major complication of childbirth. When it is undetected or untreated there is an increased risk for morbidity. Increased awareness of perinatal risk factors can improve care provided to pregnant and postpartum women. Also, increasing provider understanding of perinatal depression can help with earlier identification of prenatal risks, leading to more effective treatment prior to the traditional diagnosis of postpartum depression. This study examined how perinatal maternal risk factors, perceived stress, and depression related to postpartum depression among privately insured women and those on Medicaid. Using the Cohen Perceived Stress Scale (PSS), pregnant women were assessed twice, both during pregnancy and the postpartum period. Participants were also assessed for psychosocial challenges during pregnancy and related medical diagnoses before delivery using items from the CDC Pregnancy Risk Assessment Monitoring tool (PRAMS). The prevalence of depression was determined by completion of the Edinburgh Postnatal Depression Scale (EPDS) and the Center for Epidemiological Studies Depression Scale (CES‐D). From a larger data sample, frequency of perinatal stress and depression, psychosocial conflict, and medical conditions were described in relationship to postpartum depression among the two sample groups. Participants were women seeking prenatal care prior to 21 weeks. They were aged 21‐30 years old with no more than one previous birth, no previous preterm birth and no complications in the current pregnancy. Other inclusion criterion included residence in the Kansas City Area, fluency in reading and speaking the English language, and private or public insurance coverage at the time of enrollment. Preliminary data analysis suggested that prenatal stress has a slightly higher incidence among the public pay population. The mean PSS scores throughout the perinatal period for Medicaid mothers was 15.7 with a range from 2‐28; mean PSS scores of mothers with private pay were 15.2 with a range from 2‐26. Scores on the CES‐D through pregnancy and the EPDS during the postpartum period trended towards higher scores in the private pay group. Women with Medicaid tended to report increased social stressors and decreased social support with 50% (n=4) of these women showing the likelihood for a depressive illness in the postpartum period. Further analysis with a larger sample and study completion is needed to determine the full effects of stress and depression in relation to physical problems, social conflict, and intent of pregnancy among participants. Increased awareness of perinatal risk factors, stress and depression can improve care and lead to more effective treatments prior to the traditional diagnosis of postpartum depression. Ultimately, these actions will help to improve the health and function of the mother, newborn, and family.