Getting Help for Postpartum Depression Can Be Tough for Uninsured Women: Study

By Megan Brooks

August 29, 2014

NEW YORK (Reuters Health) - Women who lose their health insurance in the postpartum period find it hard to get mental health care for postpartum depression, new research shows.

About 13% of mothers are diagnosed with PPD in the first year after delivery. PDD causes functional impairment and distress in mothers and has been linked to adverse effects on the emotional and physical well-being of their offspring. In the U.S., nearly all women have public or private health insurance during the prenatal and early postpartum period - but many lose their coverage in the months after delivery, particularly if they have Medicaid.

Dr. Barbara Yawn from Olmsted Medical Center in Rochester, Minnesota and colleagues used the TRIPPD-UP study to investigate the relationship between losing health insurance after delivery and perceived need for and access to mental health services in a large group of women screened for PPD in a primary care setting.

Nearly all of the 2,343 women in the cohort had health insurance when they delivered. However, a large proportion of women for whom health insurance data were available were uninsured at the first postpartum visit and thereafter.

Rates of uninsured rose from 3.8% during pregnancy and delivery to 10.8% at the first postpartum visit and 13.7% at any subsequent visit after two months postpartum.

Loss of insurance coverage was driven primarily by loss of Medicaid, the researchers note.

"Given that most PPD symptoms develop during the first six to 12 weeks postpartum and often persist beyond the first postpartum year, Medicaid eligibility cutoff points occurring two months postpartum may severely limit access to screening and treatment services for women who develop PPD or those at high risk for developing it," the authors say.

"From a health economics perspective, this may be particularly troubling given evidence linking gaps in Medicaid coverage with increases in psychiatric hospitalization, emergency department care, and health care expenditures in a large cohort of nonelderly adult beneficiaries with a diagnosis of major depression or dysthymic disorder," they point out.

In the TRIPPD-UP cohort, loss of health insurance during the first postpartum year did not significantly affect depressive symptoms or perceived need for mental health care. However, a significantly greater number of women who lost their insurance reported both the need for and the inability to obtain mental health care, mostly due to cost burden.

Among patients who reported needing mental health care, 61.1% of the uninsured reported an inability to get it, compared with 27.1% of the insured.

In addition, a "sizable" number of women with elevated depression scores at screening who remained insured said their insurance plans did not cover postpartum mental health care (29.4%).

"Without access to care, these women are likely to have depressive symptoms that provide a large symptom burden for those women but are also associated with increased risk of developmental problems in their infants---risks that have been shown to last through age 18 years for those children," Dr. Yawn told Reuters Health by email.

"The take home messages," she said, "are that screening for postpartum depression is important but insufficient to assure that these women receive the care they need. Just as we have clear statements that a diagnosis of diabetes requires specific types of follow up care, we need to incorporate those same types of standards of care in postpartum depression. The standards would include programs that women can and will access without barriers such as those that faced these women---lack of access due to insurance for both insured and uninsured women. It is not enough to say people have insurance, we need to know that groups such as postpartum women who are at high risk of depression, have access to the needed mental health care services," Dr. Yawn said.


Mayo Clin Proc 2014.


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