Postpartum depression and health services expenditures among employed women

Background/Significance: Postpartum depression is a debilitating mental disorder that may increase health services expenditures, but few studies have examined this relationship. Employed postpartum women constitute a vulnerable group due to exposure to job stressors.

Objective: To investigate the association of postpartum depression with health services expenditures.

Methods: Employed women, 18 years of age and older, were recruited in 2001 from three Minnesota hospitals (N= 817; 71% response rate). 79% were followed up with interviews at 5 and 11 weeks after delivery. Using a hybrid of the household and health production theories, two stage least squares analysis was performed, with the price-weighted sum of health services (hospitalizations, outpatient surgeries, office visits, counseling visits and emergency room care) used from hospital discharge until 11 weeks postpartum as the dependent variable.

Results: The women averaged 30 years, 87% were white and 5% met the depression threshold (Edinburgh Postnatal Depression Scale) at 5 weeks postpartum. Depressed women were significantly more likely to utilize emergency room care (18.2%) versus non-depressed women (4.1%) and to seek mental health counseling (22.6% versus 3.8%). In multivariate analyses, variables significantly predicting health services expenditures were: older age, poverty, childbirth complications, acute illnesses and depression. Depressed women incurred 87% more health services expenditures than non-depressed women.

Conclusions: The disproportionate use of counseling and emergency room visits may be driving the increased costs among depressed women. Future research should explore whether earlier identification of depressed women or screening and education in primary care settings may decrease health services use after childbirth.