Is There an Association between Health Services Utilization and Postpartum Depression?

Background: We investigated the association of health services use with postpartum depression one month after childbirth. Postpartum depression is an incapacitating and prevalent disorder but scarce studies have examined its relationship with health services use.

Methods: More than 3,000 pregnant women, 18 to 35 years old, and expecting their first child in 2009 to early 2011, were interviewed in Pennsylvania after 34 weeks gestation and one month postpartum. Self-reported health services utilization included outpatient and inpatient services used after hospital discharge. Multiple linear regression was performed with postpartum depression (Edinburgh Postnatal Depression Scale) as the dependent variable.

Results: The women averaged 27 years old, 86% were white, 56% had a college degree and 3.6% met the depression threshold at 1 month postpartum. 10.2% of the women utilized the emergency room, 6.8% visited the hospital, 5.3% had outpatient surgeries, 46% had office visits, 4.5% had mental health visits, and 14% received home visits from a nurse. In multivariate analyses, variables associated with postpartum depressive symptoms were: employment status pre-delivery (B = -0.46), college education (B = 0.63), social support (B = -0.27), having a fussy infant (B = 1.15), increased office visits (B = 0.37), and having had mental health visits (B = 3.15).

Conclusions: Healthcare providers should assess and educate pregnant women about postpartum depression risk factors and explore the need for resources such as counseling, support groups, and primary health services. Future research should ascertain the causal direction of the relationship between health services use and postpartum depression.