Racial disparities in depression screening among prenatal and postpartum women

One in 10 women is depressed during pregnancy or any month within the year after childbirth. Because screening is an important entrance to treatment, we investigated the question of potential racial/ethnic disparities in prenatal and postpartum depression screening. We analyzed data from 2210 women who had a live birth while continuously enrolled (one year before pregnancy and one year after delivery) in one health plan. Diagnoses were identified by ICD-9 codes and race/ethnicity and screening were measured from plan administrative and electronic medical records. We conducted logistic regression to estimate the association of any depression screening (using the Patient Health Questionnaire, PHQ-9) by race/ethnicity, adjusted for preconception depression and anxiety, age, chronic health problems, health insurance (public or private), provider specialty, and English proficiency Women's race/ethnicity was reported as 57% White, 19% Black, 12% Asian, 5% mixed race/ethnicity, 4% Hispanic, 3% unknown, and <1% American Indian. Only 14% of women had any depression screening. Differences in screening were associated with race. Compared with white women, the following groups had lower adjusted odds ratios (AOR) revealing subgroups with decreased risk of screening: Asian 0.25; 95% CI (0.12, 0.51); Black 0.48; 95%CI (0.31, 0.74), and mixed/Native American 0.42; 95% CI (0.21, 0.87). Our findings suggest racial disparities in depression screening and represent a conservative estimate relative to the general population based upon our analyses from an insured population. Given the serious outcomes of untreated depression for mothers and infants, investigation of barriers to women's prenatal and postpartum depression screening is needed.