(267) Characteristics of perinatal depression screening and trend over time in a commercial, US-based administrative claims database

Background: Perinatal depression is common and can have serious effects on the pregnant individual, their baby, and their family. While guidelines in the US recommend universal screening in the perinatal period, screening rates remain well below goals. Given that many pregnant individuals may discontinue antidepressants during pregnancy, screening in this population is especially important.

Objectives: To use a large, US-based administrative claims database to describe the trends and characteristics of perinatal depression screening in a commercially insured population.

Methods: Using Optum’s Dynamic Assessment of Pregnancies and Infants (DAPI) database, we identified pregnancies with an estimated date of last menstrual period (LMP) between 2016 and 2022 and that had a delivery at ≥20 weeks’ gestation. We defined perinatal screening as the presence of at least one procedure or diagnosis code for depression screening during either pregnancy (LMP to delivery) or the postpartum period (≤12 weeks post-delivery). We investigated the number and timing of screening encounters during the perinatal period and calculated the proportion of pregnancies screened each calendar year of LMP.

Results: We included 620,331 pregnancies from 549,456 individuals during the study period. Overall, 13% of pregnancies had at least one code for perinatal depression screening; the proportion increased steadily each calendar year from 5.5% in 2016 to 21.0% in 2022. Among all screened pregnancies, only 15.9% were screened during both pregnancy and postpartum; 34.8% and 49.3% were screened only in pregnancy or only postpartum, respectively. Most screened pregnancies (57.9%) were screened only once during the perinatal period; 21.2%, 9.6%, and 11.3% were screened two, three, and four or more times, respectively. Among the 47,019 screening encounters during pregnancy, the plurality (46.6%) occurred in the first trimester, with similar proportions occurring in the second (25.2%) and third (28.2%) trimesters.

Conclusions: While the use of perinatal depression screening has increased in our claims database since 2016, nearly 80% of pregnancies in 2022 were unscreened. Even among those screened, nearly 80% fell short of the recommendation to be screened at least three times during the perinatal period. Together, these findings indicate a need for greater implementation of perinatal screening to identify patients who would benefit from perinatal mental health treatment. While administrative claims may not capture all screenings, providers are incentivized to file claims to obtain reimbursement for patient care.