(262) Antidepressant and Psychotherapy Initiation Among Patients with New Episodes of Depression During Pregnancy

Background: In the United States (US), < 50% of pregnant persons with a new episode of depression initiate antidepressants or psychotherapy.

Objectives: To identify predictors of treatment initiation in patients with a new depression episode during pregnancy.

Methods: Using electronic health data from 5 US healthcare systems, we identified pregnancies ending in livebirth or stillbirth (2008-2021) among prenatal care patients with a new depression episode (i.e., a depression diagnosis during pregnancy with no diagnosis, antidepressants, or psychotherapy in the 6 months before pregnancy), and no antidepressant fills or psychotherapy visits before their first depression diagnosis during pregnancy. We restricted to those with depression screening scores during pregnancy. Highest score was used to classify depressive symptom severity. Treatment initiation was defined as an antidepressant fill or psychotherapy visit within 90 days of first depression diagnosis code. We used lasso regression to predict screening score availability to calculate stabilized inverse probability weights (IPW). We estimated adjusted prevalence ratios (aPR) and 95% confidence intervals (CI) using modified Poisson regression to assess associations between potential predictors and treatment initiation adjusting for site, year, trimester of depression diagnosis, and depression severity, and IPW to mitigate selection bias due to screening score availability.

Results: There were 34,194 (5%) patients with a new depression episode in pregnancy. Among these patients, 23,926 (70%) had depression screening scores: 34% none/minimal, 24% mild, 19% moderate and 22% severe. Overall, 14% had public insurance and 35% were non-Hispanic White; 8% initiated antidepressants only, 18% initiated psychotherapy only, 7% initiated both and 67% did not initiate either treatment within 90 days of diagnosis. Greater depression severity was associated with treatment initiation: aPR: 1.80, (CI:1.67, 1.93) for mild, aPR: 2.37 (CI: 2.21, 2.54) for moderate, aPR: 3.18 (CI: 2.98, 3.39) for severe versus none/minimal. Patients were less likely to initiate treatment when their first depression diagnosis occurred in obstetric (aPR: 0.43, 95% CI: 0.41-0.45) or primary care settings (aPR: 0.66, CI: 0.62-0.70) versus behavioral health settings; when they had gestational diabetes (aPR: 0.86, CI: 0.80-0.91), a history of depression (aPR: 0.84, CI: 0.80-0.89) or had psychiatric comorbidities other than anxiety (aPR: 0.90, CI: 0.84-0.95). Patients with ≥1 previous birth (aPR: 1.14, CI: 1.09-1.18) or anxiety (aPR: 1.19, CI: 1.14-1.24) were more likely to initiate treatment.

Conclusions: These findings suggest opportunities for interventions to facilitate treatment for new episodes of depression during pregnancy.