448: Disparities in prenatal depression screening and referral: A retrospective cohort study

Abstract

Racial and socioeconomic disparities exist in depression screening in non-pregnant primary care populations. We aim to assess whether racial, insurer, or language disparities exist in frequency of screening and treatment for perinatal mood disorders (PMD). A retrospective cohort of a convenience sample (by MRN) of women who delivered at 2 urban health system hospitals over 6 months was examined. Eligible women received prenatal and/or postpartum care within the system and did not have prior psychiatric diagnoses beyond depression/anxiety. Charts were reviewed for PMD screening, medication initiation, and referral for PMD. Bivariate analysis was performed as appropriate to examine factors associated with screening Of 399 eligible women, 368 (90.2%) were screened for PMD. Women seen in the public clinic were 16.6 times more likely to be screened than those seen in private clinics (95% CI 2.4-115.4); all but 1 woman in the public clinic were screened. Of women seen in private clinics, English-speakers were more likely to be screened than non-English speakers (RR 1.1, 95% CI 1.0-1.3). See table. 68 women screened positive for PMD. Non-Hispanic ethnicity (RR 1.1), English primary language (RR 1.1), PTB in current gestation (RR 2.5), history of anxiety (RR 2.7), and history of depression (RR 4.1) were significantly associated with positive screen. Women with history of depression were more likely to be offered and prescribed a SSRI than those without a history (RR 1.3 and 1.4, respectively). Women with history of anxiety were less likely to have therapy recommended than those with no history (RR 0.6). No other demographic or clinical factors were significantly associated with treatment. 84% of screen positive women were prescribed a SSRI. 53% of screen positive women were recommended therapy and 9% were referred to psychiatry. See bar graph. The primary driver of screening was obstetric provider. Of women seen in private practice clinics, non-English speaking women were less likely to be screened. Few women were referred for therapy, though many women were offered an SSRI.View Large Image Figure ViewerDownload Hi-res image Download (PPT)