593 Racial and ethnic disparities in perinatal depression symptoms and symptom trajectories

Abstract

Improved awareness of racial/ethnic disparities in perinatal depression is important to understand areas for improvement in care. This retrospective cohort includes individuals enrolled in a perinatal collaborative care program (COMPASS) between 2/17-12/19 who completed at least 2 Patient Health Questionnaire-9 (PHQ9) screens for perinatal depression. Perinatal collaborative care is a health services intervention designed to integrate mental health care into obstetric care. All eligible clinics can refer women to COMPASS’ mental health care, irrespective of insurance status, from initiation of prenatal care until one-year postpartum. Individuals in COMPASS receive PHQ9s every 2-4 weeks with the cadence informed by their prior scores. The proportion of individuals with a positive screen (i.e., PHQ9 > 9) across time were compared across self-identified racial/ethnic groups using generalized estimating equations with a binomial distribution and a log link assumption. A segmented multiple regression model was used to compare change in rate over time before and after delivery across racial/ethnic groups. A total of 873 individuals (26% Black, 20% Latinx, 54% White) completed 6410 PHQ9 screens. Of these 6410 screens, 1477 (23%) were positive. The trajectories of positive depressive screens diverged across races/ethnicities (Figure). Compared to White individuals who experienced a population-aggregated decrease, Latinx (p=0.066) and Black (p=0.035) individuals experienced a stable or increasing prevalence of positive depression screens postpartum. In this cohort of individuals with access to perinatal mental health care via collaborative care, White individuals demonstrated an improved trajectory of positive depression screens postpartum, whereas Black and Latinx individuals did not improve postpartum. These data suggest that relieving the financial burden to mental health care is an insufficient approach to mental health equity. Determining optimal and acceptable interventions to prevent symptom worsening and delayed symptom onset of those at increased risk are next steps.