Differences in Rural and Urban Treatment of Postpartum Depression and Anxiety in the United States [ID: 1377353

Abstract

INTRODUCTION: The objective of this study was to evaluate pharmacologic and psychotherapy treatment among individuals with postpartum depression or anxiety living in urban versus rural areas of the United States. METHODS: We performed a retrospective cohort study of individuals diagnosed with postpartum depression or anxiety within 12 months of delivery from 2011 to 2020 in the MarketScan Commercial Research Database. Individuals with postpartum depression and anxiety were identified using International Classification of Diseases codes. Individuals previously receiving treatment were excluded. The exposure, urban residence, was determined by residence in a metropolitan statistical area. The primary outcome was a composite of pharmacologic and psychotherapy treatment. Secondary outcomes included components of the primary outcome and time from delivery to first prescription fill. Multivariable modeling adjusted for clinically relevant confounders including history of depression or anxiety. Sensitivity analysis included individuals with prior treatment. RESULTS: Of 1,602,058 individuals included, 1,415,793 (88%) had urban residence. Individuals with postpartum depression or anxiety residing in urban areas were less likely to receive treatment (adjusted hazard ratio [aHR] 0.86, 95% CI 0.85–0.88) than those residing in rural areas, including pharmacologic (aHR 0.75, 95% CI 0.73–0.77), and psychotherapy (aHR 0.94, 95% CI 0.92–0.96). Fifty percent of individuals filled a prescription by 107 days from delivery in urban compared to 100 days in rural areas. Results were similar in sensitivity analysis. CONCLUSION: Urban-residing individuals with postpartum depression or anxiety were less likely to receive pharmacologic or psychotherapy treatment than rural-residing individuals in this U.S. cohort. Future studies evaluating reasons for treatment differences are warranted.