Do Patient Characteristics, Prenatal Care Setting, and Method of Payment Matter When it Comes to Provider-Patient Conversations on Perinatal Mood?

Abstract

To examine factors associated with provider-patient conversations regarding prenatal and postpartum depressed mood. This study included 3,597 White, African American, Hispanic, and Asian/Pacific Islander NYC resident women who completed the Pregnancy Risk Assessment Monitoring System (PRAMS) survey from 2004-2007, a population-based assessment of patient and health care characteristics. Social determinants including race, nativity, maternal age, prenatal health care setting, and payment type were associated with patient report of having had a conversation about perinatal mood with their provider. Compared to Whites, Asian/Pacific Islanders were less likely to have this conversation (OR = 0.7, CI = 0.5-0.9). Older (OR = 0.6, CI = 0.4-0.9), non-US born (OR = 0.6, CI = 0.5-0.8), and women receiving care from a private doctor or HMO clinic (OR = 0.7, CI = 0.6-0.9) were less likely to have this conversation compared to their respective counterparts. Those who paid for their prenatal care primarily through personal income or through an expanded Medicaid program for prenatal care compared to those who did not were more likely to have had a conversation about mood with their providers. Health care providers and public health advocates should be aware that non-US born women were less likely to have conversations about mood than US born women. However, young mothers shown to be at risk for perinatal depression were more likely to have these conversations compared to older women. Protocols for assessing and educating patients about perinatal mood should be evaluated to improve conversation rates for those receiving care through private doctors and managed care organizations. Income and prenatal care assistance funds may play separate and important roles in provider-patient conversations.