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Dagher: Prevention of postpartum depression could yield health care cost savings

National Institute for Occupational Safety and Health R18 study is first to examine the relation between postpartum depression and health services expenditures

New research, just released by scholars at the University of Maryland and the University of Minnesota and published in the Journal of Occupational and Environmental Medicine finds higher health services expenditures among employed women who experienced postpartum depression five weeks after childbirth. In fact, according to Dr. Rada Dagher, Assistant Professor of Health Services Administration and Faculty Associate of the Maryland Population Research Center, “given the high rate of mothers of infants in the labor force, employers should consider introducing programs to prevent and address postpartum mental health issues as they may result in health care cost savings and a healthier workforce.” Increased health care expenditures among postpartum depressed women were primarily driven by a six fold increase in mental health counseling visits and a four-fold increase in emergency room visits as compared with nondepressed women.

This is the first study to examine the relation between postpartum depression and health services expenditures. Postpartum depression is the most prevalent serious mental disorder following childbirth, affecting around 500,000 women per year in the United States. In general, depression among workers has been shown to cost U.S. employers $44 billion per year in lost productivity and about $12.4 billion in health care expenditures. Given the high labor force participation rate of mothers of infants, which reached 56% in 2010, it is important to study the impact of postpartum depression on health services utilization and costs among employed women. This information may benefit expectant mothers, their families, and employers.

The investigators recruited 817 mothers from 3 community hospitals in Minneapolis and St. Paul, Minnesota, while they were being hospitalized for childbirth in 2001. They interviewed them by telephone at 5 weeks and 11 weeks after delivery with response rates of 88% (N=716) and 81% (N=661), respectively.  Women were included in the study if they were 18 years or older, employed, English-speaking, and had given birth to a live, singleton infant. The investigators calculated the price-weighted sum of all self-reported health services used from hospital discharge until 11 weeks postpartum using price data from Blue Cross and Blue Shield. They then estimated the impact of postpartum depression (at 5 weeks postpartum) and other personal and work-related factors on health services expenditures at 11 weeks postpartum using multivariate models with instrumental variables.

This sample of women was on average 30 years old; 87% were white, 76% were married, 49% had a college degree, 46% were first time mothers, and 99% were covered by health insurance. There was a 5% point prevalence of depression at 5 weeks postpartum, which is similar to the 2-week prevalence rate of depression among working women in the US (5.3%).

Bivariate analyses revealed that depressed women were significantly more likely (18.2%) than nondepressed women (4.1%) to attend the emergency room and to seek mental health counseling (22.6% versus 3.8%) but the two groups of women did not differ on hospitalizations, outpatient surgeries, or office visits (see table 3 [pdf]).

Multivariate analyses showed the following factors to be significantly associated with health services expenditures: older age, low income, purchased health insurance plan/uninsured (vs public assistance), increased maternal physical symptoms, and meeting the threshold for depression at 5 weeks after childbirth. Depressed women incurred 90% higher health care expenditures than nondepressed women, controlling for other factors.

“The health care costs of postpartum depression have policy implications in terms of the importance of addressing mental health issues in the workplace,” the study authors write. They recommend that employers with a high proportion of female employees of reproductive age choose health insurance plans with more generous coverage of mental health services and look into incorporating depression-related programs in the workplace. These types of plans will be readily available with the passage of the Patient Protection and Affordable Care Act which introduces state-based insurance exchanges that are required to have a base level benefit package that includes mental health coverage.

Limitations of the study include generalizability only to employed women of comparable demographic characteristics, cross-sectional design, measuring postpartum depression through self-report, and a lower rate of depression among women followed by the study compared to those who were not.

“Depressed women had considerably higher healthcare expenditures than nondepressed women. The disproportionate increase in counseling and emergency department visits may be driving the increased costs among depressed women.” The study authors conclude “. . . re­searchers should explore whether earlier identification and treatment of postpartum depression may decrease health care expenditures after childbirth.”

Clinical Significance

About 5% of working mothers in this study were clinically depressed at 5 weeks postpartum, according to the Edinburgh Postnatal Depression Scale. Compared to nondepressed mothers, depressed mothers incurred considerably higher health care expenditures. These findings highlight the importance of addressing mental health issues in the workplace.

Research details

In this research project, supported by the grant 5 R18 OH00605-05 from National Institute for Occupational Safety and Health (NIOSH), Dr. Dagher and her colleagues analyzed secondary data that came from the Maternal Postpartum Health Study, a non-randomized, prospective cohort study initiated by Patricia McGovern, Ph.D., a professor in the division of Environmental Health Sciences at the University of Minnesota.

Citation : Dagher, Rada K.; McGovern, Patricia M.; Dowd, Bryan E.; Gjerdingen, Dwenda K. (2012) "Postpartum depression and health services expenditures among employed women". Journal of Occupational & Environmental Medicine. 54(2):210-215, February 2012.

Rada Dagher is an Assistant Professor of Health Services Administration at the University of Maryland and a Faculty Associate of the Maryland Population Research Center (MPRC). For more information about the research and about the programs of the Maryland Population Research Center, go to the Center website at www.popcenter.umd.edu.

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