Pregnancy Linked to Sharp Drop in Mental Health Treatment

TOPLINE:

Women’s antidepressant use drops by nearly half during pregnancy, from 4.3% to 2.2%, without a corresponding increase in psychotherapy use. This significant reduction occurs despite pregnancy being a period of heightened depression risk.

METHODOLOGY:

• A cohort study following the Strengthening the Reporting of Observational Studies in Epidemiology reporting guideline was conducted from January to November 2024.
• Analysis utilized Merative MarketScan Research Databases containing claims data from privately insured individuals in the United States.
• Participants included women who gave birth between 2011 and 2017, with prescription drug insurance coverage during birth month and 24 months before and after.
• Researchers also analyzed spouses of 56.5% of women who shared the same insurance coverage.
• Data collection spanned from 2009 to 2019, measuring antidepressant medication fills and psychotherapy claims for 2 years before and after childbirth.

TAKEAWAY:

• Among 385,731 women studied (mean age, 31.8 years; standard deviation, 5.4), 74.8% were employed with a mean income of $84,577 (standard deviation, $39,676).
• Antidepressant prescription fills decreased by 48.8%, from 4.3% in the year before pregnancy to 2.2% during pregnancy.
• Analysis of 217,877 spouses showed no similar changes in antidepressant use, suggesting the behavior was specific to pregnancy.
• Women’s psychotherapy claims showed a slight decrease during pregnancy relative to the trend line.

IN PRACTICE:

“In this cohort study, we documented a large decrease in antidepressant use without an accompanying increase in psychotherapy during pregnancy. These findings, coupled with evidence of mental health challenges during and after pregnancy, suggest the need for increased focus on and discussion about mental health treatments by pregnant women and their clinicians,” wrote the authors of the study.

SOURCE:

The study was led by Claire Boone, PhD, Department of Economics, McGill University in Montreal, Quebec, Canada. It was published online on January 30 in JAMA Network Open.

LIMITATIONS:

Researchers relied on prescription refills in claims data rather than direct observation of medication adherence. While claims data are considered more reliable than self-reported data for measuring medication fills, the study lacked survey evidence to explore reasons for medication discontinuation. Additionally, the findings may not generalize beyond privately insured individuals in the United States.

DISCLOSURES:

Claire Boone received funding from grant T32AGO000243 from the National Institute on Aging of the National Institutes of Health. The funder had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication. No conflicts of interest were reported.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.