While we are advocating universal screening for perinatal mood and anxiety disorders, it is unclear if we have the ability to provide mental health services to this population in need. One significant obstacle to treatment is health insurance; this is a considerable problem in this population, since many women may not want or be able to return to work after the birth of a child and thus may not be eligible for health insurance. A recent study (reviewed in Medscape) followed a group of 2343 women during the first year postpartum, assessing the prevalence of postpartum depression and their ability to access care.
The researchers found that the proportion of uninsured women increased from 3.8% during pregnancy and delivery (n=87 of 2317) to 10.8% at the first postpartum visit (n=253 of 2343) and 13.7% at any subsequent visit to the practice after 2 months. While losing health insurance during the first postpartum year did not significantly increase risk for postpartum depression, it did negatively affect women’s ability to obtain mental health services. 61.1% of the uninsured vs. 27.1% of the insured women reported an inability to obtain mental health services.
“The take home messages,” she said, “are that screening for postpartum depression is important but insufficient to assure that these women receive the care they need. Just as we have clear statements that a diagnosis of diabetes requires specific types of follow up care, we need to incorporate those same types of standards of care in postpartum depression. The standards would include programs that women can and will access without barriers such as those that faced these women—lack of access due to insurance for both insured and uninsured women. It is not enough to say people have insurance, we need to know that groups such as postpartum women who are at high risk of depression, have access to the needed mental health care services,” Dr. Yawn said.
Ruta Nonacs, MD PhD
Bobo WV, Wollan P, Lewis G, Bertram S, Kurland MJ, Vore K, Yawn BP. Depressive Symptoms and Access to Mental Health Care in Women Screened for Postpartum Depression Who Lose Health Insurance Coverage After Delivery: Findings From the Translating Research Into Practice for Postpartum Depression (TRIPPD) Effectiveness Study. Mayo Clin Proc. 2014 Aug 1.
Read More: Getting Help for Postpartum Depression Can Be Tough for Uninsured Women: Study in Medscape (free subscription)