Pregnancy-Related Discontinuation of Antidepressants and Depression Care Visits Among Medicaid Recipients
Pregnancy-Related Discontinuation of Antidepressants and Depression Care Visits Among Medicaid Recipients
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DOI：
10.1176/ps.2010.61.4.386
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发表时间：
2010-04-01
影响因子：
3.8
通讯作者：
Coyne, James C.
中科院分区：
文献类型：
--
作者：
Bennett, Ian M.;Marcus, Steven C.;Coyne, James C.
目的：本研究旨在探讨低收入妇女中怀孕是否与抑郁症护理中断有关。方法：来自所有50个州的医疗补助索赔数据用于匹配队列研究设计。该研究包括3，237名在1999年至2000年期间分娩的妇女，并在开始产前护理之前接受抑郁症治疗（抗抑郁药物或抑郁症护理访视）。对照组为同期接受妇科护理的非妊娠妇女，与人口统计学和抑郁治疗特征相匹配。结果：孕前抗抑郁药使用率为66%。在妊娠期间，妊娠队列中抗抑郁药的使用率下降至27%，而对照组为62%（率比[RR] = 0.44，95%置信区间[CI]= 0.41 - 0.46），产后与对照组相比仍较低（35% vs 48%，RR= 0.74，CI= 0.70 - 0.78）。同样，妊娠期抑郁症护理就诊率在妊娠队列中降至31%，而对照组为49%（RR= 0.65，CI= 0.61 - 0.69），产后相对于对照组仍较低（24% vs 31%，RR= 0.78，CI= 0.73 - 0.85）。与怀孕状态的相互作用，发现种族，民族和接受医疗补助的现金援助。妊娠队列中的白色女性在妊娠期间抑郁症护理访视比非白色女性减少更多，但相对于对照组，产后抗抑郁药使用减少较少。与对照组相比，现金援助与产后抑郁症护理访视中断率降低相关（p
Objective: This study examined whether pregnancy is associated with discontinuation of care for depression among low-income women. Methods: Medicaid claims data from all 50 states were used in a matched cohort study design. The study included 3,237 women who gave birth between 1999 and 2000 and received depression treatment (antidepressant medications or a depression care visit) before initiating prenatal care. A control cohort of nonpregnant women receiving gynecologic care in the same period was matched by demographic and depression treatment characteristics. Results: Prepregnancy, the antidepressant use rate was 66%. During pregnancy, antidepressant use dropped to 27% in the pregnant cohort compared with 62% in the control group (rate ratio [RR] =.44, 95% confidence interval [CI]=.41-.46) and remained low postpartum compared with the control group (35% versus 48%, RR=.74, CI=.70-.78). Similarly, depression care visits during the pregnancy period were reduced to 31% among the pregnant cohort compared with 49% for the control group (RR=.65, CI=.61-.69) and remained lower postpartum relative to the control group (24% versus 31%, RR=.78, CI=.73-.85). Interactions with pregnancy status were found for race-ethnicity and receipt of cash assistance from Medicaid. White women in the pregnancy cohort had a greater reduction in depression care visits than nonwhite women during the pregnancy period but less reduction in antidepressant use postpartum relative to the control group. Cash assistance was associated with less discontinuation in depression care visits postpartum compared with the control group (p