Clinical Summary: Race, Ethnicity, Socioeconomic Status, Clinical Characteristics, and Postpartum Depression in Patients With a History of Depressive Episodes
Patients with a history of depression enter pregnancy with a high baseline risk for postpartum depression, but clinicians still need better ways to identify who is most likely to relapse after delivery. This study highlights which demographic and clinical factors mark especially high risk in a large US health system with routine perinatal depression screening.
Key Findings
- Of 6,552 eligible patients, 2,469 (37.7%) had positive depression screens or ICD diagnoses up to a year after delivery.
- Compared to patients with no depressive symptoms (PHQ-9 < 5), moderate-severe depressive symptoms early in pregnancy (PHQ-9 15–19) were associated with aRR = 1.92; 95% CI, 1.73–2.13 for PPD overall and aRR = 3.58; 95% CI, 2.77–4.61 for severe PPD.
- A history of PPD increased risk versus depression history without prior PPD (aRR = 1.31; 95% CI, 1.21–1.41).
- Stopping an antidepressant during pregnancy was associated with higher risk of PPD overall (aRR = 1.14; 95% CI, 1.08–1.20) and severe PPD symptoms (aRR = 1.28; 95% CI, 1.01–1.49 for the stopped group).
- Compared to patients identifying as White, risk was higher in patients identifying as Black (aRR = 1.21; 95% CI, 1.08–1.36 overall; aRR = 1.65; 95% CI, 1.25–2.17 severe), Asian/Pacific Islander (aRR = 1.17; 95% CI, 1.05–1.30 overall; aRR = 1.54; 95% CI, 1.18–2.01 for severe PPD), and LatinX (aRR = 1.16; 95% CI, 1.07–1.25 overall; aRR = 1.29; 95% CI, 1.06–1.58 severe).
Among pregnant patients with a recent depressive episode history, postpartum depression was common and risk was higher with prior PPD, greater antenatal depressive symptom burden, antidepressant discontinuation during pregnancy, and socioeconomic and racial/ethnic disadvantage. These factors support more intensive surveillance and treatment planning during pregnancy and the postpartum year.
Practice Implications
- Treat even mild depressive symptoms on the first prenatal PHQ-9 as clinically meaningful risk markers: compared with PHQ-9 < 5, mild symptoms (PHQ-9 score of 5–9) carried aRR = 1.39; 95% CI, 1.29–1.50 for any PPD and aRR = 1.49; 95% CI, 1.20–1.85 for severe PPD.
- When considering antidepressant discontinuation during pregnancy, discuss that stopping was associated with aRR = 1.14; 95% CI, 1.08–1.20 for overall PPD and aRR = 1.28; 95% CI, 1.01–1.49 for severe PPD.
- Flag patients with prior PPD or higher pre-LMP antidepressant dosing for closer follow-up, as prior PPD was associated with aRR = 1.31; 95% CI, 1.21–1.41 and higher-dose range antidepressant medication prior to the LMP with aRR = 1.15; 95% CI, 1.03–1.28 for overall PPD.
- Build additional outreach and support into care plans for patients with lower socioeconomic status and for patients identifying as Black, Asian/Pacific Islander, or LatinX, because these groups had higher adjusted PPD risk despite care in a system with >98% of perinatal KPNC members screened.
