Oral Concurrent Session 5 - Morbidity and Mortality & Public/Global Health
56 - Timing of Perinatal Mental Health Needs: Data to Inform Policy
Friday, January 29, 2021
4:15 PM – 4:30 PM EST
Objective: Policies pertaining to perinatal health care should be informed by medical needs. Many state public insurance plans only offer expanded coverage eligibility up to 60 days postpartum (PP), even though women may have perinatal health concerns that persist beyond this time period. Our objective was to determine how frequently perinatal mental health needs are identified outside of the window of standard obstetric care and to determine characteristics of later referrals.
Study Design: This retrospective cohort study included all women referred to a perinatal mental health program serving women up to one-year PP. The program is grant supported to ensure universal access regardless of insurance status. Women were included if they delivered between 9/2017 and 9/2019. Referral timing was recorded and characteristics of women who presented to mental health care PP were compared and stratified by timing. ROC analyses were used to identify whether patient characteristics could accurately classify women referred for perinatal mental health care beyond the time frame when PP care typically occurs.
Results: Of 1421 women referred during the study period, 774 (54%) were referred prenatally and 647 (46%) were referred PP. Women referred prenatally were referred throughout pregnancy without a specific temporal clustering pattern (Figure). Of women referred PP, 203 (31%) were referred after 8 weeks PP and 129 (20%) were referred after 12 weeks PP (Figure). Sociodemographic and medical characteristics differed by timing of referral (Table), however these characteristics classified which women would be referred later in the PP with only fair accuracy [referral >8 weeks PP AUC=0.64, (95% CI 0.58-0.68); referral >12 weeks PP AUC=0.65, (95% CI 0.60-0.71)].
Conclusion: It is not uncommon that perinatal mental health needs are first recognized beyond 8 or even 12 weeks PP. Women with later mental health needs are not accurately identified by their antecedent factors. These data should be taken into consideration when engaging in policymaking pertaining to PP health insurance to ensure ongoing access to mental health care.