Antidepressant and mental health care utilization in pregnant women with depression and/or anxiety: an interrupted time-series analysis

Abstract

ABSTRACTObjectivesTo assess mental health care utilization patterns during and after pregnancy in women with depression and/or anxiety in Norway according to antidepressant fill trajectories in pregnancy.MethodWe conducted a registry-linkage cohort study of pregnancies within women having outpatient visit for depression and/or anxiety and antidepressant fills in the six months prior to pregnancy identified from four national registries of Norway (2009-2018). Number of consultations for depression/anxiety per 100 pregnancies as proxy of mental health care utilization were modelled using interrupted time-series analysis with first month into pregnancy and first month after delivery as interruption points. We investigated the time window including six months prior to pregnancy, eight months into pregnancy and one year postpartum. Antidepressant fill trajectories in the corresponding time window were identified using longitudinal k-means trajectory modelling.ResultsThe cohort included 8,460 pregnancies within 8,062 women with depression/anxiety. We observed reduced mental health care utilization when pregnant women entered the course of pregnancy (negative slopes during pregnancy for all psychiatric specialists and psychologists). The declines were observed for all antidepressant fill trajectories (i.e., discontinuers and continuers) except interrupters (i.e., discontinued then resumed treatment). We found increased mental health care utilization in the postpartum year, notably in interrupters (positive slopes in consultation rates with specialists of outpatient clinics and public-contracted psychiatrists)..ConclusionsPregnancy was associated with reduced mental health care utilization regardless of whether antidepressant treatment was maintained during pregnancy or not. Increases in mental health care utilization were observed in the postpartum year, especially in interrupters.SIGNIFICANT OUTCOMES- Pregnancy is associated with reduced mental health care utilization in pregnant women with depression and/or anxiety in Norway.- The reduction in mental health care utilization during pregnancy was observed for all antidepressant fill trajectories, except for interrupters.- Increased in mental health care utilization in the postpartum year was observed, especially among those who discontinued then resumed antidepressant treatment.LIMITATIONS- The reasons for antidepressant discontinuation, and whether that was due to symptom remission were not assessed.- It was not possible to determine whether reduced mental health care utilization was associated with undertreatment during pregnancy.- It was not possible to measure directly the use of psychosocial interventions and psychotherapy.