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

Nhung T H Trinh; Hedvig M E Nordeng; Gretchen Bandoli; Malin Eberhard-Gran; Angela Lupattelli

doi:10.1016/j.jad.2022.04.101

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

J Affect Disord. 2022 Jul 1:308:458-465. doi: 10.1016/j.jad.2022.04.101. Epub 2022 Apr 21.

Authors

Nhung T H Trinh¹, Hedvig M E Nordeng², Gretchen Bandoli³, Malin Eberhard-Gran⁴, Angela Lupattelli⁵

Affiliations

¹ PharmacoEpidemiology and Drug Safety Research Group, Department of Pharmacy, and PharmaTox Strategic Research Initiative, Faculty of Mathematics and Natural Sciences, University of Oslo, Oslo, Norway. Electronic address: nhung.trinh@farmasi.uio.no.
² PharmacoEpidemiology and Drug Safety Research Group, Department of Pharmacy, and PharmaTox Strategic Research Initiative, Faculty of Mathematics and Natural Sciences, University of Oslo, Oslo, Norway; Department of Child Health and Development, Norwegian Institute of Public Health, Oslo, Norway.
³ Department of Pediatrics, University of California San Diego, La Jolla, CA, USA; Department of Family Medicine and Public Health, University of California San Diego, La Jolla, CA, USA.
⁴ Norwegian Research Centre for Women's Health, Women's and Children's Division, Oslo University Hospital, Rikshospitalet, Oslo, Norway; Institute for Clinical Medicine, University of Oslo, Oslo, Norway.
⁵ PharmacoEpidemiology and Drug Safety Research Group, Department of Pharmacy, and PharmaTox Strategic Research Initiative, Faculty of Mathematics and Natural Sciences, University of Oslo, Oslo, Norway.

PMID: 35461816
DOI: 10.1016/j.jad.2022.04.101

Abstract

Background: Little is known about mental health care utilization patterns in pregnant women with depression/anxiety in Norway according to antidepressant fill trajectories in pregnancy.

Method: We conducted a registry-linkage cohort study of pregnancies within women having outpatient visit for depression/anxiety and antidepressant fills 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 was modelled using interrupted time-series analysis with first month into pregnancy and first month after delivery as interruption points. We investigated the time window spanning from six months prior to one year postpartum. Antidepressant fill trajectories in the corresponding time window were identified using longitudinal k-means trajectory modelling.

Results: The cohort included 8460 pregnancies within 8062 women with depression/anxiety. We observed reduced mental health care utilization when pregnant women entered the course of pregnancy (negative slopes during pregnancy for 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).

Limitations: It was not possible to measure directly the use of psychosocial interventions and psychotherapy.

Conclusions: Pregnancy 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.

Keywords: Antidepressants; Interrupted time-series analysis; K-means trajectory modelling; Maternal anxiety; Maternal depression; Mental health care utilization; Perinatal pharmacoepidemiology; Pregnancy.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Antidepressive Agents / therapeutic use
Anxiety / drug therapy
Anxiety / epidemiology
Cohort Studies
Depression / drug therapy
Depression / epidemiology
Depression, Postpartum* / drug therapy
Female
Humans
Patient Acceptance of Health Care
Pregnancy
Pregnancy Complications* / drug therapy
Pregnancy Complications* / epidemiology
Pregnant Women / psychology

Substances

Antidepressive Agents