Mental Health
The association between antenatal depression with postpartum visit non-attendance: the mediating role of postpartum depressive symptoms Sabrina Karim* Sabrina Karim Hill L. Wolfe Lindsay S. Womack-Martenson Elizabeth Clark Angela Rohan
Introduction: Postpartum visits are important for timely interventions to prevent complications, yet 10-40% of U.S. women miss these visits. Identifying factors associated with non-attendance is important for improving visit rates. The role of mood disorders, particularly antenatal depression, is understudied. We examined the association between antenatal depression and postpartum visit non-attendance, and whether postpartum depressive symptoms (PDS) mediate the association.
Methods: This cross-sectional study used 2016–2022 Pregnancy Risk Assessment Monitoring System (PRAMS) data for women aged 18 or older with recent live birth (Unweighted n=210,854). Antenatal depression was identified based on report of experiencing depression during pregnancy. Outcome was self-reported postpartum visit non-attendance. PDS, the mediator variable, was determined by self-report of often/always feeling depressed, hopeless, and having diminished interest post-delivery. Descriptive and multivariable logistic regression analyses were conducted using sampling weights, with SAS PROC CAUSALMED assessing the mediation effect of PDS.
Results: One in ten women with a recent live birth reported not attending a visit at 4-6 weeks postpartum and 14% experienced antenatal depression. Non-attendees, compared to those who did attend, were more likely to be non-Hispanic Black (19% vs 13%) or Hispanic (25% vs 16%) women, enrolled in Medicaid during pregnancy (52% vs 32%), or had a history of intimate partner violence during pregnancy (4% vs 2%). Women who had antenatal depression had higher odds of postpartum visit non-attendance compared to those without antenatal depression (adjusted Odds Ratio 1.31, 95% CI 1.23-1.39). PDS mediated 13% of the association.
Conclusion: Our mediation results suggest that addressing PDS in women with antenatal depression may improve postpartum visit attendance.