Women’s Health
The Association between Maternal Nativity and Treatment Engagement Kendria Kelly-Taylor* Kendria Kelly-Taylor Kelly-Taylor Kelly-Taylor Kelly-Taylor Kelly-Taylor Kelly-Taylor Kelly-Taylor Kelly-Taylor Kelly-Taylor KPNC Division of Research
Racial/ethnic disparities in prenatal depression diagnosis and treatment engagement are well-documented; less is known how maternal nativity (US-born vs. non-US-born) is associated with treatment initiation and type. This study examines differences in treatment initiation and type by maternal nativity among a cohort of pregnant individuals universally screened for depression. We conducted a retrospective cross-sectional analysis (2013-2019) of Kaiser Permanente Northern California members newly diagnosed with depression between the first day of LMP to the day before a live birth (n=27,044). Nativity, determined from birth records, and treatment initiation (any vs. none), type (antidepressant medication vs. psychotherapy), and covariates (e.g., maternal age, Medicaid, anxiety, parity, substance use, depression severity via Patient Health Questionarrie-9) ascertained from electronic health records. Logistic regression models estimated the adjusted odds ratio (aOR) and 95% CIs. In models excluding depression severity, non-US-born individuals had 22% higher odds of initiating treatment compared with US-born (aOR:1.22;95%CI:1.12-1.34), yet the associated attenuated after adjusting for severity. Of those who initiated treatment, non-US-born individuals had greater odds of engaging in psychotherapy (vs. medication), persisting after adjustment for depression severity (aOR:1.29;95%CI:1.05-1.58). Findings suggest differences in treatment engagement by maternal nativity may hinge on the severity of depression symptoms, which could mediate the pathway between nativity and treatment initiation. Prior research among KPNC pregnant individuals showed non-US -born individuals presented equivalent or higher depression severity than US-born counterparts. Nativity differences vanish after adjusting for severity, underscoring severity’s possible mediating effect. Further, findings offer clinical insight for tailoring depression treatment options during pregnancy based on nativity.