麻豆传媒

A collaborative care (CC) approach to boost pregnancy-related mental health was associated with improvements in screening and treatment for depression, and also reduced racial disparities for that care, a researcher reported.

In a retrospective cohort study done before and after the implementation of a Collaborative Care Model for Perinatal Depression Support Services (COMPASS), the adjusted odds ratio was 2.44 (95% CI 1.86-3.22) for Black patients to be screened for antenatal depression versus white patients pre-COMPASS, while the aOR was 0.05 (95% CI 0.01-0.55) for Black patients to receive a recommendation for treatment if they screened positive, according to Emily Miller, MD, MPH, of Northwestern University Feinberg School of Medicine in Chicago.

Post-COMPASS, the aOR was 1.22 (95% CI 0.89-1.68) for Black patients to be screened for antenatal depression and 0.64 (95% CI 0.27-1.53) for receiving a treatment recommendation, she explained in a presentation at the Society for Maternal-Fetal Medicine virtual meeting.

Miller's group reported that the interactions terms were significant for both antenatal screening (P<0.001) and antenatal treatment recommendation (P=0.045), and demonstrated that "implementation of CC was associated with reductions in extant racial disparities." However, they noted that "Interactions terms were not significant for either postpartum screening or treatment recommendation."

COMPASS was instituted at five ambulatory obstetric centers at Northwestern beginning in January 2017. Miller and colleagues described COMPASS in a 2020 article. For the current study, they analyzed pregnant or postpartum people who identified as Black or white, and who received prenatal care at one of the obstetric clinics affiliated with COMPASS.

Participants were divided into two cohorts based on their delivery date: September 2015-October 2016 (pre-COMPASS) and August 2017-February 2019 (post-COMPASS). The authors evaluated the frequency of screening and treatment in both racial groups.

Overall, there were 4,710 birthing people included in the study, 49% of whom were in the pre-COMPASS group. Around 12% of individuals in the entire study cohort identified as Black.

"Variations in care due to non-clinical factors and biases is an impediment to quality care," Miller stated, adding that the current findings support the implementation of standardized perinatal mental health programs to promote equity.

Mental health conditions are a in the U.S., and are estimated to cause around 9% of maternal deaths, she said. Additionally, there are significant racial disparities in pregnancy-related outcomes, with Black people giving birth being three times as likely to experience pregnancy-related deaths than white people, she said. In 2008, Illinois passed the "...to increase awareness and to promote early detection and treatment of perinatal depression."

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