Differences between rural and urban residence in the detection and treatment of perinatal mood and anxiety disorders

• Published in: AJOG global reports 2024-05, Vol.4 (2), p.100351-100351, Article 100351
• Main Authors: Nacev, Erin C., Martinez Acevedo, Ann C., Kaufman, Menolly, Fuerst, Megan F., Knapp, Jacquelyn M., Rodriguez, Maria I.
• Format: Article
• Language: English
• Subjects: Mental Health; Perinatal Mood and Anxiety Disorders; Racial Disparities; Rurality
• ISSN: 2666-5778; 2666-5778
• DOI: 10.1016/j.xagr.2024.100351

Perinatal mood and anxiety disorders are common, serious complications of pregnancy. Disparities exist by race and income in the prevalence and treatment of these conditions, and overall treatment rates remain low. Outside of pregnancy, a small body of literature suggests that rural residency may contribute to higher rates of depression for those who identify as women. However, among more diverse populations, evidence suggests urban residency may be associated with higher rates of depression among women of color. It is not known whether these trends hold for mood and anxiety disorders during pregnancy and postpartum. We examined differences in the detection and treatment of perinatal mood and anxiety disorders by rural and urban residents and assessed if the observed differences varied by maternal race or ethnicity. We conducted a cross-sectional study using linked Medicaid claims and birth certificate records from Oregon and South Carolina from 2016 to 2020. We identified perinatal mood and anxiety disorder diagnoses during the perinatal period (pregnancy and within 60 days postpartum) using International Classification of Disease 10th edition codes and enumerated receipt of pharmacotherapy and psychotherapy treatment using Medicaid claims. We used logistic regression models controlling for relevant clinical and sociodemographic characteristics to estimate associations between rural residence and mood disorder detection and treatment. Among the 185,809 births in our sample, 27% of births (n=50,820) were to people who lived in rural areas and 73% (n=134,989) to those in urban areas. The prevalence of any perinatal mood and anxiety disorders diagnosis was higher for urban residents (19.5%) than for rural residents (18.0%; P