Collaborative care reduces racial disparities in mental health screening during pregnancy

The collaborative care model was associated with reductions in racial disparities in mental health screening among pregnant and postpartum women, according to recent findings.

The data were presented at The Pregnancy Meeting, held virtually by the Society for Maternal-Fetal Medicine, and published in a supplement in the American Journal of Obstetrics and Gynecology.

“In primary care, the collaborative care model allows mental health care to be seamlessly integrated into physical health care,” Emily S. Miller, MD, MPH, a maternal-fetal medicine subspecialist and assistant professor at Northwestern University, said in a press release. In the field of obstetrics, however, this model is not often utilized.”

Miller and colleagues conducted a retrospective cohort study of 4,710 Black and white pregnant and postpartum women. The median age at baseline among the Black participants was 32 years; 262 were enrolled prior to the implementation of collaborative care (August 2015 to September 2016) and 313 were enrolled after (September 2017 to February 2019). The median age among the white participants was 33.4 years; 2,024 were enrolled prior to the implementation of collaborative care and 2,111 were enrolled after implementation.

The researchers evaluated the impact of collaborative care on depression screening. Miller and colleagues created interaction terms to identify whether effect modification was present for racial disparities after the intervention.

Prior to the implementation of collaborative care, there were significant disparities in screening for depression between Black and white pregnant women, according to the researchers. Overall, the collaborative care intervention was associated with reductions in “extant racial disparities,” as shown by significant interaction terms for screening before delivery (P < .001) and after (P = .045). Disparities between the two groups were “eliminated,” according to the press release.

Also, Miller and colleagues reported that the model was associated with the elimination of racial disparities in treatment recommendations among participants who screened positive for depression.

Previously, the collaborative care model has been shown to improve outcomes with opioid use disorder treatment retention, PTSD or bipolar disorder and persistent postconcussive symptoms, Healio reported.

“What’s exciting about our research is that it demonstrates that we can implement a model — collaborative care — that has been used in primary care for years and apply it to the field of obstetrics to not only improve screening and treatment for depression, but also to promote equity,” Miller said.

References:

New research finds the collaborative care model is associated with reductions in racial disparities in mental health care for pregnant people. https://s3.amazonaws.com/cdn.smfm.org/media/3360/FINAL_Abstract_%2387_-_Collaborative_Care_and_Racial_Disparities-_Emily_Miller_et._al.pdf. Published Feb. 5, 2022. Accessed Feb. 5, 2022.

Snowber K, et al. AJOG. 2022;doi:10.1016/j.ajog.2021.11.138.

Snowber K, et al. Does implementation of collaborative care mitigate racial disparities in screening and treatment of perinatal depression? Presented at: The Pregnancy Meeting; Jan. 26-Feb. 5, 2022 (virtual meeting).