Perinatal PTSD significantly increased from 2008 to 2020, varying based on race, ethnicity

Key takeaways:

• Perinatal PTSD diagnoses rose significantly from 0.4% in 2008 to 1.9% in 2020.
• White women had the highest diagnosis rates at all time points vs. other races and ethnicities.

Perinatal PTSD diagnoses significantly increased from 2008 to 2020, with rates varying based on race and ethnicity, according to a cross-sectional study published in Health Affairs.

“Our health care system is doing a better job diagnosing perinatal PTSD. This means more people have better access to timely and effective treatment than they did 15 years ago, but we’re still seeing a lot of disparities and we need to do a better job combating bias and reducing stigma so that we can support all pregnant and postpartum people experiencing PTSD,” Stephanie V. Hall, MPH, PhD, postdoctoral research fellow in the department of psychiatry at the University of Michigan, Ann Arbor, told Healio. “A perinatal PTSD diagnosis helps clinicians provide appropriate care. If clinicians know a patient experienced past trauma, then they can provide trauma-informed care and follow-up treatment.”

Hall and colleagues utilized administrative claims data on 621,148 women aged 15 to 45 years from Optum’s Clinformatics Data Mart Database to calculate the annual rate of perinatal PTSD diagnoses. All women had continuous commercial health insurance and had at least one live birth from 2008 to 2020. Perinatal PTSD was defined as any PTSD diagnosis up to 1 calendar year before and after delivery.

During the 12-year period, 0.8% of deliveries were associated with a perinatal PTSD diagnosis. Perinatal PTSD diagnosis prevalence significantly increased from 0.4% of 63,710 deliveries in 2008 to 1.9% of 51,220 deliveries in 2020.

Perinatal PTSD diagnoses were significantly associated with younger age — women aged 15 to 26 years vs. 40 years or older were more likely to have a perinatal PTSD diagnosis (adjusted OR = 2.16; 95% CI, 1.92-2.43). Perinatal PTSD diagnoses were also associated with more vs. fewer comorbidities, such as perinatal mood and anxiety disorders (aOR = 1.85; 95% CI, 1.74-1.96) and incomes less than 250% of the poverty level (aOR = 1.4; 95% CI, 1.3-1.5) or incomes 250% to 400% (aOR = 1.2; 95% CI, 1.12-1.29) vs. higher than 400% of the poverty level.

From 2008 to 2010, odds of perinatal PTSD diagnoses were relatively stable, but grew consistently after 2011 with odds greater in 2020 compared with 2008 (aOR = 4.81; 95% CI, 4.17-5.54). Compared with white women, perinatal PTSD diagnosis odds were lower for Asian (aOR = 0.39; 95% CI, 0.34-0.45), Black (aOR = 0.77; 95% CI, 0.7-0.84) and Hispanic (aOR = 0.63; 95% CI, 0.58-0.68) women and for those of unknown race and ethnicity (aOR = 0.72; 95% CI, 0.63-0.82).

The overall predicted probability of perinatal PTSD diagnosis increased from 37.7 per 10,000 deliveries in 2008 to 186.3 per 10,000 deliveries in 2020. Predicted probability of perinatal PTSD diagnosis increased for all races and ethnicities from 2008 to 2020 and was highest for white women at all time points, the researchers reported.

From 2008 to 2020, the predicted probability of perinatal PTSD diagnosis per 10,000 deliveries rose from 42.2 to 208 for white women, from 37.6 to 188.7 for Black women, from 36.1 to 171.9 for those of unknown race and ethnicity, from 29.2 to 146.9 for Hispanic women and from 15 to 79.8 for Asian women.

“We need to devise more intentional and evidence-based strategies to diagnose PTSD during the perinatal period, such as screening guidelines that tell clinicians who, when and how to screen,” Hall said. “We also need to look farther down the care continuum: My paper shows more people are being diagnosed, but are they receiving treatment? Is treatment working? Are their needs met?”

For more information:

Stephanie V. Hall, MPH, PhD, can be reached at stephall@med.umich.edu.