Antianxiety prescriptions ‘spiked’ for postpartum women during pandemic
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Key takeaways:
- Claims data show postpartum women were more likely to fill prescriptions for benzodiazepines during the COVID-19 pandemic.
- Diagnoses for postpartum anxiety and depression did not increase during the same period.
Prescriptions for benzodiazepines among privately insured postpartum women rose 15% during the pandemic, but diagnoses for postpartum anxiety and depression did not increase during the same period, researchers reported.
The findings, published in Archives of Women’s Mental Health, suggest that fewer postpartum women were receiving mental health diagnoses despite having symptoms, during a period when patients were reluctant to attend in-person visits and seek needed mental health care, according to Grace Bagwell Adams, PhD, associate professor at the University of Georgia College of Public Health.
“We found was there was no change in these diagnoses of postpartum depression and postpartum anxiety among this privately insured population during the pandemic,” Adams told Healio. “But what we also know is that postpartum depression and postpartum anxiety are underdiagnosed. We thought there would be an uptick in diagnoses, because we saw women self-reporting increased symptoms, yet we did not find that. That, to me, is more important than the drug finding.”
Reviewing claims data
In a retrospective study, researchers analyzed pooled medical claims data from 518,835 privately insured postpartum women in the U.S. from 2016 to 2020. The mean age at delivery for women was 31 years. Researchers measured changes in diagnoses of anxiety and depression before and during the pandemic, as well as changes in prescription fills and days supplied of antidepressants, benzodiazepines and nonbenzodiazepines (zolpidem, zopiclone and zaleplon) during the same period.
“The women we were observing is a best-case scenario in terms of health care access,” Adams said during an interview. “We started with the period 3 years before the pandemic, as we wanted to understand trends during the few years before and at the onset of the pandemic. The first question was, were these women, once the pandemic happened, more likely to be diagnosed with anxiety and depression? Other studies with much smaller samples suggested these women were more anxious and more depressed after the pandemic, but we did not know what we would observe at this large scale.”
After the onset of the COVID-19 pandemic in March 2020, diagnoses of depression and anxiety were not higher among privately insured postpartum women.
The proportion of privately insured postpartum women filling a benzodiazepine prescription increased by 15.2%. Researchers did not observe an increase in prescriptions filled for selective serotonin reuptake inhibitors.
“We saw a spike in those prescriptions after the onset of the pandemic,” Adams told Healio. “We did not see a measured increased in anxiety and depression [diagnoses], but something is happening because these clinicians were more likely to prescribe benzodiazepines. Given that the sample size is so large, and we have a representative sample of privately insured women, which tells you this was quite few women who experienced this.”
Fewer women seeking care
Adams said the observed trends reflect a difficult time during a public health emergency — one where women may have been scared to attend an in-person visit with a clinician at a time of heightened anxiety overall.
“Women may not be getting official diagnoses of depression and anxiety but certainly are feeling anxious and worried. This was a difficult time,” Adams said. “Clinicians might have prescribed these drugs for intense symptoms to get them through the acute phase, before [other medications] can work. In the absence of a postpartum anxiety or postpartum depression diagnosis, you are going to see a prescription for what has a more immediate impact.”
Adams said she hopes clinicians can learn from claims data about how to better care for postpartum women and screen for mental health concerns.
“We have to have clinicians focused on providing patient-centered care with a strong behavioral health component,” Adams told Healio. “The most vulnerable time for a postpartum woman is when she is returning to the workforce. We must be diligent about using mental health screening tools effectively. Use moments of connection. Ask women, ‘How are you doing?’ at every visit. Be just as vigilant for anxiety and depression as we are for preeclampsia.”
For more information:
Grace Bagwell Adams, PhD, can be reached at gbagwell@uga.edu.