The pregnancy “super-utilizer”: how does a high-risk depression screen affect medical utilization?

Abstract

Objective: Our objective was to determine whether a score of  >11 on the Edinburgh postnatal depression scale (EPDS) at the initial prenatal visit was associated with an increased use of acute medical visits when compared to pregnant women with an initial EPDS score of ≤11.

Methods: This was a retrospective cohort study comparing the utilization of acute medical care during pregnancy and the first eight weeks after delivery amongst 200 women with an EPDS score >11 at their initial prenatal visit compared with 200 women with an EPDS score ≤11. “Super-utilization” was defined as ≥4 acute or unscheduled medical visits during pregnancy and the first eight weeks after delivery (90th percentile). Logistic regression was used to control for confounders.

Results: Women with an initial EPDS score >11 were significantly more likely to engage in super-utilization of acute medical care compared with those women scoring ≤11 (adjusted odds ratio [aOR], 2.12; 95% confidence interval [CI], 1.53–3.90).

Conclusions: Pregnant women scoring >11 on the EPDS at their initial prenatal visit are more likely to super-utilize acute medical care in the perinatal period. This subset of patients at-risk for increased utilization can be identified early during prenatal care. Interventions to better meet the medical and psychosocial needs of these women warrant future research.

• Depression
• postpartum depression
• prenatal care

Acknowledgments

The authors wish to acknowledge Lorna Imbruglio, RN, Dr Raywin Huang, PhD, and Dr Shad Deering, MD for their assistance during this research.

Declaration of interest

The authors report no conflicts of interest.