Comparative Analysis of Confirmed and Suspected Postpartum Depression

Introduction: Peripartum or postpartum depression (PPD) is a major depressive episode (MDE) with peripartum onset. Specific international classification of diseases (ICD) codes for PPD arose in 2018. This analysis evaluated the use of ICD codes for MDE during pregnancy and postpartum.
Methods and Analysis: Patients pregnant in 2018 to 2021, aged 18-45 years, were included in this study using Optum’s de-identified claims database. Major Depressive Disorder (MDD; excluding those with active supply of antidepressants before conception) or PPD ICD codes during pregnancy and up to 12 months postpartum were classified as having PPD. Major exclusion criteria were bipolar disorder, schizophrenia, schizoaffective disorder, and psychosis; patients receiving lithium; or patients receiving an antipsychotic without a concomitant antidepressant. 308,406 individuals remained in the target population.
Results: The incidence of PPD diagnosis was 9% of which only 27% coded as PPD (cPPD). 95% of cPPD patients were diagnosed postpartum versus 41% of sPPD. sPPD patients had a higher relative risk of history of substance abuse and MDD. 49% of sPPD and 62%% cPPD received pharmacotherapy. Treatment persistence of any antidepressant drug was low by 6 months (sPPD: 45%; cPPD: 51%).
Discussion: Most providers continue to use ICD codes for MDD, making estimation of PPD incidence challenging. Patients diagnosed with MDD code were more likely to have history of psychiatric disorder and less likely to be diagnosed by OB/Gyn provider. The study highlights significant differences in risks, screening, diagnosis, treatment, and outcomes between cPPD and sPPD, emphasizing the need for tailored PPD management strategies.