Utilization of Health Care Among Perinatal Women in the United States: The Role of Depression

UMMS Affiliation

Department of Psychiatry; Department of Population and Quantitative Health Sciences; Department of Obstetrics and Gynecology; UMass Memorial Health Care; Graduate School of Biomedical Sciences

Publication Date


Document Type



Health Services Administration | Health Services Research | Psychiatry and Psychology | Psychological Phenomena and Processes | Women's Health


Background: Individuals with depression have increased nonpsychiatric health care utilization. Associations between depression and utilization have not been studied in perinatal women, despite their heightened depression risk. We examined patterns of nonpsychiatric health care utilization by symptoms of perinatal depression, expecting more frequent use of acute services while being less likely to have routine medical care.

Materials and Methods: We identified 1,103 perinatal participants from the 2005 to 2016 National Health and Nutrition Examination Surveys. The Patient Health Questionnaire was used to identify depression (score > /=10). We evaluated associations between perinatal depressive symptoms and health care utilization using logistic models and relative excess risk due to interaction (RERI) using adjusted models with appropriate weighting to provide national estimates.

Results: Among perinatal U.S. women, 7.3% had depressive symptoms. Relative to those without these symptoms, women experiencing depressive symptoms were younger, more impoverished, and uninsured (p < 0.05). Women with depressive symptoms, compared with those without them, had twice the odds of being without routine medical care (21.6% vs. 12.5%, adjusted odds ratio [aOR]: 2.1, 95% confidence interval [CI]: 1.1 to 4.1) and of using urgent care more frequently (26.5% vs. 15.1%, aOR: 1.9, 95% CI: 1.0 to 3.9). Depressive symptoms combined with lack of insurance generally increased the odds of not having routine care (RERI: 8.4, 95% CI: -0.5 to 17.3) and more frequent use of urgent care (RERI: 7.1, 95% CI: -2.7 to 17.0).

Conclusions: Perinatal depression is a prevalent, high-risk illness that requires more nonpsychiatric services and increased psychiatric care. Approaches that facilitate establishing a place for routine care and decreasing acute care use are necessary.


NHANES, depression, health care utilization, perinatal, UMCCTS funding

DOI of Published Version



Masters GA, Li N, Lapane KL, Liu SH, Person SD, Byatt N. Utilization of Health Care Among Perinatal Women in the United States: The Role of Depression. J Womens Health (Larchmt). 2020 Feb 20. doi: 10.1089/jwh.2019.7903. Epub ahead of print. PMID: 32077784. Link to article on publisher's site

Journal/Book/Conference Title

Journal of women's health (2002)

PubMed ID


Related Resources

Link to Article in PubMed