A Behavioral Economics Intervention for Postpartum Primary Care Engagement Among Individuals with Anxiety and Depression

• In Event: Mental Health Services and Policy

Abstract

Importance: Mental health conditions are the most common complication of pregnancy and leading cause of pregnancy-related mortality but remain vastly undertreated in the postpartum period.  Objective: Evaluate the impact of an intervention to improve connection to postpartum primary care on postpartum mental health care utilization.  

Design: Secondary analysis of an individual-level stratified randomized clinical trial conducted from November 2022 to October 2023.  Setting: One hospital-based and five community-based outpatient obstetric clinics affiliated with a large academic medical center.  

Participants: 266 individuals with diagnosed anxiety and/or depressive mood disorder and a primary care provider listed in their electronic health record.  Intervention: A behavioral economics-informed intervention bundle designed to reduce administrative burdens and information gaps.  

Main Outcome and Measures: Outcomes were derived from administrative and self-reported data. Outcomes included completion of a primary care visit within 4 months of delivery, scheduling a primary care appointment for a mental health-related reason and mental health care utilization in the postpartum period, from primary care and otherwise, derived from administrative and self-reported data.  

Results: 266 trial participants with anxiety and/or depressive mood disorder were included in this analysis. 26.3% of this sample had both anxiety and depressive mood disorder, and 15.0% were prescribed a medication for anxiety or depression within 180 days of study enrollment. The intervention increased the rate of postpartum primary care visit attendance by 14.8 percentage points (95% CI = [3.3, 26.4]). The intervention also increased mental health care delivery in primary care, including increasing PCP visits with a discussion of mental health by 18.6 percentage points (95% CI = [3.7, 33.4]) and increasing the likelihood of self-reporting being prescribed a mood medication or referred to an MH specialist at a PCP visit by 12.8 percentage points (95% CI [1.6, 24.0])  For the subsample with depressive mood disorder, the intervention increased the likelihood of self-reporting primary care-seeking for mental health-related reasons by 19.5 percentage points (95% CI = [3.3, 35.7]) and mood medication receipt since giving birth by 26.9 percentage points (95% CI = [6.7, 47.1]).  

Conclusions and Relevance: Supported transitions from obstetric to postpartum primary care can improve mental health care utilization among postpartum individuals with mood disorders.

Author

• Julia Eddelbuettel, Harvard University
  Presenting Author