Urban mothers less likely to receive postpartum depression treatment

Urban mothers less likely to receive postpartum depression treatment | Image Credit: © Jelena Stanojkovic - © Jelena Stanojkovic - stock.adobe.com.

Pharmacologic and psychotherapy treatment are less often given to urban residing individuals with postpartum depression or anxiety vs rural residing individuals, according to a recent study published in Pregnancy.

Chronic disease and poverty disproportionately impact rural areas vs urban areas in the United States, with data indicating a higher prevalence of postpartum depression in the former region.² Despite this, there is little data about mental health treatment in rural areas.¹

“While perinatal and postpartum depression and anxiety can be treated through both psychotherapy and pharmacologic interventions, there are limited data on treatment rates of these interventions across the United States and how this may differ between urban and rural residing individuals,” wrote investigators.

Study aims to assess treatment differences

The retrospective cohort study was conducted to compare postpartum depression and anxiety treatment between rural and urban residing patients. Data was obtained from the IBM MarketScan database, an insurance-based claims data with data from all 50 states.

Female patients aged 13 to 50 years with delivery between 2011 and 2020 determined by International Classification of Diseases (ICD) codes and with a postpartum depression or anxiety diagnosis within 12 months following delivery were included in the analysis. ICD codes were also used to determine gestational age at delivery.

Exclusion criteria included under 12 months of, pre-delivery enrollment in MarketScan, receiving depression or anxiety treatment in the 12 months before delivery, and diagnoses for certain psychiatric conditions. Patients’ location of residence was determined by metropolitan statistical area and classified as rural or urban.

Treatment outcomes and participant characteristics

Depression or anxiety treatment within 12 months following delivery was reported as the primary outcome and included pharmacologic, psychotherapy, or both. Type of treatment and time from delivery to first prescription fill were reported as secondary outcomes. National Drug Codes were used to identify prescription fills.

Maternal age at delivery, mode of delivery, gestational age at delivery, depression or anxiety, and region were reported as demographics. ICD codes were used to identify cofounders such as substance use disorder.

There were 181,185 participants included in the final analysis, 88% of whom lived in urban areas. The median maternal age at delivery was 31 years in urban patients vs 28 years in rural patients, and median gestational ages at delivery were 38 weeks and 37 weeks, respectively. Tobacco and illicit substance use were also more common in rural residing patients.

Lower treatment rates in urban areas

Depression and anxiety rates before delivery did not significantly differ between groups. However, medication or psychotherapy treatment for postpartum depression or anxiety was less common in urban patients vs rural patients, with rates of 55.1% and 59.4%, respectively.

For medication alone, rates were 31.8% and 39.6%, respectively, while rates for psychotherapy alone were 44.8% and 46%, respectively. The adjusted hazard ratio (aHR) for receiving any treatment among urban patients vs rural patients was 0.90, highlighting reduced odds.

This difference was mainly driven by a significant reduction in the chance of receiving medication, with an aHR of 0.79. In comparison, the aHR for receiving psychotherapy was 0.99, which was not statistically significant.

Urban patients also reported a longer time from delivery to first fill vs rural patients, with means of 134 and 128 days, respectively. Similarly, the mean times from diagnosis to first fill were 46 and 41 days, respectively. However, these differences were not statistically significant.

Implications

These results highlighted differences in treatment for postpartum depression and anxiety between rural and urban residents. However, investigators noted the results are likely underestimated, as under 50% of individuals with postpartum depression seek treatment.

“Promotion of follow up for treatment and efforts to understand differences in treatment between urban and rural individuals during the postpartum period are warranted,” concluded investigators.

References

1. Gimbel LA, Bruno AM, Horns JJ, Paudel N, Smid MC, Silver RM. Differences in rural and urban treatment of postpartum depression and anxiety in the United States. Pregnancy. 2025. doi:10.1002/pmf2.70053
2. Mollard E, Hudson DB, Ford A, Pullen C. An integrative review of postpartum depression in rural US communities. Arch Psychiatr Nurs. 2016;30(3):418-24. doi:10.1016/j.apnu.2015.12.003