Perinatal mood and anxiety diagnoses and treatment increased among medicaid births, 2017–2021

Despite funding the most births in the United States (US), we know little about basic patterns and trends of mental health conditions among Medicaid-insured women during pregnancy and after delivery. We sought to characterize the prevalence of diagnosis and treatment for perinatal mood and anxiety disorders (PMAD) among women with Medicaid health insurance coverage. We conducted serial, cross-sectional analyses of women with live-birth deliveries during 2017-2021 using Transformed Medicaid Statistical Information System (T-MSIS) claims. To construct state-specific PMAD diagnosis and treatment trajectories including antidepressant prescriptions and psychotherapy visits, we examined geographic variations by state and year among reproductive aged women. In a national cohort of 4,579,289 women with Medicaid and a live birth, 635,785 (13.88%) had a PMAD diagnosis during the study period. Perinatal women in all age, race, ethnicity, geographic regions, comorbidity burdens, and all but one state experienced growth in PMAD diagnoses. Substantial variation occurred among states for antidepressant use, while national trends remained stable. Characterizing PMAD diagnosis and treatment patterns represents an important public health contribution. Future research should aim to better understand factors underlying variation in PMAD diagnoses and treatment across subgroups and geographic areas.