Perinatal depression and emergency department visits in the postpartum period: a quasi-experimental analysis

Perinatal depression is a significant public health problem with short- and long-term consequences for mothers and families. Providing timely access to mental health services is a key component of an effective health system and is associated with better health, lower healthcare utilization, and lower healthcare costs. Access to outpatient mental health care is limited in the U.S., especially among underserved communities experiencing structural disadvantage. Consequently, women often rely on the emergency department (ED) to access mental health services postpartum. ED use has been shown to increase costs, reduce capacity to provide care tailored for mental health, and lessen ability to intervene before patients’ needs become critical. Providing timely alternatives to the ED is therefore critical to improving the effectiveness and cost-efficiency of state programs. Yet, little is known about who is most at risk of postpartum ED use for mental health reasons, partly because suitable data are rarely made available. New Jersey’s policy of universal screening for perinatal depression and the iPHD initiative provide a unique opportunity to examine risk factors for and costs associated with postpartum ED use, using merged birth certificate and hospital discharge data. Using a quasiexperimentalapproach, we will examine demographic, social, and health determinants of ED use postpartum, with a particular focus on the impact of depression symptoms at delivery. This research will provide crucial data for informing policies in New Jersey that aim to optimize allocation of healthcare system resources to best provide perinatal women with the support they need and reduce health disparities.