Perinatal PTSD Diagnoses Rose 394 Percent From 2008 – 2020

Stephanie V. Hall, MPH, PhD

Credit: University of Michigan Medical School.

A new study found a 394 percent increase in perinatal PTSD diagnoses, from 37.7 per 10,000 deliveries in 2008 to 186.3 per 10,000 deliveries in 2020.¹

“The increase in perinatal PTSD diagnoses over the course of the study period may reflect increased awareness, diagnosis, or prevalence of the disorder or a combination of all three,” wrote investigators, led by Stephanie V. Hall, MPH, PhD, from University of Michigan Medical School. “Multiple major cultural and policy changes occurred during this period.”

For instance, the Mental Health Parity and Addiction Equity Act required insurance plans to provide mental health benefits at the same level as medical and surgical benefits, the Affordable Care Act required insurance plans to cover preventive and maternal care, and the American College of Obstetricians and Gynecologists recommended universal screening of pregnant and postpartum people for perinatal depression.

Approximately 3 – 4% of mothers who are pregnant or postpartum (up to 1 year) have PTSD, with Black and Hispanic individuals having greater rates. Perinatal PTSD can impact physical and mental health, interpersonal relationships, and parenting.

Perinatal PTSD risk factors include severe maternal morbidity, preeclampsia, comorbid psychiatric diagnoses, social factors, and distressing or traumatic delivery. Many people experience traumatic births, which applied to half of the participants in a 2014 study.

Wanting to learn more about the clinical diagnosis of perinatal PTSD, investigators sought to describe the racial and ethnic trends in perinatal PTSD diagnoses among women with commercial insurance who had live-birth deliveries during the years 2008 – 2020. The team collected data on the participants through administrative claims from Optum’s Clinformatics Data Mart database.

The study included 621,148 participants with 736,323 deliveries. All participants included had a single health plan during the calendar year before and after delivery. Covariates examined included age (broken into age groups of 15 – 26, 27 – 34, 35 – 39, and ≥ 40), comorbidities, and income as a percentage of the federal poverty level.

During the years 2008 – 2020, 6074 (0.8%) deliveries had a PTSD diagnosis during the perinatal period—and the diagnosis rate grew from 2008 – 2020 (odds of diagnosis: 5.02). In 2008, 240 (0.4%) of 63,710 deliveries had a perinatal PTSD diagnosis. The rate skyrocketed by 2020 with 954 (1.9%) of 51,220 deliveries being diagnosed with perinatal PTSD.

An unadjusted logistic regression showed the odds of a perinatal PTSD diagnosis remained stable from 2008 – 2010 but increased from 2011 – 2020. A logistic regression adjusted for age, comorbidities, and income showed the same thing.

White people had the greatest diagnosis rate throughout the years (208 per 10,000 deliveries in 2020), followed by Black people (188.7/ 10,000), people of an unknown race (171.9/ 10,000), Hispanic people (146.9/10,000), and Asian people (79.8/10,000). Overall, Black people, Hispanic people, and people of an unknown race and ethnicity had lower odds of PTSD diagnosis than White people (odds ratio [OR], 0.90, 0.70, and 0.81, respectively), with Asian people have the lowest odds of perinatal PTSD (OR, 0.37).

The predicted probability of perinatal PTSD diagnoses increased for all races and ethnicities from 2008 - 2020. Per 10,000 deliveries, the diagnoses rose from 42.2 to 208 for White people, 27.6 to 188.7 for Black people, 36.1 to 171.9 for unknown race, 29.2 to 146.9 for Hispanic people, and 15 per 79.8 for Asian people.

When evaluating sociodemographic characteristics, investigators found people had greater odds of perinatal PTSD diagnosis in the age group 15 – 26 years compared to people aged ≥ 40 (adjusted odds ratio [aOR], 2.16) but not ages 27 – 39. People also had greater odds of a diagnosis if they had more comorbidities (aOR, 1.85) and a lower income (250, 250 – 400, and unknown percent of poverty compared to 400 percent of poverty) (aOR, 1.40, 1.20, and 1.34, respectively).

The team outlined several limitations, such as the sample not being able to be generalized to the larger population, not knowing the true prevalence of perinatal PTSD, race and ethnicity of participants may not be accurate as it derives from a proprietary Optum algorithm which assigns race based on factors such as name and geographic locations, and the study only included participants with live birth deliveries.

“If anything, the rates we’re documenting for diagnosis and treatment are a floor, not a ceiling, based on what other studies have suggested about who is experiencing these symptoms,” said Kara Zivin, PhD, from VA Ann Arbor Healthcare System and Mathematica, in a press release.² “It’s important that those who are struggling get help, because not getting care has consequences.”

References

1. Hall SV, Bell S, Courant A, Admon LK, Zivin K. Perinatal Posttraumatic Stress Disorder Diagnoses Among Commercially Insured People Increased, 2008-20. Health Aff (Millwood). 2024;43(4):504-513. doi:10.1377/hlthaff.2023.01447
2. Rapid rise seen in mental health diagnosis and care during and after pregnancy. EurekAlert! April 1, 2024. https://www.eurekalert.org/news-releases/1039277. Accessed April 3, 2024.