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2019 HSR&D/QUERI National Conference Abstract

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4003 — Depression Symptoms and Mental Health Care Utilization in a Sample of Pregnant Veterans Receiving Veterans Health Administration Care

Lead/Presenter: Aimee Kroll-Desrosiers
All Authors: Kroll-Desrosiers AR (VA Central Western Massachusetts), Crawford, SL (UMass Medical School), Moore Simas, TA (UMass Medical School) Clark, MA (UMass Medical School) Bastian, LA (VA Connecticut Healthcare System) Mattocks, KM (VA Central Western Massachusetts)

Objectives:
Depression is the most commonly diagnosed medical condition among women veterans ages 18-44; however, depression during pregnancy has not been well-studied in this population. Additionally, it is unknown whether symptomatic veterans utilize mental health treatment during pregnancy. Our objective was to understand the rates and correlates of depression, as well as mental health care engagement at the Veterans Health Administration (VHA), in a sample of pregnant veterans.

Methods:
Pregnant veterans were recruited from 15 VHA sites; our sample included 501 participants. Sociodemographics, military service, medical history, and pregnancy related factors, as well as the Edinburgh Postnatal Depression Scale (EPDS) were collected as part of a telephone survey. Healthcare utilization data were obtained from electronic medical records. We used multivariable logistic regression to examine factors associated with an EPDS score suggestive of clinically significant depressive symptoms ( > = 10).

Results:
Prenatal EPDS > = 10 were calculated for 28% of our sample (n = 142). Our final model indicated that employment and spousal or partner support during pregnancy decreased odds of an EPDS > = 10 by 60%. A past diagnosis of anxiety, past antidepressant use, and active duty service all resulted in increased odds of an EPDS > = 10. Of the women with an EPDS > = 10, 70% had 1 or more VHA mental health visits or antidepressant prescriptions during pregnancy. However, women with a history of depression were more likely to receive this care than women without a history of depression.

Implications:
The prevalence of depression symptomology in our sample was greater than prevalence estimates in the general pregnant population. Pregnant women veterans without a history of depression may be less likely to receive care for depression during pregnancy. However, the majority of our veterans with prenatal depression symptoms had at least one mental health visit or antidepressant medication fill during pregnancy, suggesting that mental health care is available for pregnant veterans.

Impacts:
Further work needs to be done to understand the extent of depression screening and treatment options among veterans in the perinatal period. Furthermore, identifying ways to increase engagement with VHA mental health, especially for pregnant women with new onset symptoms, should be prioritized.