Title : Economic and clinical burden of depression in pregnancy: Disproportionate impact on minority populations
Abstract:
Introduction: Depression during pregnancy is a complication that contributes to adverse maternal outcomes and increased healthcare utilization. While previous research has documented the clinical risks associated with perinatal depression, its economic and resource implications across racial and ethnic groups remain poorly characterized. This study aimed to evaluate the association between depression in pregnancy, hospital length of stay (LOS), and hospitalization costs, with a focus on disparities by race and ethnicity.
Methods: We conducted a cross-sectional analysis of delivery hospitalizations in the United States between 2019 and 2022 using a nationally representative database. Patients were stratified by depression status, and outcomes included LOS and total hospitalization costs. Multivariable regression models adjusted for sociodemographic and clinical characteristics were used to estimate the incremental impact of depression overall and within racial and ethnic subgroups.
Results: Overall, depression in pregnancy was associated with significantly longer LOS and higher hospitalization costs. Patients with depression had an average increase in LOS of 0.52 days (p < 0.001) and incurred an additional $5,303.6 in patient costs (p < 0.001) and $1,244.6 in hospital costs (p < 0.001). Racial and ethnic minority patients experienced disproportionate increases in both LOS and costs. Black patients with depression had the highest excess costs ($12,085.3, LOS and costs. p = 0.013) and an extended LOS of 0.79 days (p < 0.001). Hispanic patients incurred an additional $4,951 in costs (p = 0.001) with 0.37 extra hospital days, while Asian or Pacific Islander patients had an excess cost of $5,494.7 (p = 0.0232) and 0.66 additional days (p < 0.006). In contrast, Caucasian patients with depression demonstrated comparatively smaller increases ($1,244.6, p < 0.001; 0.46 days, p < 0.001).
Conclusion: These findings demonstrate that perinatal depression imposes significant clinical and economic burdens, with minority populations bearing a disproportionate share of these effects. The disparities observed suggest structural inequities in maternal mental healthcare access, utilization, and outcomes. Addressing these inequities through early screening, culturally responsive care, and targeted perinatal mental health interventions is critical to improving maternal health and reducing preventable costs within the healthcare system.
