Abstract
Introduction
Mental health conditions are a leading comorbidity of pregnancy, but little is known about the use of emergency departments (EDs) for mental health-related care during pregnancy. This study aims to describe both the characteristics of pregnant women who receive mental health-related care in hospital EDs in the United States and the most common mental health diagnoses, types of medications, and mental health services that these women receive.
Methods
Pooled, cross-sectional data from the National Hospital Ambulatory Medical Care Survey (2016–2019) were used. Pregnant patients were identified based on diagnosis and reason for visit codes. Weighted descriptive analyses were performed to describe characteristics of pregnant women, services offered, and medications received for mental health-related visits.
Results
Mental health-related visits comprised 6.2% of all ED visits during pregnancy. History of depression was significantly higher in pregnant patients with mental health-related visits compared to those pregnant patients presenting for other reasons. The most common diagnoses for pregnant patients with mental health-related visits were substance use disorders (30.7%), anxiety-related disorders (19.1%), and depressive disorders (14.6%). Anxiolytics and antidepressants were the most common pharmacotherapies given. Few women saw a mental health provider during their visit (6.7%), while most were referred to an outside clinic for follow-up (55.0%).
Discussion
Many pregnant women seek care from EDs for mental health-related reasons. It remains important to train health care professionals who treat pregnant women in EDs how to deliver effective treatments, particularly for substance use disorders and anxiety.
Significance
Many pregnant patients receive care in emergency departments during pregnancy. Despite mental health conditions being a leading comorbidity of pregnancy, little is known about the use of emergency departments for mental health-related reasons during pregnancy. This study is the first to analyze a representative sample of emergency department visits by pregnant women in the United States between 2016 and 2019 and report on mental health-related visits. Among pregnant women seen in the ED for mental health-related reasons, the most common diagnoses were substance use disorders, anxiety-related disorders, and depressive disorders, but few saw a mental health provider during their visit.
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Data Availability
Data are publicly available from the National Center for Health Statistics.
Code Availability
Analyses were conducted using Stata.
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All authors, DT, KK, and LC, made substantial contributions to the concept and design of the work. DT conducted the analyses and drafted the manuscript. All authors DT, KK, and LC, contributed to writing and providing critical feedback of the manuscript, gave final approval for submission, and agree to be accountable for the work.
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Appendices
Appendix 1
Indication | ICD-10 and RFV Codes |
|---|---|
Alcohol and substance use | ICD-10: F10, F11, F12, F13, F14, F15, F16, F17, F18, F19 RFV: 11450, 23200, 45181, 59150, 59160, 11400, 11500, 11501, 23210, 59100, 45180, 45182 |
Anxiety, fear, and stress | ICD-10: F40, F41, F42, F43 RFV: 11000 |
Bipolar | ICD-10: F31 |
Depression | ICD-10: F32, F33 RFV: 11100 |
Other | ICD-10: F20, F21, F22, F23, F24, F25, F28, F29, F30, F34, F38, F39, F44, F45, F48, F50, F51, F52, F53, F54, F55, F60, F61, F62, F63, F64, F65, F66, F68, F69, F59, F90, F99 RFV: 11050, 11150, 11200, 11250, 11300, 11301, 11302, 11303, 11304, 11305, 11350, 11351, 11352, 11353, 11354, 11550, 11600, 11601, 11602, 11603, 11604, 11605, 11606, 11607, 11650, 11651, 11652, 23000, 23050, 23100, 23150, 23300, 23301, 31300, 44100, 44101 |
Suicide/Self harm | ICD-10: X60, X61, X62, X63, X64, X65, X66, X67, X68, X69, X70, X71, X72, X73, X74, X75, X76, X77, X78, X79, X80, X81, X82, X83, X84 RFV: 58180, 58200, 58201, 52250 |
Appendix 2
Multum Drug Category | Medications Identified |
|---|---|
Anxiolytics, sedatives, hypnotics* | Alprazolam, clonazepam, diazepam, hydroxyzine, lorazepam |
Antidepressants | Citalopram |
Antipsychotics | Clozapine, lithium, quetiapine |
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Tyson, D.P., Kelleher, K.J. & Chavez, L.J. Mental Health-related Utilization of Emergency Departments During Pregnancy in the U.S., 2016–2019. Matern Child Health J 26, 1953–1958 (2022). https://doi.org/10.1007/s10995-022-03487-2
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DOI: https://doi.org/10.1007/s10995-022-03487-2