Patterns of Documented Mental Illness Among Women with a Pregnancy-Related Hospitalization in Texas from 2006 to 2015

Perinatal mental illness is a significant complication of pregnancy and the postpartum period. Inadequate prenatal care and lack of mental health screening are of great concern as mental health problems during the perinatal period are associated with increased risk for adverse health outcomes for both mother and offspring. Minority populations and low-income women have a higher risk of having an untreated perinatal mental illness in the U.S. ^ The purpose of this research is twofold: 1) to examine the patterns of documented mental illness among women of childbearing age (15-44 years of age) with a pregnancy-related hospitalization in Texas from 2006 to 2015, and 2) to identify the relationship between perinatal mental health needs to the psychiatric physician capacity available to provide perinatal mental health care within their region.^ For the first aim, data from the Texas Inpatient Public Use Data File (TIPUDF) were used to identify women with a pregnancy-related hospitalization who had a documented mental illness for the years 2006 to 2015. The prevalence, demographic, clinical characteristics and total charges for pregnancy-related hospitalizations of women with a documented mental illness were examined. Logistic regression modeling was used to explore association of race, age, and insurance with perinatal mental illness. For aim two, the physician database from the Texas Medical Board (TMB) was used to identify the capacity of psychiatric physicians in Texas. The TIPUDF was used to identify women with a pregnancy-related hospitalization who had a documented mental illness during 2015 by Texas zip code. Geographical information system (GIS) analysis was used to examine the spatial access to psychiatric physicians for women with a documented perinatal mental illness in 2015 in Texas. An enhanced two-step floating catchment area (E2SFCA) method was used to map and visualize the disparities in spatial accessibility to psychiatric physicians in Texas and identify shortage areas.^ Our findings using the inpatient hospital discharge data suggest that only 2.3% of women with a pregnancy-related hospitalization have a documented perinatal mental illness, a rate that is lower than the national average (10%). Our results also showed low percentages of documented perinatal mental illness along the Texas-Mexico border with Hispanic having a lower likelihood of having a documented perinatal mental illness. Additional findings from the spatial analysis showed the uneven distribution of psychiatric physicians, with most of them clustered along major urban areas. Policy formation and practice guidelines made at the federal and state level that focus on improved recruitment and retention of psychiatrists, use of telemedicine, and extending prescribing privileges could have a significant impact on maternal mental health service delivery in Texas and access to care and on the equitable distribution of care.