Socieconomic status and psychotropic medicine use during pregnancy: a population-based study in British Columbia, Canada
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ORIGINAL ARTICLE
Socieconomic status and psychotropic medicine use during pregnancy: a population-based study in British Columbia, Canada Gillian E. Hanley 1,2,3
&
Mina Park 4,2 & Tim F. Oberlander 4,5,2
Received: 11 September 2019 / Accepted: 22 April 2020 # Springer-Verlag GmbH Austria, part of Springer Nature 2020
Abstract Women at the lower end of the socioeconomic distribution have higher rates of depression in pregnancy and lower rates of treatment. In this study, we investigate relationships between income and the use of psychotropic mediciness in pregnancy. This retrospective cohort study using population-based administrative datasets included all women who delivered a live infant in the province of British Columbia, Canada (population of 4.6 million), between April 1, 2000, and December 31, 2009. We compared the socioeconomic distribution in use of psychotropic mediciness in pregnancy. We included 305,984 deliveries among 217,721 women. Women at the low end of the income distribution were significantly more likely to have a diagnosis for all mental health conditions, except anxiety, which was more common in women of highest socioeconomic status. The adjusted odds ratios for psychotropic medicine use indicate that women in the lowest income quintile have lower odds of filling a prescription for a psychotropic medicine after controlling for covariates and diagnoses of mental health conditions. However, they were more likely to fill a prescription for an antipsychotic and were more likely to fill psychotropic medicines from three or more different drug categories during pregnancy. Our findings suggest that women of lower socioeconomic status are less likely to fill a prescription for a psychotropic medicine in pregnancy, a finding largely driven by their decreased likelihood of filling an antidepressant. This is despite overall higher rates of mental illness among women of lower socioeconomic status, suggesting a gap in treatment by socioeconomic status. Keywords Maternal mental illness . Socioeconomic status . Psychotropic medicine use in pregnancy . Administrative data
Introduction
* Gillian E. Hanley [email protected] 1
Department of Obstetrics & Gynaecology, University of British Columbia, Suite 930, 1125 Howe Street, Vancouver, BC V6Z 2K8, Canada
2
BC Children’s Hospital Research Institute, University of British Columbia, 950 West 28th Ave., Vancouver, BC V5Z 4H4, Canada
3
VGH Research Pavilion, 828 W 10th Ave, Vancouver, BC V5Z 1M9, Canada
4
School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, BC V6T 1Z3, Canada
5
Department of Paediatrics, University of British Columbia, BC Children’s Hospital, Rm2D19, 4480 Oak St., Vancouver, BC V6H3V4, Canada
Socioeconomic status (SES) is a powerful determinant of health and disease (Evans et al. 1994) and considerable research suggests that this is also true of maternal mental health during pregnancy and the postpartum period (Kim et al. 2018; Margerison et al. 2019). Averaging across all pregnant wo
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