J Clin Med Res

Journal of Clinical Medicine Research, ISSN 1918-3003 print, 1918-3011 online, Open Access

Article copyright, the authors; Journal compilation copyright, J Clin Med Res and Elmer Press Inc

Journal website http://www.jocmr.org

Original Article

Volume 10, Number 6, June 2018, pages 516-522

Depressed Women of Low Socioeconomic Status Have High Numbers of Physician Visits in the Year Before Pregnancy: Implications for Care

**Table 1.** Births by Maternal Age, SES, Parity and at Least One Maternal Physician Visit Associated With Depression
	SES decile	Total
SES: socioeconomic status.
Maternal age
< 20 years	1,541 (4.3%)	1,195 (3.1%)	1,111 (2.9%)	970 (2.6%)	895 (2.5%)	851 (2.4%)	721 (2.1%)	666 (2.0%)	645 (2.0%)	449 (1.7%)	9,044 (2.6%)
20 - 29 years	16,766 (46.9%)	17,613 (45.8%)	17,406 (44.9%)	15,888 (42.9%)	14,918 (40.9%)	13,945 (39.1%)	12,749 (37.3%)	12,212 (36.2%)	10,772 (34.1%)	8,034 (30.2%)	140,303 (40.3%)
30 - 39 years	16,186 (45.3%)	18,427 (47.9%)	18,925 (48.8%)	18,946 (51.1%)	19,283 (52.8%)	19,411 (54.5%)	19,243 (56.3%)	19,382 (57.5%)	18,577 (58.8%)	16,439 (61.8%)	184,819 (53.1%)
> 40 years	1,252 (3.5%)	1,262 (3.3%)	1,347 (3.5%)	1,259 (3.4%)	1,400 (3.8%)	1,419 (4.0%)	1,437 (4.2%)	1,428 (4.2%)	1,567 (5.0%)	1,657 (6.2%)	14,028 (4.0%)
Missing	6 (0.0%)	5 (0.0%)	7 (0.0%)	9 (0.0%)	10 (0.0%)	7 (0.0%)	8 (0.0%)	11 (0.0%)	12 (0.0%)	4 (0.0%)	79 (0.0%)
Parity
Nulliparous	16,503 (46.2%)	17,373 (45.1%)	17,504 (45.1%)	16,618 (44.8%)	16,139 (44.2%)	15,842 (44.5%)	15,176 (44.4%)	14,671 (43.5%)	13,684 (43.3%)	11,539 (43.4%)	155,049 (44.5%)
Multiparous	19,240 (53.8%)	21,120 (54.9%)	21,284 (55.4%)	20,442 (55.1%)	20,355 (55.8%)	19,782 (55.5%)	18,973 (55.5%)	19,014 (56.4%)	17,875 (56.6%)	15,040 (56.6%)	193,125 (55.5%)
Missing	8 (0.0%)	9 (0.0%)	8 (0.0%)	12 (0.0%)	12 (0.0%)	9 (0.0%)	9 (0.0%)	14 (0.0%)	14 (0.0%)	4 (0.0%)	99 (0.0%)
At least one physician visit associated with depression before the pregnancy
No	33,980 (95.1%)	36,812 (95.3%)	36,979 (95.3%)	35,339 (95.3%)	34,911 (95.6%)	33,989 (95.4%)	32,613 (95.5%)	32,170 (95.5%)	30,192 (95.6%)	25,435 (95.7%)	332,420 (95.5%)
Yes	1,771 (5.0%)	1,690 (4.4%)	1,817 (4.7%)	1,733 (4.7%)	1,595 (4.4%)	1,644 (4.6%)	1,545 (4.5%)	1,529 (4.5%)	1,381 (4.4%)	1,148 (4.3%)	15,853 (4.6%)
Total	35,751 (100%)	38,502 (100%)	38,796 (100%)	37,072 (100%)	36,506 (100%)	35,633 (100%)	34,158 (100%)	33,699 (100%)	31,573 (100%)	26,583 (100%)	348, 273 (100%)

Table 1. Births by Maternal Age, SES, Parity and at Least One Maternal Physician Visit Associated With Depression

SES decile

Total

SES: socioeconomic status.

Maternal age

< 20 years

1,541 (4.3%)

1,195 (3.1%)

1,111 (2.9%)

970 (2.6%)

895 (2.5%)

851 (2.4%)

721 (2.1%)

666 (2.0%)

645 (2.0%)

449 (1.7%)

9,044 (2.6%)

20 - 29 years

16,766 (46.9%)

17,613 (45.8%)

17,406 (44.9%)

15,888 (42.9%)

14,918 (40.9%)

13,945 (39.1%)

12,749 (37.3%)

12,212 (36.2%)

10,772 (34.1%)

8,034 (30.2%)

140,303 (40.3%)

30 - 39 years

16,186 (45.3%)

18,427 (47.9%)

18,925 (48.8%)

18,946 (51.1%)

19,283 (52.8%)

19,411 (54.5%)

19,243 (56.3%)

19,382 (57.5%)

18,577 (58.8%)

16,439 (61.8%)

184,819 (53.1%)

> 40 years

1,252 (3.5%)

1,262 (3.3%)

1,347 (3.5%)

1,259 (3.4%)

1,400 (3.8%)

1,419 (4.0%)

1,437 (4.2%)

1,428 (4.2%)

1,567 (5.0%)

1,657 (6.2%)

14,028 (4.0%)

Missing

6 (0.0%)

5 (0.0%)

7 (0.0%)

9 (0.0%)

10 (0.0%)

7 (0.0%)

8 (0.0%)

11 (0.0%)

12 (0.0%)

4 (0.0%)

79 (0.0%)

Parity

Nulliparous

16,503 (46.2%)

17,373 (45.1%)

17,504 (45.1%)

16,618 (44.8%)

16,139 (44.2%)

15,842 (44.5%)

15,176 (44.4%)

14,671 (43.5%)

13,684 (43.3%)

11,539 (43.4%)

155,049 (44.5%)

Multiparous

19,240 (53.8%)

21,120 (54.9%)

21,284 (55.4%)

20,442 (55.1%)

20,355 (55.8%)

19,782 (55.5%)

18,973 (55.5%)

19,014 (56.4%)

17,875 (56.6%)

15,040 (56.6%)

193,125 (55.5%)

Missing

8 (0.0%)

9 (0.0%)

8 (0.0%)

12 (0.0%)

9 (0.0%)

14 (0.0%)

4 (0.0%)

99 (0.0%)

At least one physician visit associated with depression before the pregnancy

33,980 (95.1%)

36,812 (95.3%)

36,979 (95.3%)

35,339 (95.3%)

34,911 (95.6%)

33,989 (95.4%)

32,613 (95.5%)

32,170 (95.5%)

30,192 (95.6%)

25,435 (95.7%)

332,420 (95.5%)

Yes

1,771 (5.0%)

1,690 (4.4%)

1,817 (4.7%)

1,733 (4.7%)

1,595 (4.4%)

1,644 (4.6%)

1,545 (4.5%)

1,529 (4.5%)

1,381 (4.4%)

1,148 (4.3%)

15,853 (4.6%)

Total

35,751 (100%)

38,502 (100%)

38,796 (100%)

37,072 (100%)

36,506 (100%)

35,633 (100%)

34,158 (100%)

33,699 (100%)

31,573 (100%)

26,583 (100%)

348, 273 (100%)

**Table 2.** Odds* of at Least One Physician Visit Associated With Depression During Pre-Pregnancy by SES
SES decile	Model	No visit	Odds ratio
SES: socioeconomic status; uOR; unadjusted odds ratio; aOR; adjusted odds ratio; No visit; No physician visit associated with depression. *P < 0.0056 (lowered from 0.05 in accordance with Bonferroni’s approximation). Age at the birth of the child and parity are included in the multivariate model.
1	uOR	….	1.13 (1.05, 1.22)**
	aOR		1.10 (1.02, 1.19)
2	uOR	….	0.97 (0.90, 1.05)
	aOR		0.97 (0.89, 1.04)
3	uOR	….	1.04 (0.97, 1.12)
	aOR		1.03 (0.96, 1.11)
4	uOR	….	1.05 (0.98, 1.14)
	aOR		1.05 (0.97, 1.13)
5	uOR	….	0.96 (0.89, 1.04)
	aOR		0.97 (0.89, 1.04)
6	Comparator group
7	uOR	….	1.00 (0.93, 1.09)
	aOR		1.01 (0.93, 1.09)
8	uOR	….	1.04 (0.96, 1.12)
	aOR		1.05 (0.97, 1.13)
9	uOR	….	1.00 (0.93, 1.08)
	aOR		1.01 (0.94, 1.10)
10	uOR	….	0.98 (0.90, 1.07)
	aOR		0.99 (0.91, 1.08)

Table 2. Odds* of at Least One Physician Visit Associated With Depression During Pre-Pregnancy by SES

SES decile

Model

No visit

Odds ratio

SES: socioeconomic status; uOR; unadjusted odds ratio; aOR; adjusted odds ratio; No visit; No physician visit associated with depression. **P < 0.0056 (lowered from 0.05 in accordance with Bonferroni’s approximation). *Age at the birth of the child and parity are included in the multivariate model.

uOR

….

1.13 (1.05, 1.22)**

aOR

1.10 (1.02, 1.19)

uOR

….

0.97 (0.90, 1.05)

aOR

0.97 (0.89, 1.04)

uOR

….

1.04 (0.97, 1.12)

aOR

1.03 (0.96, 1.11)

uOR

….

1.05 (0.98, 1.14)

aOR

1.05 (0.97, 1.13)

uOR

….

0.96 (0.89, 1.04)

aOR

0.97 (0.89, 1.04)

Comparator group

uOR

….

1.00 (0.93, 1.09)

aOR

1.01 (0.93, 1.09)

uOR

….

1.04 (0.96, 1.12)

aOR

1.05 (0.97, 1.13)

uOR

….

1.00 (0.93, 1.08)

aOR

1.01 (0.94, 1.10)

uOR

….

0.98 (0.90, 1.07)

aOR

0.99 (0.91, 1.08)

**Table 3.** Odds* of Various Numbers of Physician Visits in Women by Depressive Status and SES During Pre-Pregnancy
SES decile	Model	Non-depressed	Depressed
SES: socioeconomic status; uOR; unadjusted odds ratio; aOR; adjusted odds ratio; 0-1: no visit or one physician visit associated with depression. **P < 0.0005. Note: Significance level is 0.0019 (lowered from 0.05 in accordance with Bonferroni’s approximation). Age at the birth of the child and parity are included in the multivariate model.
1	uOR	….	1.03 (1.00, 1.07)	1.05 (0.98, 1.13)	1.23 (1.10, 1.37)***	1.12 (0.95, 1.32)	1.13 (0.93, 1.39)	1.44 (1.14, 1.83)
	aOR		1.05 (1.01, 1.09)	1.07 (0.99, 1.14)	1.26 (1.13, 1.41)***	1.12 (0.95, 1.32)	1.14 (0.93, 1.39)	1.46 (1.15, 1.86)
2	uOR	….	1.04 (1.00, 1.08)	1.07 (1.00, 1.15)	1.20 (1.08, 1.34)	1.12 (0.96, 1.32)	1.01 (0.83, 1.25)	1.23 (0.96, 1.57)
	aOR		1.06 (1.02, 1.09)	1.09 (1.01, 1.16)	1.24 (1.11, 1.38)***	1.12 (0.95, 1.32)	1.02 (0.83, 1.26)	1.26 (0.98, 1.61)
3	uOR	….	1.00 (0.96, 1.03)	1.07 (0.99, 1.14)	1.08 (0.97, 1.21)	1.06 (0.90, 1.24)	0.92 (0.75, 1.12)	0.98 (0.77, 1.26)
	aOR		1.01 (0.98, 1.05)	1.08 (1.01, 1.16)	1.11 (0.99, 1.23)	1.03 (0.88, 1.21)	0.90 (0.74, 1.11)	0.99 (0.77, 1.26)
4	uOR	….	1.02 (0.98, 1.05)	1.09 (1.02, 1.17)	1.12 (1.01, 1.25)	1.13 (0.96, 1.33)	1.03 (0.84, 1.27)	1.22 (0.96, 1.56)
	aOR		1.03 (0.99, 1.06)	1.11 (1.03, 1.19)	1.14 (1.03, 1.28)	1.12 (0.95, 1.32)	1.03 (0.84, 1.27)	1.23 (0.96, 1.58)
5	uOR	….	1.00 (0.97, 1.05)	1.07 (1.00, 1.15)	1.09 (0.98, 1.22)	0.99 (0.84, 1.17)	1.01 (0.82, 1.24)	1.00 (0.78, 1.29)
	aOR		1.01 (0.97, 1.05)	1.08 (1.01, 1.16)	1.10 (0.99, 1.23)	0.97 (0.82, 1.15)	0.99 (0.80, 1.25)	0.99 (0.77, 1.28)
6	Comparator group
7	uOR	….	1.01 (0.97, 1.05)	1.03 (0.96, 1.10)	0.97 (0.86, 1.08)	1.12 (0.95, 1.32)	1.06 (0.86, 1.31)	0.97 (0.75, 1.26)
	aOR		1.00 (0.97, 1.04)	1.02 (0.95, 1.10)	0.96 (0.85, 1.07)	1.12 (0.95, 1.33)	1.06 (0.86, 1.31)	0.97 (0.75, 1.26)
8	uOR	….	1.01 (0.97, 1.04)	0.97 (0.90, 1.05)	1.02 (0.91, 1.15)	1.14 (0.96, 1.35)	1.07 (0.86, 1.32)	1.30 (1.01, 1.67)
	aOR		1.00 (0.96, 1.04)	0.97 (0.90, 1.04)	1.02 (0.91, 1.14)	1.11 (0.94, 1.32)	1.05 (0.84, 1.29)	1.29 (1.00, 1.65)
9	uOR	….	0.99 (0.95, 1.03)	1.01 (0.93, 1.08)	1.06 (0.95, 1.19)	1.21 (1.02, 1.44)	1.05 (0.85, 1.31)	1.10 (0.84, 1.45)
	aOR		0.98 (0.94, 1.02)	0.99 (0.92, 1.07)	1.04 (0.93, 1.16)	1.15 (0.97, 1.37)	1.00 (0.80, 1.25)	1.04 (0.79, 1.36)
10	uOR	….	0.98 (0.94, 1.02)	0.96 (0.88, 1.03)	0.89 (0.79, 1.01)	1.17 (0.98, 1.40)	1.12 (0.89, 1.41)	0.91 (0.84, 1.43)
	aOR		0.95 (0.91, 0.99)	0.92 (0.85, 1.00)	0.85 (0.75, 0.96)	1.13 (0.94, 1.36)	1.08 (0.86, 1.36)	0.86 (0.64, 1.16)

Table 3. Odds* of Various Numbers of Physician Visits in Women by Depressive Status and SES During Pre-Pregnancy

SES decile

Model

Non-depressed

Depressed

0 - 1 visits

2 - 10 visits

11 - 20 visits

More than 20 visits

2 - 10 visits

11 - 20 visits

More than 20 visits

SES: socioeconomic status; uOR; unadjusted odds ratio; aOR; adjusted odds ratio; 0-1: no visit or one physician visit associated with depression. ***P < 0.0005. Note: Significance level is 0.0019 (lowered from 0.05 in accordance with Bonferroni’s approximation). *Age at the birth of the child and parity are included in the multivariate model.

uOR

….

1.03 (1.00, 1.07)

1.05 (0.98, 1.13)

1.23 (1.10, 1.37)***

1.12 (0.95, 1.32)

1.13 (0.93, 1.39)

1.44 (1.14, 1.83)

aOR

1.05 (1.01, 1.09)

1.07 (0.99, 1.14)

1.26 (1.13, 1.41)***

1.12 (0.95, 1.32)

1.14 (0.93, 1.39)

1.46 (1.15, 1.86)

uOR

….

1.04 (1.00, 1.08)

1.07 (1.00, 1.15)

1.20 (1.08, 1.34)

1.12 (0.96, 1.32)

1.01 (0.83, 1.25)

1.23 (0.96, 1.57)

aOR

1.06 (1.02, 1.09)

1.09 (1.01, 1.16)

1.24 (1.11, 1.38)***

1.12 (0.95, 1.32)

1.02 (0.83, 1.26)

1.26 (0.98, 1.61)

uOR

….

1.00 (0.96, 1.03)

1.07 (0.99, 1.14)

1.08 (0.97, 1.21)

1.06 (0.90, 1.24)

0.92 (0.75, 1.12)

0.98 (0.77, 1.26)

aOR

1.01 (0.98, 1.05)

1.08 (1.01, 1.16)

1.11 (0.99, 1.23)

1.03 (0.88, 1.21)

0.90 (0.74, 1.11)

0.99 (0.77, 1.26)

uOR

….

1.02 (0.98, 1.05)

1.09 (1.02, 1.17)

1.12 (1.01, 1.25)

1.13 (0.96, 1.33)

1.03 (0.84, 1.27)

1.22 (0.96, 1.56)

aOR

1.03 (0.99, 1.06)

1.11 (1.03, 1.19)

1.14 (1.03, 1.28)

1.12 (0.95, 1.32)

1.03 (0.84, 1.27)

1.23 (0.96, 1.58)

uOR

….

1.00 (0.97, 1.05)

1.07 (1.00, 1.15)

1.09 (0.98, 1.22)

0.99 (0.84, 1.17)

1.01 (0.82, 1.24)

1.00 (0.78, 1.29)

aOR

1.01 (0.97, 1.05)

1.08 (1.01, 1.16)

1.10 (0.99, 1.23)

0.97 (0.82, 1.15)

0.99 (0.80, 1.25)

0.99 (0.77, 1.28)

Comparator group

uOR

….

1.01 (0.97, 1.05)

1.03 (0.96, 1.10)

0.97 (0.86, 1.08)

1.12 (0.95, 1.32)

1.06 (0.86, 1.31)

0.97 (0.75, 1.26)

aOR

1.00 (0.97, 1.04)

1.02 (0.95, 1.10)

0.96 (0.85, 1.07)

1.12 (0.95, 1.33)

1.06 (0.86, 1.31)

0.97 (0.75, 1.26)

uOR

….

1.01 (0.97, 1.04)

0.97 (0.90, 1.05)

1.02 (0.91, 1.15)

1.14 (0.96, 1.35)

1.07 (0.86, 1.32)

1.30 (1.01, 1.67)

aOR

1.00 (0.96, 1.04)

0.97 (0.90, 1.04)

1.02 (0.91, 1.14)

1.11 (0.94, 1.32)

1.05 (0.84, 1.29)

1.29 (1.00, 1.65)

uOR

….

0.99 (0.95, 1.03)

1.01 (0.93, 1.08)

1.06 (0.95, 1.19)

1.21 (1.02, 1.44)

1.05 (0.85, 1.31)

1.10 (0.84, 1.45)

aOR

0.98 (0.94, 1.02)

0.99 (0.92, 1.07)

1.04 (0.93, 1.16)

1.15 (0.97, 1.37)

1.00 (0.80, 1.25)

1.04 (0.79, 1.36)

uOR

….

0.98 (0.94, 1.02)

0.96 (0.88, 1.03)

0.89 (0.79, 1.01)

1.17 (0.98, 1.40)

1.12 (0.89, 1.41)

0.91 (0.84, 1.43)

aOR

0.95 (0.91, 0.99)

0.92 (0.85, 1.00)

0.85 (0.75, 0.96)

1.13 (0.94, 1.36)

1.08 (0.86, 1.36)

0.86 (0.64, 1.16)