June 13, 2024 | Erin Bluvas, bluvase@sc.edu

In a collaboration between the Rural and Minority Health Research Center and South Carolina SmartState Center for Healthcare Quality, USC researchers have discovered a hidden crisis impacting rural and minority South Carolinians. Their recent paper, published in the American Journal of Obstetrics and Gynecology, reveals that members of rural and minority populations are more likely to be readmitted to the hospital for mental health and/or substance use disorders after giving birth.

“The postpartum period is challenging for many birthing individuals who may experience significant needs related to physical, psychosocial and behavioral functioning,” says Peiyin Hung, an associate professor in the Arnold School of Public Health’s Department of Health Services Policy and Management and deputy director of the Rural and Minority Health Research Center. “After giving birth, they are susceptible to mental health and substance use disorders, leading to maternal morbidity and mortality inequity. This is especially true for those facing social or economic hardships or with a history of mental health disorders.”

 

Members of rural and minority populations are more likely to be readmitted to the hospital for mental health and/or substance use disorders after giving birth.

As the most common complication of pregnancy and childbirth, mental health conditions impact one in every five mothers in the U.S., with 75 percent of them undiagnosed and untreated. More than 800,000 families are affected by this epidemic which has been exacerbated by the COVID-19 pandemic by an estimated 300 to 400 percent. Black and rural populations are disproportionately impacted, with the first group experiencing double the depression rates and the second facing increased stigma and supply shortages.

During the first year postpartum, suicides and overdoses are the leading causes of mortality for the 20 percent of mothers who experience mental health disorders, though most of these deaths are preventable. Though rare, maternal suicide is also associated with a risk of infanticide. 

To better understand these challenges in South Carolina, Hung and co-principal investigator Xiaoming Li, professor of health promotion education, and behavior and director of the Center for Healthcare Quality, designed a study using funding from the Eunice Kennedy Shriver National Institute of Child Health & Human Development. The research team analyzed hospital records from more than 71,000 South Carolinians who gave birth between March 2020 and January 2022 – following up on readmissions for one year postpartum.

They found that 1,125 individuals were readmitted for mental health disorders and 588 were readmitted for substance use disorders. Though rural and urban residents experienced similar rates of readmission for mental health disorders up until 300 days, rural populations had higher incidences past that point. Black individuals had the highest rates of postpartum mental health readmissions overall. Further, patients who had more health challenges during pregnancy (e.g., gestational hypertension/diabetes) and labor/birth (e.g., emergency c-section) were more likely to be readmitted for mental health reasons during the postpartum period.   

“These geographic and racial disparities in postpartum readmissions highlight the need for greater efforts to deliver timely interventions to at-risk postpartum individuals,” Hung says. “It is well-documented that Black individuals face systemic barriers to preventive health care access and quality, and our results suggest that these barriers may result in delayed access to care and more postpartum readmissions.”

The authors believe that learning more about the protective factors that help certain groups could help avoid the need for hospital readmissions among vulnerable populations. In addition, these insights could inform targeted interventions universally.

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