| Pregnancy-related discontinuation of antidepressants and depression care visits among Medicaid recipients. | |
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MedLine Citation:
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PMID: 20360278 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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OBJECTIVE: This study examined whether pregnancy is associated with discontinuation of care for depression among low-income women. METHODS: Medicaid claims data from all 50 states were used in a matched cohort study design. The study included 3,237 women who gave birth between 1999 and 2000 and received depression treatment (antidepressant medications or a depression care visit) before initiating prenatal care. A control cohort of nonpregnant women receiving gynecologic care in the same period was matched by demographic and depression treatment characteristics. RESULTS: Prepregnancy, the antidepressant use rate was 66%. During pregnancy, antidepressant use dropped to 27% in the pregnant cohort compared with 62% in the control group (rate ratio [RR] =.44, 95% confidence interval [CI]=.41-.46) and remained low postpartum compared with the control group (35% versus 48%, RR=.74, CI=.70-.78). Similarly, depression care visits during the pregnancy period were reduced to 31% among the pregnant cohort compared with 49% for the control group (RR=.65, CI=.61-.69) and remained lower postpartum relative to the control group (24% versus 31%, RR=.78, CI=.73-.85). Interactions with pregnancy status were found for race-ethnicity and receipt of cash assistance from Medicaid. White women in the pregnancy cohort had a greater reduction in depression care visits than nonwhite women during the pregnancy period but less reduction in antidepressant use postpartum relative to the control group. Cash assistance was associated with less discontinuation in depression care visits postpartum compared with the control group (p<.05). CONCLUSIONS: Pregnancy was associated with discontinuation of any depression care among women receiving Medicaid; care did not resume postpartum. Race-ethnicity and Medicaid cash benefit status moderated this finding. Efforts are needed to mitigate these reductions. |
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Authors:
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Ian M Bennett; Steven C Marcus; Steven C Palmer; James C Coyne |
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Publication Detail:
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Type: Journal Article; Research Support, N.I.H., Extramural |
Journal Detail:
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Title: Psychiatric services (Washington, D.C.) Volume: 61 ISSN: 1557-9700 ISO Abbreviation: Psychiatr Serv Publication Date: 2010 Apr |
Date Detail:
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Created Date: 2010-04-02 Completed Date: 2010-06-30 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 9502838 Medline TA: Psychiatr Serv Country: United States |
Other Details:
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Languages: eng Pagination: 386-91 Citation Subset: IM |
Affiliation:
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Department of Family Medicine and Community Health, University of Pennsylvania School of Medicine, Philadelphia, PA 19104, USA. ian.bennett@uphs.upenn.edu |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Adolescent Adult Antidepressive Agents / adverse effects, therapeutic use* Cohort Studies Depressive Disorder, Major / drug therapy*, epidemiology, ethnology Female Follow-Up Studies Humans Insurance Claim Review Medicaid / utilization* Medication Adherence / ethnology, psychology, statistics & numerical data* Motivation Postpartum Period Poverty / statistics & numerical data* Pregnancy Pregnancy Complications / drug therapy*, ethnology, psychology Referral and Consultation / utilization* United States Utilization Review / statistics & numerical data Young Adult |
| Grant Support | |
ID/Acronym/Agency:
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1K23-HD048915-01A2/HD/NICHD NIH HHS; 1R03-MH074750-01/MH/NIMH NIH HHS; 5R01-MH061992/MH/NIMH NIH HHS |
| Chemical | |
Reg. No./Substance:
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0/Antidepressive Agents |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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