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Diagnosis of Postpartum Depression and Timing and Types of Treatment Received Differ for Women with Private and Medicaid Coverage

  • Laura J. Sherman
    Correspondence
    Correspondence to: Laura J. Sherman, PhD, Substance Abuse and Mental Health Services Administration, Center for Behavioral Health Statistics and Quality, 5600 Fishers Lane, Rockville, MD 20852. Phone: +240-276-1766; fax: +301-480-8493.
    Affiliations
    Substance Abuse and Mental Health Services Administration, Center for Behavioral Health Statistics and Quality, Rockville, Maryland
    Search for articles by this author
  • Mir M. Ali
    Affiliations
    Substance Abuse and Mental Health Services Administration, Center for Behavioral Health Statistics and Quality, Rockville, Maryland
    Search for articles by this author
Published:October 09, 2018DOI:https://doi.org/10.1016/j.whi.2018.08.007

      Abstract

      Background

      Postpartum depression is underdiagnosed and undertreated. The purpose of this study was to describe the prevalence and timing of depression diagnoses and treatment use in the year after childbirth among women with private and Medicaid health insurance coverage.

      Methods

      Using two large claims databases (private employer-sponsored and multistate Medicaid), we identified women with a live birth in 2014. We calculated the percentage of women with a depression diagnosis in the year after giving birth and identified their mental health treatment use (antidepressant medication filled and/or psychotherapy). We calculated days to diagnosis, days to treatment initiation, and number of therapy sessions. Percentages were compared using Cohen's h measure of effect size between two independent proportions (h ≥ 0.20 are meaningful).

      Results

      After childbirth, 7% of privately insured women and 13% with Medicaid were newly diagnosed with depression (h = 0.22). Those with Medicaid were diagnosed earlier (median 43 days vs. 78 days for private), but treatment initiation occurred later (h = 0.38) and at a lower rate (54% with Medicaid received some treatment vs. 71% with private insurance, h = 0.35). Many women received medication without therapy (44% with Medicaid vs. 51% with private insurance). Therapy was used more commonly by private enrollees (20% vs. 10% of Medicaid; h = 0.28). Among those who received therapy, the median was three sessions.

      Conclusions

      Postpartum depression diagnosis was more prevalent among women with Medicaid coverage, yet the treatment gap was greater and initiation was later. These findings suggest that there is room for improvement when it comes to early intervention and treatment engagement.
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      Biography

      Laura J. Sherman, PhD, is a developmental psychologist and statistician, Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration. She conducts behavioral health services research and analytic studies related to issues affecting children, youth, and families.

      Biography

      Mir M. Ali, PhD, is a health economist in the Center for Behavioral Health Statistics and Quality at the Substance Abuse and Mental Health Services Administration. He has published extensively on issues of behavioral health and behavioral health policy.