Predictors of adequate depression treatment among Medicaid-enrolled youth

Abstract

While the majority of youth appear to be receiving minimally adequate acute care for depression, a substantial number are not. Given current child mental health workforce constraints, efforts to substantially improve the provision of adequate care to depressed youth are likely to require both quality improvement and system redesign efforts.

Racial and Ethnic Differences in Minimally Adequate Depression Care Among Medicaid-Enrolled Youth

“…Notably, the relative size of the disparity was larger for minimally adequate pharmacotherapy than for minimally adequate psychotherapy. This pattern of findings is similar to prior research, 17 which compared adequate treatment between non-white and white Medicaid-enrolled youth in an urban county. The residual disparities can be explained by unmeasured racial/ethnic differences in attitudinal barriers, such as stigma concerning depression and its treatment, or unmeasured systems-level barriers, such as patient-provider language concordance or provider cultural competency.…”

“…AACAP guidelines recommend that 4 to 6 weeks of supportive therapy (in uncomplicated or brief cases of depression) or 6 to 8 weeks of other types of psychotherapy (eg, cognitive behavioral therapy) are needed to assess responsiveness to treatment. 8 Consistent with the work of Stein et al, 17 we used a 4-visit threshold for the main analyses to capture the lower bound of this recommendation (assuming 1 visit per week over 4 weeks). We also created an alternative measure using an 8-visit threshold in supplemental analyses.…”

“…We also created an indicator for the receipt of minimally adequate pharmacotherapy in the acute phase of treatment, defined as filling antidepressant medication prescription(s) for 84 days (ie, 12 weeks) of the 144 days after the index date (Table S2, available online; Figure 1). This measure follows the strategy used by Stein et al, 17 which modified the Healthcare Effectiveness Data and Information Set (HEDIS) measure of acute antidepressant medication treatment (ie, filled antidepressant medication for 84 of the first 114 days of treatment). 19 The 114-day treatment period in the HEDIS allows for up to 30 days for gaps in medication refills or for washout periods when switching medications.…”

“…We defined the index visit as the first outpatient visit or inpatient stay with a primary diagnosis of major depression after a 90-day exclusion period during which there was no health care encounter with a major depression diagnosis or antidepressant medication that was filled. 16,17 We excluded those who were not continuously enrolled in Medicaid during the 90-day exclusion and 144-day treatment periods (n ¼ 6,181), had dual Medicare eligibility (n ¼ 23), had inaccurate or multiple county codes (n ¼ 636), and/or had a missing value on sex (n ¼ 1). Our final cohort consisted of 45,816 Medicaid-enrolled youth diagnosed with a new episode of major depression across 9 states.…”

A Longitudinal Study of Health Care Resources, Family Support, and Mental Health Outcomes Among Suicidal Adolescents

“…Studies have found that Medicaid recipients are at higher risk for major mental health diagnoses and substance use disorders when compared to national averages (Adelmann, 2003) and that youth with Medicaid are more likely to meet criteria for a Severe Emotional Disturbance (SED) than youth with private insurance (Mark & Buck, 2006). Additionally, many children with public insurance do not receive adequate access to quality care (Semansky, Koyanagi, & Huffine, 2004;Stein et al, 2013). For suicidal youth, barriers to quality care may prevent them from receiving treatment that adequately addresses their mental health needs.…”