Prenatal Psychosocial Needs: Differences Between a TennCare Group and a Privately Insured Group in Appalachia

Abstract

The purpose of this study was to determine the prenatal psychosocial needs of a group of women enrolled in TennCare, a Medicaid managed care program designed to cover all otherwise uninsured people in Tennessee, and compare them with privately insured women. Face-toface interviews were conducted using standard and reliable questionnaires with a convenience sample of 120 pregnant women between 14 and 44 years of age and 16 to 28 weeks gestation at three prenatal clinics in East Tennessee. Chi-square analysis revealed that the TennCare enrollees in East Tennessee were significantly more Hkely to report higher psychosocial needs in pregnancy than the privately insured group. Women enrolled in TennCare had a significantly higher incidence of physical abuse, depressive symptoms, and smoking than the privately insured group. Pregnancy provides a window of opportunity for assessing and intervening with vulnerable women enrolled in Medicaid managed care who report psychosocial problems.

Risk factors for depressive symptoms during pregnancy: a systematic review

“…Six studies compared insurance status in depressed and nondepressed pregnant women 29,30,34,50,57,58. Five of these studies specifically compared women with Medicaid vs women with private insurance in the United States.…”

“… ADS-K , Allgemeine Depressions Skala (German version of CESD); BDI , Beck Depression Inventory; CESD , Center for Epidemiological Studies Depression Scale; DACL , Depression Adjective Checklist; DEM , demographic factors (age, race, income, education, employment, insurance status, socioeconomic status); DEPS , the Depression Scale; DSSI , Delusions-Symptoms-States Inventory; DV , domestic violence; EPDS , Edinburgh Postnatal Depression Scale; HADS , Hospital Anxiety and Depression Scale; HSCL , Hopkins Symptom Checklist; MINI , Mini International Neuropsychiatric Interview; OB , obstetric factors (pregnancy intention, parity, obstetric history); PHQ , Patient Health Questionnaire; POMS , Profile of Mood States; PSY , psychiatric factors (history of depression, maternal anxiety); REL , relationship factors (cohabitation status, relationship quality); SADS , Schedule for Affective Disorders and Schizophrenia; SCID , Structural Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders; SS , social support; STR , life stress; SUB , substance abuse (tobacco, alcohol, illicit drugs). a SD not provided b Mean not provided (Holzman et al29: 56% aged 20-29 y), (Jesse et al57: 83% adult), (Jesse58: 83% ≥20 y), (Jesse et al30: 78% ≥20 y), (Larsson et al59 : 71% aged 25-34 y), (Najman et al61: 51% aged 19-25 y), (Orr and Miller63: all subjects ≥18 y), (Pascoe et al65: 48% aged 20-25 y), (Rubertsson68: 70% aged 25-35 y), (Smith et al40: 80% ≥20 y), (Zuckerman et al32: 49% aged 21-29 y), (Zuckerman et al74: 83% >18 y) c Median 27. Lancaster. Risk factors for depressive symptoms during pregnancy.…”

“… b Mean not provided (Holzman et al29: 56% aged 20-29 y), (Jesse et al57: 83% adult), (Jesse58: 83% ≥20 y), (Jesse et al30: 78% ≥20 y), (Larsson et al59 : 71% aged 25-34 y), (Najman et al61: 51% aged 19-25 y), (Orr and Miller63: all subjects ≥18 y), (Pascoe et al65: 48% aged 20-25 y), (Rubertsson68: 70% aged 25-35 y), (Smith et al40: 80% ≥20 y), (Zuckerman et al32: 49% aged 21-29 y), (Zuckerman et al74: 83% >18 y) …”

The prevalence and determinants of antepartum mental health problems among women in the USA: a nationally representative population-based study

“…Women who are younger (Borjesson et al 2005; Kearns et al 1997; Paarlberg et al 1996), African-American (Jesse and Swanson 2007; Orr et al 2006), in poor physical health (Marcus et al 2003), unemployed (Bolton et al 1998; Borjesson et al 2005; Marcus et al 2003), or having their first baby (Kearns et al 1997; Records and Rice 2007) may also be at greater a risk. In addition, women with limited or no social support (Demyttenaere et al 1995; Jesse and Swanson 2007; Kearns et al 1997; Lancaster et al 2010; Lee et al 2007; Leigh and Milgrom 2008; Rudnicki et al 2001; Seguin et al 1995; Westdahl et al 2007), low socioeconomic status (Bolton et al 1998; Holzman et al 2006; Kearns et al 1997; Marcus et al 2003), public insurance (Canady et al 2008; Jesse 2003; Jesse et al 2005; Kermode et al 2000; Lancaster et al 2010), poor coping skills or sense of control (Bernazzani et al 1997; Da Costa et al 2000; Demyttenaere et al 1995; Rudnicki et al 2001), low self-esteem (Jesse and Swanson 2007; Jesse et al 2005; Lee et al 2007; Leigh and Milgrom 2008; Ritter et al 2000), chronic stress (Jesse and Swanson 2007; Monk et al 2008; Mora et al 2009; Paarlberg et al 1996; Seguin et al 1995), alcohol or substance abuse problems (Marcus et al 2003; Mora et al 2009; Pajulo et al 2001), or a history of childhood or adult abuse (Benedict et al 1999; Holzman et al 2006; Jesse and Swanson 2007; Lancaster et al 2010; Leigh and Milgrom 2008; Nayak and Al-Yattama 1999) are more susceptible to having antepartum mental health problems. Pregnant women are also at an increased risk if they are unmarried (Bolton et al 1998; Marcus et al 2003; Orr et al 2006; Westdahl et al 2007), not living with a partner (Canady et al 2008; Hobfoll et al 1995; Lancaster et al 2010; Marcus et al 2003; Orr et al 2006; Rich-Edwards e...…”

PROYECTO MAMÁFELIZ: Estudio sobre la Salud Mental prenatal a través de Internet

“…En la revisión de Lancaster et al (2010), los autores proponen seis estudios que comparan la cobertura sanitaria en un grupo de mujeres embarazadas con depresión y sin depresión (Cooklin et al, 2007;Holzman et al, 2006;Jesse, 2003;Jesse, Seaver y Wallace, 2003;Jesse et al, 2005;Nicholson et al, 2006). Cinco de estos estudios, comparaban específicamente un grupo de mujeres de EEUU con seguro privado de salud y un grupo de mujeres bajo cobertura pública (Medicaid).…”