Pregnancy-Related Discontinuation of Antidepressants and Depression Care Visits Among Medicaid Recipients

Department of Family Medicine and Community Health, University of Pennsylvania School of Medicine, Philadelphia, PA 19104, USA.
Psychiatric services (Washington, D.C.) (Impact Factor: 2.41). 04/2010; 61(4):386-91. DOI: 10.1176/
Source: PubMed


This study examined whether pregnancy is associated with discontinuation of care for depression among low-income women.
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.
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).
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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    • "Some limitations of the MAX cohort are common to other pregnancy cohorts assembled from healthcare utilization data, such as the exclusion of pregnancies ending in miscarriage [9]–[18], [25] and the reliance on algorithms to estimate the date of the LMP [11], [14]–[16], [18], [25]. Furthermore, validity of mother-infant linkage by subscriber or family number is not typically reported. "
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    ABSTRACT: In the absence of clinical trial data, large post-marketing observational studies are essential to evaluate the safety and effectiveness of medications during pregnancy. We identified a cohort of pregnancies ending in live birth within the 2000-2007 Medicaid Analytic eXtract (MAX). Herein, we provide a blueprint to guide investigators who wish to create similar cohorts from healthcare utilization data and we describe the limitations in detail. Among females ages 12-55, we identified pregnancies using delivery-related codes from healthcare utilization claims. We linked women with pregnancies to their offspring by state, Medicaid Case Number (family identifier) and delivery/birth dates. Then we removed inaccurate linkages and duplicate records and implemented cohort eligibility criteria (i.e., continuous and appropriate enrollment type, no private insurance, no restricted benefits) for claim information completeness. From 13,460,273 deliveries and 22,408,810 child observations, 6,107,572 pregnancies ending in live birth were available after linkage, cleaning, and removal of duplicate records. The percentage of linked deliveries varied greatly by state, from 0 to 96%. The cohort size was reduced to 1,248,875 pregnancies after requiring maternal eligibility criteria throughout pregnancy and to 1,173,280 pregnancies after further applying infant eligibility criteria. Ninety-one percent of women were dispensed at least one medication during pregnancy. Mother-infant linkage is feasible and yields a large pregnancy cohort, although the size decreases with increasing eligibility requirements. MAX is a useful resource for studying medications in pregnancy and a spectrum of maternal and infant outcomes within the indigent population of women and their infants enrolled in Medicaid. It may also be used to study maternal characteristics, the impact of Medicaid policy, and healthcare utilization during pregnancy. However, careful attention to the limitations of these data is necessary to reduce biases.
    PLoS ONE 06/2013; 8(6):e67405. DOI:10.1371/journal.pone.0067405 · 3.23 Impact Factor
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    Current opinion in psychiatry 11/2010; 24(1):34-40. DOI:10.1097/YCO.0b013e3283413451 · 3.94 Impact Factor
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    ABSTRACT: The goal of this study was to characterize racial-ethnic differences in mental health care utilization associated with postpartum depression in a multiethnic cohort of Medicaid recipients. In a retrospective cohort study, administrative claims data from New Jersey's Medicaid program were obtained for 29,601 women (13,001 whites, 13,416 blacks, and 3,184 Latinas) who delivered babies between July 2004 and October 2007. Racial-ethnic differences were estimated with logistic regression for initiation of antidepressant medication or outpatient mental health visits within six months of delivery, follow-up (a prescription refill or second visit), and continued mental health care (at least three visits or three filled antidepressant prescriptions within 120 days). Nine percent (N=1,120) of white women initiated postpartum mental health care, compared with 4% (N=568) of black women and 5% (N=162) of Latinas. With analyses controlling for clinical factors, the odds of initiating treatment after delivery were significantly (p<.001) lower for blacks (adjusted odds ratio [AOR]=.43) and Latinas (AOR=.59) compared with whites. Among those who initiated treatment, blacks and Latinas were less likely than whites to receive follow-up treatment (blacks, AOR=.66, p<.001; Latinas, AOR=.67, p<.05) or continued care (blacks, AOR=.81, p=.069; Latinas, AOR=.67, p<.05). Among those who initiated antidepressant treatment, black women and Latinas were less likely than whites to refill a prescription. There were significant racial-ethnic differences in depression-related mental health care after delivery. Suboptimal treatment was prevalent among all low-income women in the study. However, racial and ethnic disparities in the initiation and continuation of postpartum depression care were particularly troubling and warrant clinical and policy attention.
    Psychiatric services (Washington, D.C.) 06/2011; 62(6):619-25. DOI:10.1176/ · 2.41 Impact Factor
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