Antidepressant Adequacy and Work Status Among Medicaid Enrollees with Disabilities: A Restriction-based, Propensity Score-adjusted Analysis

Abstract

This cross-sectional study of adult survey respondents with disability and depression (n = 199) enrolled in Massachusetts' Medicaid program examined the association of adequately or inadequately prescribed antidepressant treatment and self-reported work status using conditional logistic regression, controlling for age, gender, race, marital status, education, receipt of SSI/SSDI, self-reported disabling condition, and health status. Confounding by severity was addressed by two methods: restriction of our sample and subsequent stratification by propensity score. Individuals receiving adequate antidepressant treatment had an increased odds of working compared to individuals receiving inadequate treatment, both in analyses in which restriction was used to limit confounding (OR = 3.45, 95% CI = 1.15-10.32, P < .03), and in analyses which combined restriction with adjustment by propensity score stratification (OR = 3.04, 95% CI = 1.01-9.62, P < .05). Among this sample of Medicaid enrollees with disability and depression, those receiving adequate antidepressant treatment were significantly more likely to report working.

Low mood and employment: When affective disorders are intertwined with the workplace–A UK perspective

“…Similar findings were reported by Burton, Chen, Conti, Schultz, and Edington (2007) who found that adherence to antidepressant medication was associated with a decreased likelihood of filing short-term disability claims. Simon et al (2001) and Smith, Henry, Zhang, Hooven, and Banks (2009) confirmed these findings. Such data could make a useful basis for developing and evaluating programmes.…”

A systematic review of validated methods for identifying depression using administrative data

“…The heterogeneity of the algorithms across the studies constrains strict comparisons. For example, the study that defined depression on the basis of at least two outpatient or one inpatient codes for depression (296.2, 296.3, 300.4, and 311) in a 12‐month period likely included a narrower patient population than did the study that required only a single depression claim (296.2, 296.3, and 311) …”

“…Five studies focused exclusively on populations with specific conditions including diabetes, asthma, and disability . Of the other six studies, two were limited to patients who had received inpatient treatment, and one was limited to veterans and focused on new onsets of depression .…”

Adherence and healthcare utilization among older adults with COPD and depression

“…These codes have been used previously and exclude bipolar disorder, schizoaffective disorder, and dysthymic disorder. 8,11,22,26–28 Presence of depression was defined as at least one diagnosis code on at least 1 inpatient claim or 2 outpatient claims during the study period. To be included in our study cohort, we required a diagnosis of depression at least once following initial COPD diagnosis.…”