Utilization of Mental Health Services by Low-Income Pregnant and Postpartum Women on Medical Assistance

Abstract

This paper examines mental health service use among publicly insured white and African-American pregnant and postpartum women who live in a metropolitan area. The study examines the extent to which ethnicity, physical health problems, and behavioral health risk factors are associated with the probability of service use during the prenatal-postpartum period. It also analyzes the patterns of service utilization for those women who used mental health services.Medicaid claims and eligibility data, County Reporting System claims and admissions data, and Pennsylvania State Vital Birth Records were integrated using a unique algorithm. Logistic regression was employed to estimate the probability of mental health service use among 3,841 low-income women residing in Philadelphia who were continuously enrolled in Medicaid for 9 months preceding delivery and 6 months postpartum. Analyses were also conducted on the intensity and location of service use, as well as psychiatric diagnosis, during pregnancy and the postpartum period.About 10% of the women used mental health services during the study period. Women were more likely to use services if they were Caucasian, had a number of chronic diseases, had a number of pregnancy complications, and smoked. Among users, the same proportion (ca. 6%) used services during pregnancy and postpartum, with the average number of outpatient visits slightly higher during pregnancy than during the postpartum period. Most outpatient services (86%) were delivered in the specialty sector. Most women who used mental health services (84%) were diagnosed with minor psychiatric disorders including minor depression and anxiety disorders. Women who used services during the postpartum only were more likely to be diagnosed with major depression, whereas women who used services throughout the perinatal period were more likely to be diagnosed with severe mental disorders. Health providers can use information generated in this study to identify women who are likely to have a need for mental health services. ABSTRACT. This paper examines mental health service use among publicly insured white and African-American pregnant and postpartum women who live in a metropolitan area. The study examines the extent to which ethnicity, physical health problems, and behavioral health risk factors are associated with the probability of service use during the prenatal-postpartum period. It also analyzes the patterns of service utilization for those women who used mental health services. Comments Reprinted fromMedicaid claims and eligibility data, County Reporting System claims and admissions data, and Pennsylvania State Vital Birth Records were integrated using a unique algorithm. Logistic regression was employed to estimate the probability of mental health service use among 3,841 low-income women residing in Philadelphia who were continuously enrolled in Medicaid for 9 months preceding delivery and 6 months postpartum. Analyses were also conducted on the intensity and location of service use, as well as psychiatri...

Pregnant African American women's attitudes toward perinatal depression prevention.

“…Second, low income African American women are even less likely than low income White women to seek treatment for perinatal depression (Song, Sands, & Wong, 2004) and thus, may also be less likely to take advantage of preventive interventions. Among women receiving Medicaid, African American women were about half as likely as White women to use mental health services during pregnancy or the first six months postpartum, even after controlling for other demographic variables (e.g., age and number of children), physical health problems, and behavioral health risk factors (e.g., smoking; Song et al, 2004). Importantly, having sought help for depression during pregnancy was the strongest predictor of seeking help for postpartum depression, suggesting the imporiance of intervening in pregnancy (McGarry, Kim, Sheng, Egger, & Baksh, 2009).…”

Racial and Ethnic Disparities in Postpartum Depression Care Among Low-Income Women

“…These differences represent stark racial-ethnic disparities potentially related to outreach, detection, service provision, quality, and processes of postpartum mental health care. Although suboptimal detection and treatment rates are not uncommon for this condition or in this population (7,42,43), these results emphasize that postpartum depression remains an underrecognized and undertreated condition for all low-income women, especially for those from racial and ethnic minority groups.…”

A Pilot Study to Reduce Risk for Antepartum Depression Among Women in A Public Health Prenatal Clinic

“…Although these women would probably benefit from early intervention, few receive treatment (Song, Sands, & Wong, 2004). Cognitive behavioral interventions (CBIs) are brief interventions that focus on the present, and specific skills are taught that can reduce risk of depression, even after treatment is completed (Hollon et al, 2005).…”