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Predictors of adequate depression treatment among Medicaid-enrolled youth

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Social Psychiatry and Psychiatric Epidemiology Aims and scope Submit manuscript

Abstract

Purpose

To determine if Medicaid-enrolled youth with depressive symptoms receive adequate acute treatment, and to identify the characteristics of those receiving inadequate treatment.

Methods

We used administrative claims data from a Medicaid-enrolled population in a large urban community to identify youth aged 6–24 years who started a new episode of treatment for a depressive disorder between August 2006 and February 2010. We examined rates and predictors of minimally adequate psychotherapy (four visits in first 12 weeks) and pharmacotherapy (filled antidepressant prescription for 84 of the first 144 days) among youth with a new treatment episode during the study period (n = 930).

Results

Fifty-nine percent of depressed youth received minimally adequate psychotherapy, but 13 % received minimally adequate pharmacotherapy. Youth who began their treatment episode with an inpatient psychiatric stay for depression and racial minorities were significantly less likely to receive minimally adequate pharmacotherapy and significantly more likely to receive inadequate overall treatment.

Conclusions

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.

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Acknowledgments

The authors are indebted to Kim Falk and Allegheny County Department of Human Services for their support of this project, and to Amanda Ayers for assistance with manuscript preparation. This work was supported in part by Ortho Macneil Janssen Scientific Affairs.

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Authors and Affiliations

  1. Community Care Behavioral Health Organization, Pittsburgh, USA

    Bradley D. Stein, Mark J. Sorbero, Amanda M. Ayers & Jane N. Kogan

  2. RAND Corporation, Pittsburgh, USA

    Bradley D. Stein & Carrie Farmer

  3. Department of Psychiatry, University of Pittsburgh, Pittsburgh, USA

    Bradley D. Stein, Jane N. Kogan & Upasna Goswami

  4. Allegheny County Department of Human Services, Pittsburgh, USA

    Erin Dalton

  5. UPMC Center for High-Value Health Care, Pittsburgh, Pennsylvania, USA

    Jane N. Kogan

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  1. Bradley D. Stein
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  2. Mark J. Sorbero
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  3. Erin Dalton
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  4. Amanda M. Ayers
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  5. Carrie Farmer
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  6. Jane N. Kogan
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  7. Upasna Goswami
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Correspondence to Bradley D. Stein.

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Stein, B.D., Sorbero, M.J., Dalton, E. et al. Predictors of adequate depression treatment among Medicaid-enrolled youth. Soc Psychiatry Psychiatr Epidemiol 48, 757–765 (2013). https://doi.org/10.1007/s00127-012-0593-7

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  • DOI: https://doi.org/10.1007/s00127-012-0593-7

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