Factors associated with mental health treatment among Michigan medicaid enrollees with perinatal mood and anxiety disorders, 2012-2015.

Hall SV, Zivin K, Piatt GA, Weaver A, Tilea A, Zhang X, Moyer CA. Factors associated with mental health treatment among Michigan medicaid enrollees with perinatal mood and anxiety disorders, 2012-2015. General hospital psychiatry. 2023 May 16; 83:164-171.

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Abstract:

OBJECTIVE: Perinatal mood and anxiety disorders (PMADs) represent the most prevalent pregnancy-related comorbidity and a leading cause of maternal mortality. Effective treatments exist, but remain underutilized. We sought to identify factors associated with receipt of prenatal and postpartum mental health treatment. METHODS: This observational, cross-sectional analysis used self-reported survey data from the Michigan Pregnancy Risk Assessment Monitoring System linked to Michigan Medicaid administrative claims for births from 2012 to 2015. We used survey-weighted multinomial logistic regression to predict prescription medication and psychotherapy utilization among respondents with PMADs. RESULTS: Only 28.0% of respondents with prenatal PMAD and 17.9% of respondents with postpartum PMAD received both prescription medication and psychotherapy. During pregnancy, Black respondents were 0.33 (95%CI: 0.13-0.85, p  =  0.022) times less likely to receive both treatments while more comorbidities were associated with receipt of both treatments (adjRR  =  1.31, 95%CI: 1.02-1.70, p  =  0.036). In the first three months postpartum, respondents with four or more stressors were 6.52 times more likely to receive both treatments (95%CI: 1.62-26.24, p  =  0.008) and those satisfied with prenatal care were 16.25 times more likely to receive both treatments (95%CI: 3.35-78.85, p  =  0.001). DISCUSSION: Race, comorbidities, and stress are critical factors in PMAD treatment. Satisfaction with perinatal healthcare may facilitate access to care.