Abstract
Objective
To determine the impact of losing health insurance coverage on perceived need for
and access to mental health care in women screened for postpartum depression (PPD)
in primary care settings.
Patients and Methods
The study sample included 2343 women enrolled in a 12-month, multisite, randomized
trial that compared clinical outcomes of a comprehensive PPD screening and management
program with usual care (March 1, 2006, through August 31, 2010). Screening for PPD
occurred at the first postpartum visit (5-12 weeks) using the Edinburgh Postnatal
Depression Scale followed by the 9-item Patient Health Questionnaire. Insurance status
during the prenatal period, at delivery, and during the first postpartum year and
perceived need for and access to mental health care during the first postpartum year
were assessed via questionnaires completed by individual patients and participating
practices.
Results
Rates of uninsured increased from 3.8% during pregnancy and delivery (n=87 of 2317)
to 10.8% at the first postpartum visit (n=253 of 2343) and 13.7% at any subsequent
visit to the practice after 2 months post partum (n=226 of 1646) (P<.001, both comparisons vs baseline). For patients with data on insurance type during
follow-up, insurance loss occurred primarily in Medicaid beneficiaries. Nine-item
Patient Health Questionnaire scores and self-reported need for mental health care
did not differ significantly between patients who remained insured and those who lost
insurance during the first postpartum year. However, of patients who reported the
need for mental health care, 61.1% of the uninsured (n=66 of 108) vs 27.1% of the
insured (n=49 of 181) reported an inability to obtain mental health care (P<.001).
Conclusion
Loss of insurance during the first postpartum year did not significantly affect depressive
symptoms or perceived need for mental health care but did adversely affect self-reported
ability to obtain mental health care.
Abbreviations and Acronyms:
EPDS (Edinburgh Postnatal Depression Scale), IOM (Institute of Medicine), OR (odds ratio), PHQ-9 (9-item Patient Health Questionnaire), PPD (postpartum depression), TRIPPD (Translating Research Into Practice for Postpartum Depression study), TRIPPD-UP (Translating Research Into Practice for Postpartum Depression for Underinsured/Uninsured Patients)To read this article in full you will need to make a payment
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Article Info
Publication History
Published online: August 01, 2014
Footnotes
Grant Support: This study was supported by Agency for Healthcare Research and Quality grant R01 HS40471 (B.P.Y.) and by National Institute of Mental Health grant K23 MH087747 (W.V.B.).
Identification
Copyright
© 2014 Mayo Foundation for Medical Education and Research. Published by Elsevier Inc. All rights reserved.
