title: Pregnancy-related discontinuation of antidepressants and depression care visits among Medicaid recipients.
abstract: OBJECTIVE
  This study examined whether pregnancy is associated with discontinuation of care for depression among low-income women.
  
  
  METHODS
  Medicaid claims data from all 50 states were used in a matched cohort study design. The study included 3,237 women who gave birth between 1999 and 2000 and received depression treatment (antidepressant medications or a depression care visit) before initiating prenatal care. A control cohort of nonpregnant women receiving gynecologic care in the same period was matched by demographic and depression treatment characteristics.
  
  
  RESULTS
  Prepregnancy, the antidepressant use rate was 66%. During pregnancy, antidepressant use dropped to 27% in the pregnant cohort compared with 62% in the control group (rate ratio [RR] =.44, 95% confidence interval [CI]=.41-.46) and remained low postpartum compared with the control group (35% versus 48%, RR=.74, CI=.70-.78). Similarly, depression care visits during the pregnancy period were reduced to 31% among the pregnant cohort compared with 49% for the control group (RR=.65, CI=.61-.69) and remained lower postpartum relative to the control group (24% versus 31%, RR=.78, CI=.73-.85). Interactions with pregnancy status were found for race-ethnicity and receipt of cash assistance from Medicaid. White women in the pregnancy cohort had a greater reduction in depression care visits than nonwhite women during the pregnancy period but less reduction in antidepressant use postpartum relative to the control group. Cash assistance was associated with less discontinuation in depression care visits postpartum compared with the control group (p<.05).
  
  
  CONCLUSIONS
  Pregnancy was associated with discontinuation of any depression care among women receiving Medicaid; care did not resume postpartum. Race-ethnicity and Medicaid cash benefit status moderated this finding. Efforts are needed to mitigate these reductions.
authors.affiliation: Department of Family Medicine and Community Health, University of Pennsylvania School of Medicine, Philadelphia, PA 19104, USA. ian.bennett@uphs.upenn.edu
authors.forename: Ian M
authors.initials: IM
authors.lastname: Bennett
authors.forename: Steven C
authors.initials: SC
authors.lastname: Marcus
authors.forename: Steven C
authors.initials: SC
authors.lastname: Palmer
authors.forename: James C
authors.initials: JC
authors.lastname: Coyne
mesh_terms: D000293:Adolescent; D000328:Adult; D000928:Antidepressive Agents / Q000009:adverse effects / Q000627:therapeutic use*; D015331:Cohort Studies; D003865:Major Depressive Disorder / Q000188:drug therapy* / Q000453:epidemiology / Q000208:ethnology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007345:Insurance Claim Review; D008484:Medicaid / Q000706:statistics & numerical data*; D055118:Medication Adherence / Q000208:ethnology / Q000523:psychology; D009042:Motivation; D049590:Postpartum Period; D011203:Poverty / Q000706:statistics & numerical data*; D011247:Pregnancy; D011248:Pregnancy Complications / Q000188:drug therapy* / Q000208:ethnology / Q000523:psychology; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D014481:United States; D014600:Utilization Review / Q000706:statistics & numerical data; D055815:Young Adult; D016903:Drug Monitoring
chemical_list: D000928:Antidepressive Agents