title: Depressive symptoms and access to mental health care in women screened for postpartum depression who lose health insurance coverage after delivery: findings from the Translating Research into Practice for Postpartum Depression (TRIPPD) effectiveness study.
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.
  
  
  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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN.
authors.forename: William V
authors.initials: WV
authors.lastname: Bobo
authors.affiliation: Department of Research, Olmsted Medical Center, Rochester, MN.
authors.forename: Peter
authors.initials: P
authors.lastname: Wollan
authors.affiliation: Family Medicine Residency, St Joseph's Hospital, Maricopa County Clinic, Phoenix, AZ.
authors.forename: Greg
authors.initials: G
authors.lastname: Lewis
authors.affiliation: Department of Research, Olmsted Medical Center, Rochester, MN.
authors.forename: Susan
authors.initials: S
authors.lastname: Bertram
authors.affiliation: Department of Research, Olmsted Medical Center, Rochester, MN.
authors.forename: Margary J
authors.initials: MJ
authors.lastname: Kurland
authors.affiliation: Washington Health System, Washington, PA.
authors.forename: Kimberle
authors.initials: K
authors.lastname: Vore
authors.affiliation: Department of Research, Olmsted Medical Center, Rochester, MN. Electronic address: byawn@olmmed.org.
authors.forename: Barbara P
authors.initials: BP
authors.lastname: Yawn
mesh_terms: D000328:Adult; D019052:Depression, Postpartum / Q000175:diagnosis / Q000453:epidemiology* / Q000523:psychology / Q000628:therapy; D005260:Female; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006301:Health Services Needs and Demand / Q000706:statistics & numerical data; D006801:Humans; D019458:Insurance Coverage / Q000706:statistics & numerical data; D007348:Insurance, Health / Q000706:statistics & numerical data*; D017057:Medically Uninsured / Q000706:statistics & numerical data; D011247:Pregnancy; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D016896:Treatment Outcome