title: Baseline Insurance Status and Risk of Common Mental Disorders: A Propensity-Based Analysis of a Longitudinal U.S. Sample.
abstract: OBJECTIVE
  Because of pervasive poor general medical and mental health status among patients receiving Medicaid, there has been substantial debate about whether Medicaid, as currently financed and delivered, is better than no insurance. The study aimed to address whether insurance status is associated with the subsequent incidence and persistence of common mental disorders.
  
  
  METHODS
  Data came from a nationally representative U.S. population-based longitudinal survey that assessed mental disorders at two time points three years apart. Propensity score methods were used to adjust for potential confounding and to assess the association between three mutually exclusive insurance status groups (no insurance, private insurance only, and Medicaid only) and the subsequent incidence and persistence of mood, anxiety, and substance use disorders for persons ages 18-65 (N=26,410).
  
  
  RESULTS
  Compared with private insurance, lack of insurance was associated with higher odds of both the incidence and persistence of substance use disorders and with higher odds of persistence of any mood or anxiety disorder. Compared with having private insurance, having Medicaid insurance was associated with increased odds of persistent mood and anxiety disorders during follow-up. Overall, findings did not significantly differ between the uninsured and Medicaid groups.
  
  
  CONCLUSIONS
  The findings do not support prior reports that U.S. adults with Medicaid have worse mental health outcomes than uninsured adults. Lacking insurance may put individuals at higher risk of developing substance use disorders, and uninsured individuals with preexisting mental conditions were more likely to have mood, anxiety, and substance use problems that persist over time.
authors.affiliation: Dr. Sareen and Dr. Bolton are with the Department of Psychiatry, Ms. Wang and Ms. Henriksen are with the Department of Psychology, Dr. Mota is with the Department of Clinical Health Psychology, and Dr. Lix and Dr. Afifi are with the Department of Community Health Sciences, all at the University of Manitoba, Winnipeg, Manitoba, Canada. Dr. Mojtabai is with the Department of Mental Health, Johns Hopkins School of Public Health, Dr. Bienvenu is with the Department of Psychiatry and Behavioral Sciences, and Dr. Crum is with the Department of Epidemiology, Johns Hopkins University, Baltimore. Send correspondence to Dr. Sareen (e-mail: sareen@cc.umanitoba.ca ).
authors.forename: Jitender
authors.initials: J
authors.lastname: Sareen
authors.affiliation: Dr. Sareen and Dr. Bolton are with the Department of Psychiatry, Ms. Wang and Ms. Henriksen are with the Department of Psychology, Dr. Mota is with the Department of Clinical Health Psychology, and Dr. Lix and Dr. Afifi are with the Department of Community Health Sciences, all at the University of Manitoba, Winnipeg, Manitoba, Canada. Dr. Mojtabai is with the Department of Mental Health, Johns Hopkins School of Public Health, Dr. Bienvenu is with the Department of Psychiatry and Behavioral Sciences, and Dr. Crum is with the Department of Epidemiology, Johns Hopkins University, Baltimore. Send correspondence to Dr. Sareen (e-mail: sareen@cc.umanitoba.ca ).
authors.forename: Yunqiao
authors.initials: Y
authors.lastname: Wang
authors.affiliation: Dr. Sareen and Dr. Bolton are with the Department of Psychiatry, Ms. Wang and Ms. Henriksen are with the Department of Psychology, Dr. Mota is with the Department of Clinical Health Psychology, and Dr. Lix and Dr. Afifi are with the Department of Community Health Sciences, all at the University of Manitoba, Winnipeg, Manitoba, Canada. Dr. Mojtabai is with the Department of Mental Health, Johns Hopkins School of Public Health, Dr. Bienvenu is with the Department of Psychiatry and Behavioral Sciences, and Dr. Crum is with the Department of Epidemiology, Johns Hopkins University, Baltimore. Send correspondence to Dr. Sareen (e-mail: sareen@cc.umanitoba.ca ).
authors.forename: Natalie
authors.initials: N
authors.lastname: Mota
authors.affiliation: Dr. Sareen and Dr. Bolton are with the Department of Psychiatry, Ms. Wang and Ms. Henriksen are with the Department of Psychology, Dr. Mota is with the Department of Clinical Health Psychology, and Dr. Lix and Dr. Afifi are with the Department of Community Health Sciences, all at the University of Manitoba, Winnipeg, Manitoba, Canada. Dr. Mojtabai is with the Department of Mental Health, Johns Hopkins School of Public Health, Dr. Bienvenu is with the Department of Psychiatry and Behavioral Sciences, and Dr. Crum is with the Department of Epidemiology, Johns Hopkins University, Baltimore. Send correspondence to Dr. Sareen (e-mail: sareen@cc.umanitoba.ca ).
authors.forename: Christine A
authors.initials: CA
authors.lastname: Henriksen
authors.affiliation: Dr. Sareen and Dr. Bolton are with the Department of Psychiatry, Ms. Wang and Ms. Henriksen are with the Department of Psychology, Dr. Mota is with the Department of Clinical Health Psychology, and Dr. Lix and Dr. Afifi are with the Department of Community Health Sciences, all at the University of Manitoba, Winnipeg, Manitoba, Canada. Dr. Mojtabai is with the Department of Mental Health, Johns Hopkins School of Public Health, Dr. Bienvenu is with the Department of Psychiatry and Behavioral Sciences, and Dr. Crum is with the Department of Epidemiology, Johns Hopkins University, Baltimore. Send correspondence to Dr. Sareen (e-mail: sareen@cc.umanitoba.ca ).
authors.forename: James
authors.initials: J
authors.lastname: Bolton
authors.affiliation: Dr. Sareen and Dr. Bolton are with the Department of Psychiatry, Ms. Wang and Ms. Henriksen are with the Department of Psychology, Dr. Mota is with the Department of Clinical Health Psychology, and Dr. Lix and Dr. Afifi are with the Department of Community Health Sciences, all at the University of Manitoba, Winnipeg, Manitoba, Canada. Dr. Mojtabai is with the Department of Mental Health, Johns Hopkins School of Public Health, Dr. Bienvenu is with the Department of Psychiatry and Behavioral Sciences, and Dr. Crum is with the Department of Epidemiology, Johns Hopkins University, Baltimore. Send correspondence to Dr. Sareen (e-mail: sareen@cc.umanitoba.ca ).
authors.forename: Lisa M
authors.initials: LM
authors.lastname: Lix
authors.affiliation: Dr. Sareen and Dr. Bolton are with the Department of Psychiatry, Ms. Wang and Ms. Henriksen are with the Department of Psychology, Dr. Mota is with the Department of Clinical Health Psychology, and Dr. Lix and Dr. Afifi are with the Department of Community Health Sciences, all at the University of Manitoba, Winnipeg, Manitoba, Canada. Dr. Mojtabai is with the Department of Mental Health, Johns Hopkins School of Public Health, Dr. Bienvenu is with the Department of Psychiatry and Behavioral Sciences, and Dr. Crum is with the Department of Epidemiology, Johns Hopkins University, Baltimore. Send correspondence to Dr. Sareen (e-mail: sareen@cc.umanitoba.ca ).
authors.forename: Ramin
authors.initials: R
authors.lastname: Mojtabai
authors.affiliation: Dr. Sareen and Dr. Bolton are with the Department of Psychiatry, Ms. Wang and Ms. Henriksen are with the Department of Psychology, Dr. Mota is with the Department of Clinical Health Psychology, and Dr. Lix and Dr. Afifi are with the Department of Community Health Sciences, all at the University of Manitoba, Winnipeg, Manitoba, Canada. Dr. Mojtabai is with the Department of Mental Health, Johns Hopkins School of Public Health, Dr. Bienvenu is with the Department of Psychiatry and Behavioral Sciences, and Dr. Crum is with the Department of Epidemiology, Johns Hopkins University, Baltimore. Send correspondence to Dr. Sareen (e-mail: sareen@cc.umanitoba.ca ).
authors.forename: O Joseph
authors.initials: OJ
authors.lastname: Bienvenu
authors.affiliation: Dr. Sareen and Dr. Bolton are with the Department of Psychiatry, Ms. Wang and Ms. Henriksen are with the Department of Psychology, Dr. Mota is with the Department of Clinical Health Psychology, and Dr. Lix and Dr. Afifi are with the Department of Community Health Sciences, all at the University of Manitoba, Winnipeg, Manitoba, Canada. Dr. Mojtabai is with the Department of Mental Health, Johns Hopkins School of Public Health, Dr. Bienvenu is with the Department of Psychiatry and Behavioral Sciences, and Dr. Crum is with the Department of Epidemiology, Johns Hopkins University, Baltimore. Send correspondence to Dr. Sareen (e-mail: sareen@cc.umanitoba.ca ).
authors.forename: Rosa M
authors.initials: RM
authors.lastname: Crum
authors.affiliation: Dr. Sareen and Dr. Bolton are with the Department of Psychiatry, Ms. Wang and Ms. Henriksen are with the Department of Psychology, Dr. Mota is with the Department of Clinical Health Psychology, and Dr. Lix and Dr. Afifi are with the Department of Community Health Sciences, all at the University of Manitoba, Winnipeg, Manitoba, Canada. Dr. Mojtabai is with the Department of Mental Health, Johns Hopkins School of Public Health, Dr. Bienvenu is with the Department of Psychiatry and Behavioral Sciences, and Dr. Crum is with the Department of Epidemiology, Johns Hopkins University, Baltimore. Send correspondence to Dr. Sareen (e-mail: sareen@cc.umanitoba.ca ).
authors.forename: Tracie O
authors.initials: TO
authors.lastname: Afifi
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001008:Anxiety Disorders / Q000453:epidemiology*; D005260:Female; D006801:Humans; D015994:Incidence; D019458:Insurance Coverage / Q000706:statistics & numerical data*; D007358:Insurance, Psychiatric / Q000706:statistics & numerical data; D008137:Longitudinal Studies; D008297:Male; D008484:Medicaid / Q000706:statistics & numerical data*; D017057:Medically Uninsured / Q000706:statistics & numerical data*; D008605:Mental Health Services; D008875:Middle Aged; D058991:Patient Protection and Affordable Care Act / Q000331:legislation & jurisprudence; D057216:Propensity Score; D019966:Substance-Related Disorders / Q000453:epidemiology*; D014481:United States / Q000453:epidemiology; D055815:Young Adult