Janet Currie Publications

Objective

To examine a 2018 rule change allowing pediatric providers to bill the child’s Medicaid ID for post-partum depression (PPD) screening of mothers conducted during well-child visits, and document its relationship with PPD treatment and infant hospitalizations.

Study setting and design

Screening rates during well-child visits are calculated at the zip code level and used in linear probability and Instrumental Variable (IV) models to examine increases in screening after the policy change and relate them to PPD treatment and infant hospitalizations.

Data sources and analytic sample

Individual-level Medicaid claims were used to compute PPD screening rates and measures of PPD treatment and infant hospitalization.

Principal findings

The policy was associated with increases in screening rates, although take up was uneven and overall screening rates remained low at 8.8%. There was little overall increase in treatment, although in zip codes in the top third of screening rates, higher screening was associated with 10.1% higher probability of maternal treatment. Zip codes with high fractions in poverty and/or minority had low screening rates, but screening was more likely to be associated with increases in treatment in these areas. There are no effects in the full sample of children, but among children above the poverty line, the observed increases in screening reduced the probability of infant hospitalization in the first six months by 7.7%.

Conclusions

The policy change had only limited success increasing screening, but increased screening could lead to more maternal PPD treatment and lower infant hospitalization rates if accompanied by expanded access to PPD treatment.

The child mental health crisis has been described as the "defining public health crisis of our time." This article addresses three myths about the crisis: (i) the idea that the crisis is new; (ii) the belief that increases in youth suicide mainly reflect deterioration in children's underlying mental health; and (iii) the myth that investments in children have little impact on children's mental health. In fact, the crisis has existed for decades, youth suicides vary asynchronously with other mental health measures and are impacted by external factors such as firearms legislation, and investments can improve child mental health and prevent suicide.

Many mental health disorders start in adolescence and appropriate initial treatment may improve trajectories. But what is appropriate treatment? We use a large national database of insurance claims to examine the impact of initial mental health treatment on the outcomes of adolescent children over the next two years, where treatment is either consistent with FDA guidelines, consistent with looser guidelines published by professional societies (“grey-area” prescribing), or inconsistent with any guidelines (“red-flag” prescribing). We find that red-flag prescribing increases self-harm, use of emergency rooms, and health care costs, suggesting that treatment guidelines effectively scale up good treatment in practice.