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Cited by 72Mental Health Treatment and AccessChild and Adolescent Psychosocial and Emotional DevelopmentHealth disparities and outcomes

Racial and ethnic differences in minimally adequate depression care among Medicaid-enrolled youth

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Cummings, Janet R., Ji, Xu, Lally, Cathy, Druss, Benjamin G.·2019·Journal of the American Academy of Child & Adolescent Psychiatry
DOI 10.1016/j.jaac.2018.04.025PMC PMC8051617
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Abstract

Objective To examine racial and ethnic disparities in the receipt of minimally adequate depression treatment in Medicaid-enrolled youth. Method Medicaid claims data of 2008 through 2011 were used to derive a cohort of youth (5-17 years old) who were diagnosed with a new episode of major depression (N = 45,816) across 9 states. Dichotomous outcomes measured the receipt of minimally adequate psychotherapy (≥4 psychotherapy visits within 12 weeks of initiation); minimally adequate medication (filled antidepressants for 84 of 144 days); any minimally adequate treatment (psychotherapy or medication); and no psychotherapy or medication. Racial/ethnic disparities in the outcome measures were estimated using logistic regression models that controlled for predisposing, enabling, and need-related factors. Results Less than four-tenths (38.3%) of the cohort received minimally adequate psychotherapy, 19.2% received minimally adequate pharmacotherapy, and 49.9% received any minimally adequate treatment; conversely, 16.4% received no treatment. Adjusted percentages of black (42.3%; p < .001) and Hispanic (48.2%; p < .001) youth who received minimally adequate treatment were significantly smaller than for non-Hispanic whites (54.7%) because of lower likelihoods of receiving minimally adequate psychotherapy and/or minimally adequate pharmacotherapy. In addition, adjusted percentages of black (20.2%; p < .001) and Hispanic (15.0%; p < .01) youth who received no treatment were significantly larger than for non-Hispanic white youth (12.9%). Conclusion The percentage of Medicaid-enrolled youth who receive minimally adequate treatment for depression is small overall and even smaller for racial/ethnic minorities than for whites. Future research is needed to identify strategies that improve the overall quality of depression treatment in Medicaid-enrolled youth and decrease disparities in care.

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  • Only a small minority of young people can access adequate care even in high-resource settings, and primary forms of prevention are typically a very low priority.

    “Despite this compelling evidence of need, only a small minority of young people can access adequate care even in high-resource settings, 46-48 and primary forms of prevention are daunting, elusive, and typically a very low priority.”

    From The Lancet Psychiatry Commission on youth mental health (2024) · cites this paper as [47]

    The Results (Minimally Adequate Depression Care; page unavailable) show that many Medicaid-enrolled youth diagnosed with depression did not receive minimally adequate treatment. But 49.9% received some minimally adequate treatment, which is not a small minority; the study measures receipt of depression care in this specific cohort, not access to adequate care among young people generally. The prevention statement follows the citations and is not assessed as an attribution to this paper. (LLM, conf=0.86)

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Research works printed but not linked: 27

  1. [2]Weissman MM, Wolk S, Wickramaratne P, Children with prepubertal-onset major depressive disorder and anxiety grown up. Archives of general psychiatry. 1999; 56(9): 794– 801. 12884885
  2. [3]Weissman MM, Wolk S, Goldstein RB, Depressed adolescents grown up. Journal of the American Medical Association. 5 12 1999; 281(18): 1707– 1713. 10328070
  3. [4]Cummings JR, Druss BG. Racial/ethnic differences in mental health service use among adolescents with major depression. J Am Acad Child Adolesc Psychiatry. 2 2011; 50(2): 160– 170. 21241953 PMC3057444
  4. [8]Birmaher Boris, Brent David, AACAP Work Group on Quality Issues. Practice parameter for the assessment and treatment of children and adolescents with depressive disorders. J Am Acad Child Adolesc Psychiatry. 2007; 46(11): 1503– 1526. 18049300
  5. [9]Zito JM, Safer DJ, Gardner JF, Soeken K, Boles M, Lynch F. Rising prevalence of antidepressants among US youths. Pediatrics. 2002; 109(5): 721– 727. 11986427
  6. [10]Richardson LP, DiGiuseppe D, Christakis DA, McCauley E, Katon W. Quality of Care for Medicaid-Covered Youth Treated With Antidepressant Therapy. Archives of General Psychiatry. 2004; 61(5): 475– 480. 15123492
  7. [11]Richardson LP, DiGiuseppe D, Garrison M, Christakis DA. Depression in Medicaid-covered youth: differences by race and ethnicity. Archives of Pediatrics and Adolescent Medicine. 2003; 157(10): 984– 989. 14557159
  8. [12]Fontanella CA, Bridge JA, Marcus SC, Campo JV. Factors associated with antidepressant adherence for Medicaid-enrolled children and adolescents. Annals of Pharmacotherapy. 2011; 45(7–8): 898– 909. 21775691
  9. [16]Teh CF, Sorbero MJ, Mihalyo MJ, Predictors of adequate depression treatment among Medicaid-enrolled adults. Health Services Research. 2 2010; 45(1): 302– 315. 19878343 PMC2813450
  10. [17]Stein BD, Sorbero MJ, Dalton E, Predictors of adequate depression treatment among Medicaid-enrolled youth. Soc Psychiatry Psychiatr Epidemiol. 5 2013; 48(5): 757– 765. 23589098
  11. [18]Work Group on Major Depressive Disorder, Gelenberg AJ, Freeman MP, Practice Guideline for the Treatment of Patients with Major Depressive Disorder, 3rd Edition. Washington D.C.: American Psychiatric Association; 2010.
  12. [19]National Quality Measures Clearinghouse. Antidepressant Medication Management. In: Agency for Healthcare Research and Quality, ed. Vol 2017. Rockville, MD; 2013. 21923316
  13. [21]Cummings JR, Ji X, Allen L, Lally C, Druss BG. Racial and Ethnic Differences in ADHD Treatment Quality Among Medicaid-Enrolled Youth. Pediatrics. 6 2017; 139 (6). PMC5470500 28562259
  14. [23]Cummings JR, Wen H, Ko M, Druss BG. Geography and the Medicaid mental health care infrastructure: implications for health care reform. JAMA Psychiatry. 2013; 70(10): 1084– 1090. 23965816 PMC4048197
  15. [24]Cummings JR, Case BG, Ji X, Marcus SC. Availability of Youth Services in US Mental Health Treatment Facilities. Administration and Policy in Mental Health and Mental Health Services Research. 2016; 43(5): 717– 727. 26467795 PMC4833684
  16. [25]Cummings JR. Contextual socioeconomic status and mental health counseling use among US adolescents with depression. Journal of Youth and Adolescence. 2014; 43(7): 1151– 1162. 24114588 PMC4028419
  17. [26]Santiago CD, Kaltman S, Miranda J Poverty and Mental Health: How Do Low-Income Adults and Children Fare in Psychotherapy? Journal of Clinical Psychology. 2013; 69(2): 115– 126. 23280880
  18. [27]Syed ST, Gerber BS, Sharp LK. Traveling Towards Disease: Transportation Barriers to Health Care Access. Journal of Community Health. 2013; 38(5): 976– 993. 23543372 PMC4265215
  19. [29]Cauce AM, Domenech-Rodriguez M, Paradise M, Cultural and contextual influences in mental health help seeking: a focus on ethnic minority youth. Journal of Consulting and Clinical Psychology. 2 2002; 70(1): 44– 55. 11860055
  20. [31]Lewis-Fernandez R, Das AK, Alfonso C, Weissman MM, Olfson M. Depression in US Hispanics: diagnostic and management considerations in family practice. J Am Board Fam Pract. Jul-Aug 2005; 18(4): 282– 296. 15994474
  21. [32]Takeuchi DT, Bui KV, Kim L. The referral of minority adolescents to community mental health centers. Journal of Health and Social Behavior. 6 1993; 34(2): 153– 164. 8277127
  22. [33]Cummings JR, Case BG, Ji X, Chae DH, Druss BG. Racial/ethnic differences in perceived reasons for mental health treatment in US adolescents with major depression. J Am Acad Child Adolesc Psychiatry. 9 2014; 53(9): 980– 990. 25151421 PMC4238285
  23. [35]Bains RM, Diallo AF. Mental Health Services in School-Based Health Centers: Systematic Review. J Sch Nurs. 2 2016; 32(1): 8– 19. 26141707
  24. [36]Anglin TM, Naylor KE, Kaplan DW. Comprehensive school-based health care: high school students’ use of medical, mental health, and substance abuse services. Pediatrics. 3 1996; 97(3): 318– 330. 8604264
  25. [37]Juszczak L, Melinkovich P, Kaplan D. Use of health and mental health services by adolescents across multiple delivery sites. The Journal of Adolescent Health. 6 2003; 32(6 Suppl): 108– 118. 12782449
  26. [41]Carson NJ, Progovac AM, Wang Y, Cook BL. A decline in depression treatment following FDA antidepressant warnings largely explains racial/ethnic disparities in prescription fills. Depression and Anxiety. 12 2017; 34(12): 1147– 1156. 28962069 PMC5895183
  27. [42]O’Malley KJ, Cook KF, Price MD, Wildes KR, Hurdle JF, Ashton CM. Measuring diagnoses: ICD code accuracy. Health Services Research. 2005; 40(5p2): 1620– 1639. 16178999 PMC1361216

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Authors
Cummings, J. R., Ji, X., Lally, C., & Druss, B. G.
Affiliations
Emory University (US)
Corresponding author
Cummings, Janet R.
ORCID
Venue
Journal of the American Academy of Child & Adolescent Psychiatry
Publisher
Elsevier BV
Published
2019-01
Volume
58
Issue
1
Pages
128-138
ISSN
0890-8567 (ISSN-L)
DOI
10.1016/j.jaac.2018.04.025
PMC
PMC8051617
OpenAlex
W2896127578
Cited by
72
References
4
Citations by year
2026: 8 · 2025: 14 · 2024: 12 · 2023: 11 · 2022: 12 · 2021: 7 · 2020: 5 · 2019: 3
FWCI
4.80
Type
journal article
Language
en
Open access
Licence
www.elsevier.com/tdm/userlicense/1.0/ (tdm)
Locations
  • Journal of the American Academy of Child & Adolescent Psychiatry (publishedVersion)
  • PubMed (publishedVersion)
  • PubMed Central (acceptedVersion)
Funders
National Institute of Mental Health (K01MH095823)
Topics
  • Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
  • Social Sciences › Psychology › Clinical Psychology › Child and Adolescent Psychosocial and Emotional Development
  • Social Sciences › Health › Health disparities and outcomes
Keywords
depression treatment, racial and ethnic disparities, Medicaid, youth, access to psychotherapy, antidepressants, treatment gap, Black youth, Latino youth, pediatric mental health care
MeSH terms
Adolescent, Antidepressive Agents, Black or African American, Child, Child, Preschool, Major Depressive Disorder, Female, Hispanic or Latino, Humans, Male, Medicaid, Drug Prescriptions, Psychotherapy, Quality of Health Care, United States, Cohort Studies, White People, Healthcare Disparities

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