Mustafa Karakus

Background: Prenatal depression is common and may be associated with adverse prenatal and postpartum outcomes when untreated. However, treatment rates among pregnant women remain relatively low. As Medicaid is the largest public insurer during pregnancy in the United States, it is important to understand whether Medicaid beneficiaries receive appropriate depression treatment during pregnancy and the characteristics of women engaging in treatment. Methods: The national 2021 Transformed Medicaid Statistical Information System Analytic Files identified 200,368 pregnant women with a confirmed depression diagnosis (13% of all pregnancies within Medicaid). Women were categorized into four groups: no treatment, antidepressant medication-only, psychotherapy-only, and both medication and psychotherapy. Pearson chi-square tests evaluated differences in characteristics of women across treatment groups. Because this study relies on administrative claims data, treatment may be underestimated due to incomplete capture of behavioral health services, including non-billed care, integrated care models, and services not reimbursed through Medicaid. Results: Ninety-seven percent of women diagnosed with depression during pregnancy did not receive documented depression treatment. White, older women enrolled in Medicaid managed care were apparently more likely to engage in any treatment. Women with a co-occurring mental illness in addition to depression or gestational hypertension were more likely to receive documented treatment. Comparisons within those receiving treatment demonstrate that women prescribed medication-only according to documentation were more likely to be younger, Black or Hispanic, live in rural areas, and have gestational hypertension. Most women receiving documented treatment had high levels of co-occurring mental illness. Conclusions: Depression during pregnancy is apparently overwhelmingly untreated within the Medicaid population. Despite established clinical recommendations supporting effective behavioral and pharmacological interventions within pregnant populations, most women do not receive any documented treatment under their Medicaid insurance plans. Enhancing screening and psychotherapeutic treatment availability along with providing comprehensive information concerning maternal and fetal safety may contribute to improved health outcomes for pregnant women and their infants.

Experiencing the death of a loved one, or the state of being bereaved, is associated with increased anxiety (Snaman et al., 2023), depression (Brent et al., 2009; Snaman et al., 2023), and substanc...

Dually eligible individuals, enrolled in both Medicare and Medicaid, have complex medical, social, and behavioral health needs and account for a disproport

Objectives: Alcohol use in later life may pose health risks that are hidden by contemporaneous measures or slowly accumulating outcomes. We examined whether alcohol use predicts subsequent healthcare utilization among midlife and older adults. Methods: Using 2012–2022 Health and Retirement Study data, we estimated fixed-effects negative binomial models of within-person associations between alcohol use and hospitalizations and doctor visits. Contemporaneous and 2-year lagged alcohol measures were evaluated, and interactions with chronic disease burden were tested. Results: Contemporaneous models consistently showed fewer hospitalizations among drinkers. Lagged models showed a less protective and, for hospitalizations, more adverse pattern two years later. For doctor visits, lagged main effects were less consistent. Prior drinking predicted greater subsequent utilization as chronic conditions increased. Discussion: Findings suggest that recent drinking history may reveal risks not apparent from current drinking alone and may be especially important among older adults with multimorbidity.

Objective This study examines associations between opioid use disorder (OUD) treatment and pregnancy outcomes among Medicaid enrollees. Study design Using 2021 Medicaid claims, we identified 29,193 women with OUD and a pregnancy-related outcome receiving (1) Medication Only, (2) Behavioral Therapy Only, (3) Medication and Behavioral Therapy, or (4) No Treatment. Multivariable logistic regression estimated adjusted odds ratios (ORs) for outcomes. Results Among pregnant women with OUD, over half (52.5%) received no treatment; 27.9% received medication and therapy, 12.5% received medication only, and 7.0% received therapy only. Any form of treatment was linked to reduced risk of fetal death. Medication, alone or with therapy, was associated with lower risk of preterm labor, and medication alone was linked to reduced risk of abruptio placentae. Conclusion Receiving treatment for OUD is significantly associated with better pregnancy outcomes. Expanding access to medication for OUD and integrating therapy are crucial for improving maternal health.

Schools are an important component in the mental health system of care for youths. Teachers and other school staff have unique opportunities to promote emotional wellness and prevent mental health conditions. Although numerous programs are available, identifying evidence-based and effective options is a significant challenge. This introduction lays out the rationale and methodology of the Assessing the Evidence Base (AEB) Series, a collection of systematic reviews of school-based mental health promotion and prevention approaches recommended by the National Academies of Sciences, Engineering, and Medicine for students in kindergarten through grade 12. Authors of the current AEB Series used the rating criteria derived from the 2014 AEB Series, which provided systematic reviews of a wide spectrum of interventions for mental and substance use disorders. Like its predecessor, the current series upholds a high standard of scientific rigor while ensuring that the information is easily accessible to various stakeholders in education, behavioral health, and communities. It describes the universal features included in each systematic review, such as a rating of the level of evidence for interventions, intervention program components, identification of interventions that have yielded positive outcomes for students from underserved populations, and a review of cost data. The AEB systematic reviews will serve as an important tool for decision makers involved in managing limited resources for various programs in school-based mental health services by synthesizing large bodies of research for use by leaders in education and behavioral health.

The purpose of this Open Forum is to highlight strategies that can be implemented by federal health care policy makers to improve the delivery of effective behavioral health care services in the public and private sectors. The recommendations can be accomplished by using existing funds or authorities allocated to federal agencies dealing with the behavioral health system. These recommendations do not require new or additional funding and focus on strategies with a track record for success. The strategies described require relatively small changes but have the potential for big impacts.

Previous studies suggest that providing employment services to individuals with serious mental illnesses can help them obtain competitive, real-world employment. However, these services are still not easily accessible to this population. This paper provides a brief summary of recent federal initiatives that may influence widespread implementation of employment services. While there is an increasing recognition of the need to remove barriers and provide supported employment services to individuals with mental illnesses, a wide-spread coordination across Federal polices, financing and regulatory changes are necessary to promote measurable and lasting effects on the broad availability of employment services among this population.