Predictors and Patterns of Psychiatric Treatment Dropout During Pregnancy Among Low-Income Women.

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TitlePredictors and Patterns of Psychiatric Treatment Dropout During Pregnancy Among Low-Income Women.
Publication TypeJournal Article
Year of Publication2018
AuthorsKornfield, SL, Kang-Yi, CD, Mandell, DS, C Epperson, N
JournalMatern Child Health J
Volume22
Issue2
Pagination226-236
Date Published2018 02
ISSN1573-6628
KeywordsAdolescent, Adult, Female, Humans, Medicaid, Mental Disorders, Outpatients, Patient Compliance, Patient Dropouts, Pennsylvania, Poverty, Pregnancy, Pregnancy Complications, Pregnant Women, Psychotherapy, United States
Abstract

Objective This study compared psychiatric treatment discontinuation rates among pregnant women using psychotropic medications, outpatient psychotherapy, or both before conception. Methods Using data from Pennsylvania Medicaid Fee-For-Service and Managed Care Organization claims and Medicaid enrollment, 3030 women were identified who gave birth between 2007 and 2009, had ≥ 1 claim for psychiatric treatment during the 120 days prior to pregnancy, and were enrolled in Medicaid until they delivered. Kaplan-Meier and Cox regression analyses were used to estimate psychiatric treatment dropout rate during pregnancy and examine relationships between treatment dropout and age, race/ethnicity, and pre-pregnancy psychiatric diagnosis and treatment pattern. Results After the first trimester, the probability of discontinuing psychotropic medications was 83 versus 37.8% for cessation of psychotherapy among combined treatment users. Two or more psychotherapy sessions in the 4 months prior to pregnancy were associated with decreased psychotherapy dropout during pregnancy. Psychotherapy during pregnancy was associated with prenatal psychotropic medication adherence. Conclusions To retain women in treatment during pregnancy, when discontinuation from care is common, innovative models of care should consider type of pre-pregnancy mental healthcare and individual characteristics.

DOI10.1007/s10995-017-2394-9
Alternate JournalMatern Child Health J
PubMed ID29143169
PubMed Central IDPMC5821232
Grant ListR01 DA037289 / DA / NIDA NIH HHS / United States
R01 AG030641 / AG / NIA NIH HHS / United States
K23 MH102360 / MH / NIMH NIH HHS / United States
P50 MH099910 / MH / NIMH NIH HHS / United States
K24 DA030301 / DA / NIDA NIH HHS / United States
13-ECA-01L / / Autism Science Foundation (US) / International
K23-MH102360 / MH / NIMH NIH HHS / United States