THE EFFECT OF RURALITY ON UTILIZATION OF PSYCHOTHERAPY FOR PERINATAL MOOD DISORDERS AMONG GEORGIA CONGENITAL HEART DEFECT MEDICAID PATIENTS Público
Reynolds, Erin (Spring 2020)
Published
Abstract
Purpose:
As the number of people born with congenital heart defects (CHD) living into childbearing years increases, the need to assess possible health risks of pregnant women living with CHD is paramount. Perinatal mood disorders (PMD) affect 15-20% of women experiencing pregnancy and are the number one complication in pregnancy and childbirth in the U.S, yet remain undertreated. Literature suggests that a major barrier to the receipt of treatment, such as psychotherapy, is geographic access to mental health providers. There is no current research concerning the receipt of psychotherapy for PMD in women with CHD. Therefore, this study seeks to address this gap in knowledge utilizing the geographic distribution of Georgia’s CHD Medicaid beneficiaries.
Methods:
This study uses Medicaid claims data from the Medicaid Analytic Extract (MAX) files spanning the years 1999-2013 to assess the effect of rurality on the receipt of psychotherapy for PMD in a CHD population. A two-part model using logistic regression analysis will be used to evaluate the receipt of any treatment and adequate treatment, given any treatment, across the urban to rural continuum.
Results:
Results indicate that of the 5,235 women with CHD who had a delivery, 931 (17.8%) had a diagnosis of PMD. Only approximately 15% of these women received any psychotherapy. Those living in rural areas were significantly less likely to receive any psychotherapy within 12 weeks of diagnosis of PMD as compared to their urban counterparts, even after accounting for differences in geographic access
Conclusion:
This study suggests that pregnant and postpartum women with CHD and a PMD diagnosis who live in rural areas are less likely to receive psychotherapy. These findings provide support for adopting a prescriptive approach to perinatal mental health services for women with chronic disease and encourage the formation of public health policies that address barriers to mental health treatment in the perinatal period.
Table of Contents
Table of Contents
Chapter 1: Introduction…1
Chapter 2: Background and Literature Review…3
CHD in the U.S.: definition and prevalence…3
CHD in pregnancy…4
CHD and mental health…5
Perinatal mood disorders: definition, prevalence, treatment….6
Mental health in Medicaid populations….8
Utilization of mental healthcare across urban & rural population…8
Access to and acceptability of mental health services in rural areas... 9
National Legislative Context of Maternal Mental Health...10
State Legislative and Policy Context of Maternal Mental Health…11
Hypothesis and Conceptual Framework….14
Summary of findings and gaps in the literature…15
Chapter 3: Methodology…16
Conceptual Model…16
Focal Relationship …18
Access: A mechanism …18
Stigma: A mechanism…18
Confounders and associations with the focal relationship…19
Outcome Variable…23
Hypotheses…23
Study Design…24
Data Management and IRB…24
Analytic sample… 25
Measurement of constructs…26
Analytic Strategy…30
Chapter 4: Results…34
Descriptive Results…34
Logistic Regression Results …41
Multinomial Logistic Regression Results…49
Chapter 5: Discussion…51
Key findings…51
Importance of Findings…51
Implications for policy and practice…54
Recommendations for further research…56
Strengths and Limitations…58
Chapter 6: Conclusion…59
References…61
About this Master's Thesis
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