The Role of Insurance in the Treatment of Adolescents with Co-Occurring Major Depressive Episode and Substance Use Disorder Open Access

Abstract

Little is known about the treatment received by adolescents with co-occurring psychiatric and substance use disorders (SUD). Even among adolescents with only one diagnosis, the factors associated with treatment, insurance status in particular, are not fully understood. Prior studies examining the role of insurance in treatment have not differentiated between forms of private insurance coverage that do and do not cover mental health and/or substance abuse treatment. A better understanding of the role of insurance is necessary given recent legislative efforts to improve treatment rates through insurance coverage expansions and equalizing benefits for mental health and substance abuse treatment. We examined the patterns and predictors of treatment for major depressive episode (MDE) and SUD in U.S. adolescents with co-occurring MDE and SUD. Data came from seven years (2004-2010) of the National Survey on Drug Use and Health, a cross-sectional annual survey that collects information about of the use of alcohol, tobacco, and illicit drugs in the United States' noninstitutionalized civilian population. Using logistic regression, we examined the effect of insurance status on any treatment for MDE, treatment for MDE by a mental health professional, treatment for MDE by a medical professional, any treatment for SUD, treatment for SUD in a specialty setting, and treatment for SUD in a self-help group. We found overall treatment rates of only 47.7% for MDE and 10.2% for SUD. Public insurance and private insurance that covered mental health treatment were both positively associated with any treatment for MDE and treatment for MDE by a mental health professional. Public insurance also improved adolescents' odds of treatment for SUD in a specialty setting. The observed association of public and private insurance with MDE treatment supports the idea that expansions in public insurance coverage and benefit parity in private insurance plans may improve adolescent treatment rates. On the contrary, the exceptionally low rate of treatment for SUD and the limited associations between public and private insurance coverage and SUD treatment suggest that increased screening and integration of SUD treatment services may be more effective than changes in insurance coverage in improving rates of treatment.

Table of Contents

Table of Contents

1. Introduction - 1

2. Literature Review- 3

3. Methods - 13

4. Results - 26

5. Discussion - 40

6. Conclusion - 45

References - 46

About this Master's Thesis

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School	Rollins School of Public Health
Department	Health Policy and Management
Degree	MSPH
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Public Health Health Sciences, Mental Health
Keyword	Insurance Alcohol Abuse Adolescent Mental Health Substance Abuse Substance Use Illicit Drug Abuse Mental Health Alcohol Dependence Major Depressive Episode Substance Dependence Treatment Illicit Drug Dependence Depression
Committee Chair / Thesis Advisor	Cummings, Janet, Emory University
Committee Members	Druss, Benjamin G, Emory University Gaydos, Laura, Emory University
Partnering Agencies	Emory University schools, faculty or affiliated programs

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