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.

Prenatal depression, Medicaid, Maternal health, Mental health