Mental health resource utilization and health care costs associated with race and comorbid anxiety among medicaid enrollees with major depressive disorder

Disclosure: This study was a part of Dr Wu's original doctoral dissertation, "Interactive Associations of Race and Comorbidity in Medication Treatment and Outcomes of Medicaid Enrolled Patients with Major Depressive Disorder." The study was not funded by any resource. Objective: The objective of this study was to assess the association among race, comorbid anxiety, and mental health resource utilization among Medicaid enrollees with major depressive disorder (MDD). Methods: A retrospective cross-sectional study design was used to identify adult patients with MDD newly initiating an antidepressant between January 1, 2004, and December 31, 2006, from the MarketScan Multi-State Medicaid Database. Measures of mental health resource utilization included mental health-related office visits, hospitalizations, emergency department visits, and health care costs. The associations of mental health resource utilization with race and comorbid anxiety were examined respectively using multivariable logistic regression, negative binominal regression, and log-transformed linear regression models. Results: A total of 3083 Medicaid enrollees with MDD were included. Approximately 25% of patients had comorbid anxiety. Caucasians were more likely to have comorbid anxiety than African Americans (30.2% vs 16.4%, p < .01). After controlling for covariates, comorbid anxiety was significantly associated with more frequent mental health resource utilization. African Americans were significantly less likely than Caucasians to have mental health-related office visits (OR, 0.54; 95% CI, 0.45-0.66) but more likely to be hospitalized (OR, 2.57; 95% CI, 1.84-3.60) and to have emergency department visits (OR, 1.52; 95% CI, 1.05-2.19). Conclusions: Comorbid anxiety was positively associated with mental health resource utilization among Medicaid enrollees with MDD. Health disparities in health care utilization between African Americans and Caucasians still exist.