PROJECT SUMMARY
This goal of this K01 is to provide the mentorship and training for Dr. Sarah Gordon to become an independent
investigator studying access to mental health services among low-income populations. Nationally, 1 in 8
women experience symptoms of postpartum depression (PPD), and rates of PPD are twice as high among
women enrolled in Medicaid compared to commercially-insured women. This research examines the effects of
postpartum Medicaid eligibility and benefit policies on PPD care among low-income women using a two-phase
explanatory mixed-methods design. Aims 1 and 2 will analyze secondary data from a novel linked database of
all payer claims data, birth certificates, and individual-level income data, consistent with NIMH's strategic
objective to combine data from multiple sources to identify underserved groups. Using a regression
discontinuity design, Aim 1 will evaluate the effects of retaining Medicaid eligibility beyond the pregnancy-
related eligibility limit of 60 days postpartum on PPD screening, diagnosis, and treatment rates in the
postpartum year. Aim 2 will use a difference-in-differences approach to measure the effects of Medicaid
reimbursement for PPD screening during well-child visits on PPD screening, diagnosis, and treatment rates in
the postpartum year, comparing outcomes among women who maintain versus lose Medicaid eligibility
postpartum. Aims 1 and 2 will implement multi-level modeling techniques to examine county-level moderators
of policy effects. In Aim 3, I will conduct qualitative interviews with key policy informants, providers, and patient
focus groups to explore how postpartum Medicaid policies impact access to PPD services. Purposive
qualitative sampling will be guided by county-level moderators of policy effects observed in Aims 1 and 2 and a
ZIP-code level geospatial cluster analysis of PPD screening and treatment rates. Dr. Sarah Gordon is an
assistant professor at the Boston University School of Public Health. She has four key training objectives: (1)
acquire content expertise in the organization and delivery of mental health services, with a focus on maternal
mental health; (2) obtain skills in mixed-methods research; (3) develop expertise in qualitative data collection
and analysis, and (4) acquire skills to measure and map area-level variation in policy effects. Postpartum
mental health conditions are a leading cause of preventable postpartum maternal morbidity and mortality. The
goal of this proposal is to examine the effects of Medicaid policies in order to increase detection and treatment
of PPD, thereby improving postpartum mental health. This research aligns with NIMH's high priority research
area on women's mental health during the perinatal period and is responsive to the NIMH Strategic Plan
priority to strengthen the public health impact of NIMH research by testing approaches for reducing empirically
documented disparities in care access for socioeconomically disadvantaged persons.