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Mental and Substance Use Disorders Among Medicaid Recipients: Prevalence Estimates from Two National Surveys

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Abstract

This paper presents national estimates of behavioral disorders among Medicaid recipients. The 12-month prevalence of 14 disorders in the National Comorbidity Survey was 48% (43% mental, 14% substance use), and of 6 disorders in the National Household Survey on Drug Abuse was 27% (21% mental, 9% substance use). Total and specific disorder rates are from 50% to more than 100% higher in Medicaid than in the total population, and exceed most other insurance status groups. By promoting detection and treatment of these disorders in Medicaid, mental health administrators and policymakers may reduce barriers to education, employment, family stability, and departure from welfare.

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REFERENCES

  • Agency for Health Care Policy and Research. (1993a). Depression in primary care. Volume 1. Detection and diagnosis. Clinical Practice Guideline Number 5. (AHCPR Publication No. 93-0550). Washington, DC: Agency for Health Care Policy and Research.

    Google Scholar 

  • Agency for Health Care Policy and Research. (1993b). Depression in primary care: Volume 2. Treatment of major depression. Clinical Practice Guideline Number 5. (AHCPR Publication No. 93-0551). Washington, DC: Agency for Health Care Policy and Research.

    Google Scholar 

  • American Psychiatric Association. (1987). Diagnostic and Statistical Manual of Mental Disorders(3rded., rev.). Washington, DC: American Psychiatric Association.

    Google Scholar 

  • American Psychological Association. (n.d.-a). Medical cost offset. Practice Directorate. Retrieved February 14, 2001 from http://www.apa.org/practice/offset3.html.

  • American Psychological Association. (n.d.-b). The effectiveness of psychological services in improving employee productivity and attendance. Practice Directorate. Retrieved February 14, 2001 from http://www.apa.org/practice/prodpap2.html.

  • Bassuk, E.L., Buckner, J.C., Perloff, J.N., & Bassuk, S.S. (1998). Prevalence of mental health and substance use disorders among homeless and low-income housed mothers. American Journal of Psychiatry, 155, 1561-1564.

    Google Scholar 

  • Blazer, D.G., Kessler, R.C., McGonagle, A., & Swartz, M.S. (1994). The prevalence and distribution of major depression in a national community sample: The National Comorbidity Survey. American Journal of Psychiatry, 151, 979-986.

    Google Scholar 

  • Borowsky, S.J., Rubenstein, L.V., Meredith, L.S., Camp, P., Jackson-Triche, M., & Wells, K.B. (2000). Who is at risk of nondetection of mental health problems in primary care? Journal of General Internal Medicine, 15, 381-388.

    Google Scholar 

  • Brown, J. A., Nederend, S.E., Hays, R.D., Short, P.F., & Farley, D.O. (1999). Special issues in assessing care of Medicaid recipients. Medical Care, 37, MS79-MS88.

    Google Scholar 

  • Bruce, M.L., Takeuchi, D.T., & Leaf, P.J. (1991). Poverty and psychiatric status: Longitudinal evidence from the New Haven epidemiologic catchment area study. Archives of General Psychiatry, 48, 470-474.

    Google Scholar 

  • Buck, J.A., Teich, J.L., Bae, J., & Dilonardo, J. (2001). Mental health and substance abuse services in ten state Medicaid programs. Administration and Policy in Mental Health, 28, 181-192.

    Google Scholar 

  • Campbell, T.L., Franks, P., Fiscella, K., McDaniel, S.H., Zwanziger, J., Mooney, C., Sorbero, M. (2000). Do physicians who diagnose more mental health disorders generate lower health care costs? The Journal of Family Practice, 49, 305-310.

    Google Scholar 

  • Danziger, S., Corcoran, M., Danziger, S., Siefert, K., Tolman, R., & Kalil, A. (n.d.). Barriers to the employment of welfare recipients. Research Development Center on Poverty, Risk, and Mental Health. Retrieved February 15, 2001 from University of Michigan, School of Social Work web site: http://www.ssw.umich.edu/nimhcenter/Barriers.html.

  • Delva, J., Neumark, Y.D., Furr, C.D., & Anthony, J.C. (2000). Drug use among welfare recipients in the United States. The American Journal of Drug and Alcohol Abuse, 26, 335-342.

    Google Scholar 

  • Derr, M.K., Hill, H., & Pavetti, L. (2000). Addressing mental health problems among TANF recipients: A guide for program administrators. Final report submitted to U.S. Department of Health and Human Services (Contract No. 282-98-0021, MPR Ref. No. 8528-100). Princeton, NJ: Mathematica Policy Research.

    Google Scholar 

  • Ettner, S.L., Frank, R.G., & Kessler, R.C. (1997). The impact of psychiatric disorders on labor market outcomes. Industrial and Labor Relations Review, 51, 64-80.

    Google Scholar 

  • Fournier, L., Lesage, A.D., Toupin, J., & Cyr, M. (1997). Telephone surveys as an alternative for estimating prevalence of mental disorders and service utilization: A Montreal catchment area study. Canadian Journal of Psychiatry, 42, 737-743.

    Google Scholar 

  • Grant, B.F., & Dawson, D.A. (1996). Alcohol and drug use, abuse, and dependence among welfare recipients. American Journal of Public Health, 86, 1450-1454.

    Google Scholar 

  • Higgins, E.S. (1994). A review of unrecognized mental illness in primary care. Prevalence, natural history, and efforts to change the course. Archives of Family Medicine, 3, 908-917.

    Google Scholar 

  • Jayakody, R., Danziger, S., & Pollack, H. (2000). Welfare reform, substance use, and mental health. Journal of Health Politics, Policy and Law, 25, 623-651.

    Google Scholar 

  • Johnson, A., & Meckstroth, A. (1998). Ancillary services to support welfare to work. Report submitted to U.S. Department of Health and Human Services. Princeton, NJ: Mathematica Policy Research.

    Google Scholar 

  • Johnson, J.G., Spitzer, R.L., Williams, J.B., Kroenke, K., Linzer, M., Brody, D., deGruy, F., & Hahn, S. (1995). Psychiatric comorbidity, health status, and functional impairment associated with alcohol abuse and dependence in primary care patients: findings of the PRIME-MD-1000 study. Journal of Consulting and Clinical Psychology, 63, 133-140.

    Google Scholar 

  • Jones, L., Badger, L.W., Ficken, R.P., Leeper, J.D., & Anderson, R.L. (1988). Mental health training of primary care physicians: An outcomes study. International Journal of Psychiatry in Medicine, 18, 107-121.

    Google Scholar 

  • Judd, L.L., Hagop, S.A., Zeller, P.J., Paulus, M., Leon, A.C., Maser, J.D., Endicott, J., Coryell, W., Kunovac, J.L., Mueller, T.I., Rice, J.P., & Keller, M.B. (2000). Psychosocial disability during the long-term course of unipolar major depressive disorder. Archives of General Psychiatry, 57, 375-380.

    Google Scholar 

  • Judd, L.L., Paulus, M.P., Wells, K.B., & Rapaport, M.H. (1996). Socioeconomic burden of subsyndromal depressive symptoms and major depression in a sample of the general population. American Journal of Psychiatry, 153, 1411-1417.

    Google Scholar 

  • Kessler, R.C. (2000). National Comorbidity Survey, 1990—1992[Computer file]. Conducted by University of Michigan, Survey Research Center. Ann Arbor, MI: Inter-university Consortium for Political and Social Research [Producer and distributor].

    Google Scholar 

  • Kessler, R.C., DuPont, R.L., Berglund, P., & Wittchen, H.U. (1999). Impairment in pure and comorbid generalized anxiety disorder and major depression at 12 months in two national surveys. American Journal of Psychiatry, 156, 1915-1923.

    Google Scholar 

  • Kessler, R.C., & Frank, R.G. (1997). The impact of psychiatric disorders on work loss days. Psychiatric Medicine, 27, 861-873.

    Google Scholar 

  • Kirby, G., & Anderson, J. (2000). Addressing substance abuse problems among TANF recipients: A guide for program administrators. Final report submitted to U.S. Department of Health and Human Services (Contract No. 282-98-0021, MPR Ref. No. 8528-100). Princeton, NJ: Mathematica Policy Research.

    Google Scholar 

  • Larson, M.J., Farrelly, M.C., Hodgkin, D., Miller, K., Lubalin, J.S., Witt, E., McQuay, L., Simpson, J., Pepitone, A., Keme, A., & Manderscheid, R.W. (1998). Payments and use of services for mental health, alcohol, and other drug abuse disorders: Estimates from Medicare, Medicaid, and private health plans. In R. Manderscheid & M. Henderson (Eds.), Mental health, United States, 1998(pp. 124-141). DHHS Pub. No. (SMA) 99-3285. Washington, DC.

  • Lenz, G., & Demal, U. (2000). Quality of life in depression and anxiety disorders: An exploratory follow-up study after intensive inpatient cognitive behaviour therapy. Psychopathology, 33, 297-302.

    Google Scholar 

  • Leon, A.C., Portera, L., & Weissman, M.M. (1995). The social costs of anxiety disorders. British Journal of Psychiatry, 27, 19-22.

    Google Scholar 

  • Mark, T.L., Coffey, R.M., King, E., Harwood, H., McKusick, D., Genuardi, J., Dilonardo, J., & Buck, J.A. (2000). Spending on mental health and substance abuse treatment, 1987–1997. Health Affairs, 19, 108-120.

    Google Scholar 

  • Mendlowicz, M.V., & Stein, M.B. (2000). Quality of life in individuals with anxiety disorders. American Journal of Psychiatry, 157, 669-682.

    Google Scholar 

  • Mutaner, C., Eaton, W.W., Diala, C., Kessler, R.C., & Sorlie, P.D. (1998). Social class, assets, organizational control and the prevalence of common psychiatric disorders. Social Science and Medicine, 47, 2043-2053.

    Google Scholar 

  • National Center on Addiction and Substance Abuse. (1994). Substance abuse and women on welfare. New York, NY: Columbia University.

    Google Scholar 

  • Nelson, C.T., & Mills, R.J. (2001). The March CPS health insurance verification question and its effect on estimates of the uninsured. U. S. Bureau of the Census. Retrieved March 20, 2002 from http://www.census.gov/hhes/hlthins/verif.html.

  • Norquist, G., & Wells, K. (1991). Mental health needs of the uninsured. Archives of General Psychiatry, 48, 475-478.

    Google Scholar 

  • Olfson, M., Fireman, B., Weissman, M.M., Leon, A.C., Sheehan, D.V., Kathol, R.G., Hoven, C., & Farber, L. (1997). Mental disorders and disability among patients in a primary care group practice. American Journal of Psychiatry, 154, 1734-1740.

    Google Scholar 

  • Olfson, M., Sing, M., & Schlesinger, H.J. (1999). Mental health/medical care cost offsets: Opportunities for managed care. Health Affairs, 18, 79-90.

    Google Scholar 

  • Rajan, S., Zuckerman, S., & Brennan, N. (2000). Confirming insurance coverage in a telephone survey: Evidence from the National Survey of America's Families. Inquiry, 37, 317-327.

    Google Scholar 

  • Schulberg, H.C., Katon, W., Simon, G.E., & Rush, A.J. (1998). Treating major depression in primary care practice: An update of the Agency for Health Care Policy and Research Practice Guidelines. Archives of General Psychiatry, 55, 1121-1127.

    Google Scholar 

  • Sisco, C.B., & Pearson, C.L. (1994). Prevalence of alcoholism and drug abuse among female AFDC recipients. Health & Social Work, 19, 75-77.

    Google Scholar 

  • Spitzer, R.L., Kroenke, K., Linzer, M., Hahn, S.R., Williams, J.B., deGruy, F.V., Brody, D., & Davies, M. (1995). Health-related quality of life in primary care patients with mental disorders. Results from the PRIME-MD 1000 Study. JAMA, 274, 1511-1517.

    Google Scholar 

  • Spitzer, R.L., Kroenke, K., & Williams, J.B. (1999). Validation and utility of a self-report version of PRIME-MD: The PHQ primary care study. Primary Care Evaluation of Mental Disorders. Patient Health Questionnaire. JAMA, 282, 1737-1744.

    Google Scholar 

  • Substance Abuse Policy Research Program. (1999). Building bridges: States respond to substance abuse and welfare reform. Princeton, NJ: Robert Wood Johnson Foundation.

    Google Scholar 

  • Sullivan, E., & Fleming, M. (1997) A guide to substance abuse services for primary care clinicians. Treatment Improvement Protocol (TIP) Series 24. (DHHS Publication No. (SMA) 97-3139). Washington, DC: U.S. Department of Health and Human Services.

    Google Scholar 

  • Thompson, B.L., Nelson, D.E., Davenport, N.J., Cautley, E., Penaloza, L.J., & Smith, S.M. (1998). The validity of self-reported health care coverage information. Presented at the Annual Meeting of the Association for Health Services Research.

  • U.S. Department of Health and Human Services. (1994). Patterns of substance use and program participation. Washington, DC: Office of the Assistant Secretary for Planning Evaluation.

    Google Scholar 

  • U.S. Department of Health and Human Services: Substance Abuse and Mental Health Services Administration. Office of Applied Studies. (2000). National Household Survey on Drug Abuse, 1997. [Computer file]. 2ndICPSR version, 1999. Research Triangle Park, NC: Research Triangle Institute [Producer]. Ann Arbor, MI: Inter-university Consortium for Political and Social Research [Distributor].

    Google Scholar 

  • Zedlewski, S.R. (1999). Work activity and obstacles to work among TANF recipients. Number B-2. Series B. New Federalism: National Survey of America's Families. Washington, DC: The Urban Institute.

    Google Scholar 

  • Zhang, M., Rost, K.M., & Fortney, J.C. (1999). Earnings changes for depressed individuals treated by mental health specialists. American Journal of Psychiatry, 156, 108-114.

    Google Scholar 

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Adelmann, P.K. Mental and Substance Use Disorders Among Medicaid Recipients: Prevalence Estimates from Two National Surveys. Adm Policy Ment Health 31, 111–129 (2003). https://doi.org/10.1023/B:APIH.0000003017.78877.56

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