Maternal psychotic disorders and pediatric health care utilization: Medicaid-insured families in the Commonwealth of Pennsylvania

Objective: Research has found that women with mental illness utilize less preventive and prenatal health services for themselves as compared to women in the general population, suggesting a similar pattern of utilization for their children. This study is a first step in examining the impact of maternal psychotic disorders on pediatric health care use. Methods: Using the Andersen Behavioral Model of Health Services Use as a conceptual framework, a retrospective secondary data analysis of Medicaid claims data from 1998–2003 for the state of Pennsylvania compared age-cohorts of children of mothers with and without psychotic disorders (PD). Bivariate and multivariate logistic regression models examined whether mothers with and without a PD differed with respect to predisposing, enabling and need factors associated with pediatric health care use in the general population; preventive pediatric health care utilization; and reliance on emergency care. Multivariate regression models tested whether maternal psychotic disorder moderated the relationship between pediatric health care use and other predisposing, enabling, and need factors. A sub-analysis of mothers with a PD examined the association between mental health treatment and pediatric health care utilization. Results: While there were few significant differences between the groups, mothers with a PD were 1.41 times more likely to have at least one visit in the first year of their child.s life and 0.67 times less likely to have at least one visit in year 3–4. Mothers with a PD were significantly more likely to have high emergency department reliance for their children in the first two years of life (year 0–1: AOR=1.40, p=.003, 95% CI [1.13, 1.75]; year 1–2: AOR=1.35, p=.007, 95% CI [1.09, 1.68]). Conclusions: Findings suggest that mothers with and without a PD utilize pediatric health care at comparable levels. Still, all Medicaid-insured mothers could benefit from strategies improving compliance with preventive care and decreasing reliance on emergency care for infant and young children. Since mental health treatment for mothers with a PD was associated with higher rates of preventive health care compliance, integrated strategies between health and mental health systems could enhance the health and well-being of families impacted by maternal mental illness