Differential Patterns of Service Use for Depression Among Diverse Medicaid-Insured Children and Youth

This study explored differences in service use by race/ethnicity across the full continuum of care for Medicaid-enrolled youth diagnosed with depression, using a hybrid cross-sectional and longitudinal cohort design of children (0–17 years) in New York City (N = 865,281) with new episodes of depression in 2021 (n = 11,093). Measures included clinical setting on initial presentation and over the six months that followed; hospitalization on initial diagnosis; receipt of any follow-up care, any outpatient service, minimally adequate outpatient care, or any antidepressant; and ER/inpatient services received during six-month follow-up. Compared to White children, Black children were more likely to initially present in an emergency room setting (AOR = 1.44, 95%CI:1.12–1.85) and were more likely to be hospitalized on initial diagnosis (AOR = 1.52, 95%CI:1.02–2.26); Black and Hispanic/Latinx children were less likely to use private practice for initial treatment (AOR = 0.37, 95%CI:0.29–0.47 and AOR = 0.44 95%CI:0.36–0.55, respectively) or for follow-up treatment (AOR = 0.56, 95%CI:0.44–0.72 and AOR = 0.76, 95%CI:0.61–0.94, respectively). Overall, 58% of children received any follow-up treatment after diagnosis; two-thirds of those received four or more outpatient services. Black children had the lowest receipt of any treatment after diagnosis (AOR = 0.80, 95%CI:0.67–0.96), and, when they did receive outpatient treatment, the lowest completion of at least four visits (AOR = 0.62, 95%CI:0.47–0.81), lowest receipt of any antidepressant (AOR = 0.60, 95%CI:0.47–0.75), and higher rates of ER/inpatient admissions during the six months of the episode (AOR = 1.38, 95%CI:1.10–1.73). Gaps in depression care exist for all children, but these gaps are greater for Black children. These barriers warrant both research and public policy attention.