The February, 2011 issue of Health Affairs has published a study entitled “New Jersey’s Efforts to Improve Postpartum Depression Care Did Not Change Treatment Patterns for Women on Medicaid”. The title of the article, authored by Kozhimannil, Adams, Soumerai, Busch and Huskamp, is curiously conclusive in its declaration of outcome for this population of Medicaid women, given subject exclusions which considerably weaken its limited findings and an overall perspective which I feel lacks understanding of New Jersey's Maternal Child Health consortia system and demographics of those served.
Also absent from the study’s context are current legislative and clinical references which would have provided more context for the study’s structure, subject selection, policy recommendations and conclusions. Given the involvement of public health policy makers/advisors associated with several major U.S. institutions, this narrow context is surprising.
For starters, the population of Medicaid recipients chosen to participate in the study was taken from an initial group of 103,414 women, all of whom gave birth between July 1, 2004 and October 31, 2007 to a final group of just over 30,000, less than a third of those receiving Medicaid while pregnant/giving birth. No other groups in the state of New Jersey who may have benefited from its initiatives were included.
The women who made it to the final study group had to have had deliveries covered by Medicaid and the mothers had to have had continuous enrollment in Medicaid for at least six months before and one year post delivery. Therefore, the study noted that “many women were excluded from the study based on the continuous Medicaid coverage requirement."
The study also excluded women who were suffering from bipolar disorder (an illness which may have its first presentation or exacerbation of symptoms in the postpartum), and schizophrenia. It further excluded another 1,193 women who were receiving medication during pregnancy in order to “distinguish new cases from ongoing illnesses.