Medicaid expansion linked to a reduction in pre-pregnancy depression

The expansion of Medicaid under the Affordable Care Act was linked to a lower chance of low-income individuals reporting that they experienced depression before pregnancy, a study led by a Michigan State University researcher found.

“The takeaway message is that having health insurance before, during, and after pregnancy may be an important determinant of a woman’s mental health, because it may increase access to timely and effective care,” said Claire Margerison, PhD, the study’s lead author and an associate professor of epidemiology and biostatistics in the College of Human Medicine.

That finding is significant, Margerison said, because depression and other mental health problems often affect not only pregnant individuals but their children and other family members.  

The study, published in the October issue of Health Affairs, a peer-reviewed health policy journal, found that Medicaid expansion was associated with a 16% decline in self-reported pre-pregnancy depression among low-income individuals. The researchers analyzed data from the Pregnancy Risk Assessment Monitoring System or PRAMS, which surveyed women in several states who gave birth between 2012 and 2018.

The study compared the percentage of individuals who reported experiencing depression prior to pregnancy in states that expanded Medicaid coverage with women in states that did not and compared changes in this percentage from before and after the expansion of Medicaid under the Affordable Care Act.  

Margerison speculated that Medicaid expansion was linked with lower self-reported depression because having health insurance can decrease financial stress and increase access to mental health care, although future research is needed to understand exactly why this link was found.  

However, the study did not find a link between the Medicaid expansion and post-partum depression, possibly because the risk factors for postpartum depression are different than for depression that occurs before pregnancy, Margerison said.

The study suggests that further expansion of Medicaid to more low-income women could have benefits beyond improving their mental health in the short term and could have long-term benefits for their children.

“The parents’ ability to care for their infants can be impacted negatively if they have mental health concerns,” Margerison said.