RTI International
Maternal Depressive Symptoms and Healthcare
Expenditures for Children with Chronic Conditions
Heather Beil, MPH, PhD
RTI International
Jada Brooks, PhD, MSPH, RN
Linda S. Beeber, PhD, RN, CS
University of North Carolina at Chapel Hill
RTI International is a trade name of Research Triangle Institute.
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www.rti.org
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Acknowledgements
This work was funded by Grant 2T32 NR007091 and
Grant 2T32 NR008856 from the National Institute of
Nursing Research, NIH
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Background
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Healthcare spending for children is highly concentrated
among children with chronic health conditions
Mothers of children with chronic conditions show higher
rates of depression
Management of a child’s chronic condition requires
reliable and accurate assessments and responses to the
child’s health needs
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Background
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Depressive symptoms include cognitive, behavioral, and
physical symptoms that accompany an unremitting sad
mood
Mothers with depressive symptoms may not be able to
help children adhere to treatment and may have anxiety
that could lead to over use of the ED
Previous work on children with asthma found that ED
use and expenditures declined after treating mothers for
depression
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Objective
The purpose of this study was to assess the relationships
between maternal depressive symptoms and their child’s
healthcare utilization and expenditures in a nationally
representative population of children with chronic health
conditions.
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Methods
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A cross-sectional analysis of the 2004-2009 Medical
Expenditure Panel Survey (MEPS)
Identified children as chronically ill if met at least one of
following conditions:
1) the caregiver reported that the child had a health condition that
required ongoing medical care that had or was expected to last
longer than one year;
2) the caregiver reported that the child had a functional limitation
that had or was expected to last longer than one year;
3) the child had a condition with an ICD-9 code that had been
determined to meet the criteria for a chronic condition in previous
studies.
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Methods
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Dependent variables: Annual number of ED visits, inpatient
admissions, preventive office based visits, acute office based visits,
outpatient and dental visits and associated expenditures
Main explanatory variable: binary variable indicating whether or not
the mother reported depressive symptoms
Control variables: Demographic information and child’s condition
severity
Negative binomial models for utilization variables
Two part models with logistic regression to estimate probability of
any expenditure and Generalized Linear Models to estimate amount
of expenditure conditional on having any for expenditures
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Results
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Among the 54,673 children identified the sample,
13,242, or 24% had a chronic health condition
14% of mothers with CCHC reported depressive
symptoms, while 9% of mothers with children without a
chronic health condition reported depressive symptoms
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Survey weighted average number of visits and adjusted Incidence Rate Ratios (IRR)
for each category for children with a chronic health condition (N=12,813; weighted
flN=17,217,068)
Mothers with Mothers without
Depressive
Depressive
symptoms
symptoms
Unadjusted
Unadjusted
Mean (SE)
Mean (SE)
Adjusted IRR
95% CI
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ED visits
0.30** (.03)
0.19 (.007)
1.21*
(1.01-1.45)
Acute office based
visits
4.15 (.31)
3.77 (.15)
1.12
(0.97-1.25)
Preventive visits
1.07 (.14)
1.09 (.03)
1.01
(0.86-1.20)
Outpatient visits
0.23 (.04)
0.25 (.02)
0.83
(0.59-1.16)
Inpatient admissions
0.10** (.02)
0.05 (.004)
1.78*
(1.06-2.98)
Dental visits
0.91** (.06)
1.34 (.04)
0.81*
(0.72-0.92)
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Adjusted expenditures by category for publicly insured children with a
chronic condition (N=12,812; weighted N=17,213,543)
Expenditure
Any expenditure
Amount
OR
95% CI
ß (SE)
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Total
0.80
(0.61-1.05)
.06 (.09)
ED
1.23*
(1.02-1.48)
-.12 (.09)
Office visit
0.90
(0.74-1.08)
.03 (.07)
Inpatient hospital
1.13
(0.94-1.37)
-.10 (.23)
Outpatient
0.99
(0.82-1.20)
-.16 (.21)
Prescription
0.95
(0.80-1.13)
.005 (.08)
Dental
0.73**
(0.62-0.87)
.03 (.10)
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Unconditional Predicted Expenditures
$2,861
Total**
$3,780
$103
$119
Emergency Department**
$2,678
$2,957
Inpatient**
$594
$435
Outpatient**
$641
$657
Office based visits
$348
$263
Dental**
$594
$755
Prescription**
$-
$500
$1,000 $1,500 $2,000 $2,500 $3,000 $3,500 $4,000
No depressive symptoms
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Depressive symptoms
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Discussion
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Mothers with CCHC were more likely to report
depressive symptoms than other mothers
 Children of mothers with depressive symptoms had
higher ED and inpatient utilization, lower dental
utilization, and higher predicted expenditures
 Dental care is number one unmet among children,
findings indicate that children of mothers with depressive
symptoms may be at higher risk for not getting care
 The association with higher ED visits could be due to
lack of management of disease or an inability to cope
with disease at home
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Limitations
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Mothers of children in worse health may be more likely to
report depressive symptoms, attempted to control for by
including measure of condition severity
Self-reporting bias
Cross-sectional, observational study
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Policy Implications
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Healthcare providers treating children with chronic conditions may
need to incorporate a more integrated approach to care
Both the American Academy of Pediatrics Task Force on the Family
and the Bright Futures practice guidelines emphasize the need to
support families by addressing maternal health conditions, including
depression
This study suggests that screening for and treating maternal
depressive symptoms may be important when caring for children
with chronic conditions