Dissertation
Understanding follow-up care trajectories and quality for depression among Medicaid-enrolled autistic young people
Doctor of Philosophy (Ph.D.), Drexel University
Sep 2024
DOI:
https://doi.org/10.17918/00010743
Abstract
Autistic people are at higher risk for depression compared to the general population. Though autistic young people are frequent utilizers of health services, difficulties in communication for autistic young people, and their complex clinical presentation may complicate providers' ability to make mental health diagnoses and therefore delay condition management. Depression tends to arise during adolescence, a developmental period that sets the stage for outcomes later in adulthood. Outcomes among autistic adults are poor in the domains of physical and mental health, independence, employment, social engagement, even compared to peers with other developmental or intellectual disabilities. Females, marginalized racial and ethnic groups, and individuals with co-occurring ID have established delays in diagnosis for autism, and may be at increased risk for delays in depression diagnosis. Understanding the follow-up care and quality of these conditions matters because better management of conditions can have positive downstream effects on morbidity and mortality, and mitigate the 7-fold increase in suicide rate observed among autistic people compared to the general population. The dissertation followed autistic Medicaid enrollees ages 8-29 through their initial diagnoses of depression and subsequent treatment for it. Aim 1 of this project describes the prevalence, incidence, and profiles of treated depression among Medicaid-enrolled autistic young people. Aim 2 identified group-based trajectories of treatment following a new major depressive episode. Aim 3 investigated the quality and predictors of follow-up care received following ED visits and hospitalization for depression using established healthcare quality measures. All study aims examined differences in findings by subgroups within the autistic community: females, marginalized racial and ethnic groups, and individuals with co-occurring ID. This project has multiple short- and long-term impacts on the autistic community, such as in the short-term pointing toward improvements in the quality of follow-up care received after ED visits or hospitalizations related to depression, which could reduce readmissions and risk of suicide. In the long-term, study results can guide Medicaid resource allocation and planning for future programmatic enrollment needs as well as support the ability of the Medicaid program to make available the services that the autistic community need for depression.
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Details
- Title
- Understanding follow-up care trajectories and quality for depression among Medicaid-enrolled autistic young people
- Creators
- Meghan Elizabeth Carey
- Contributors
- Kristen Lyall (Advisor)Lindsay Shea (Advisor)
- Awarding Institution
- Drexel University
- Degree Awarded
- Doctor of Philosophy (Ph.D.)
- Publisher
- Drexel University; Philadelphia, Pennsylvania
- Number of pages
- viii , 137 pages
- Resource Type
- Dissertation
- Language
- English
- Academic Unit
- Dana and David Dornsife School of Public Health; Drexel University
- Other Identifier
- 991021903508004721