Therapy and Antidepressant Use in 8- to 29-Year-Old Autistic Medicaid Enrollees With Depression

Promoting access to effective depression treatment represents a crucial opportunity to mitigate increased suicide risk. We examined treatment trajectories for 8- to 29-year-old autistic enrollees of Medicaid, the U.S. safety net insurance program, with a new claim for major depressive disorder (MDD; N = 44,074). Using group-based trajectory modeling, we identified groups with similar probabilities of receiving psychotherapy or antidepressants in the 5 months following their new MDD claim - a period of acute treatment need. We also examined odds of trajectory group membership by demographic factors and co-occurring intellectual disability (ID) using multinomial logistic regression. Trajectory modeling suggested existence of four treatment trajectories: no/limited treatment (39%), gradual treatment decline (21%), late treatment initiation (14%), and continuous treatment (25%). Adjusted odds of continuous treatment, relative to no/limited treatment, were lower for Black enrollees (odds ratio [OR]: 0.63, 95% confidence interval [CI]: [0.59, 0.68]), Hispanic enrollees (OR: 0.58, 95% CI: [0.54, 0.62]), and those with co-occurring ID (OR: 0.84, 95% CI: [0.79, 0.89]), and highest for 8- to 12-year-olds (OR: 1.80, 95% CI: [1.60, 2.03]) and females (OR: 1.15, 95% CI: [1.09, 1.21]). Many Medicaid-enrolled autistic people do not receive depression treatment. Improving treatment in autistic enrollees requires varied and multi-faceted approaches that must consider demographic and clinical factors.Lay AbstractWe wanted to know if autistic people on Medicaid get therapy or antidepressants after being diagnosed with depression. We also looked at whether people who are also diagnosed with intellectual disability, are female, are children, or are Black or Hispanic are more or less likely to get this care. Earlier studies show that just over half of the people on Medicaid get any treatment after being diagnosed with depression. But no one has looked closely at autistic people on Medicaid. Getting treatment can help reduce depression symptoms and may lower the risk of suicide. In our study, we looked at autistic people on Medicaid who were newly diagnosed with depression. We tracked whether they got therapy or antidepressants over the next 5 months. We grouped people based on how much treatment they got. The largest group (39%) got no treatment. The second group (21%) started treatment but did not continue for all 5 months. The third group (14%) started treatment around the third month and kept going for 2 months. The last group (25%) got treatment for all 5 months. Autistic people who were Black, Hispanic, or had intellectual disability were least likely to get enough treatment. Autistic children and females were most likely to get enough treatment. In short, many autistic people are not getting the care they need for depression. Some may not get enough treatment to feel better. This can make depression last longer and raise the risk of suicide. We need to improve access to care, especially for those who are least likely to get it.