Impact of mental health diagnosis and treatment on asthma related services in medicaid youth with asthma

The most common chronic condition among children and adolescents in the United States is asthma. An association between asthma and mental health has been reported by a multitude of studies. However, characterizing, specifying and quantifying the relationships between mental health comorbidities with the delivery of asthma related services have not been accomplished. This study examines asthma related health services in youth with asthma, including assessment of specific factors which may impact asthma-related utilization. Specifically, this study investigates the impact of depression, anxiety and attention deficit hyperactivity disorder (ADHD) and the treatment of these conditions on asthma-related expenditures and health service use using a statewide sample of 8,241 youth with asthma between age 6 years and 16 years continuously enrolled in Florida Medicaid over 36 months from January 2002 through December 2004.;The current research methodology improves upon prior studies by using individual mental health diagnoses, a larger sample size, and longitudinal data. Four models are used to address the delivery of health services. The first model seeks to explain the effect of ADHD, anxiety, and depression on asthma related use and expenditures. The second model examines the length of mental health diagnosis on asthma-related use and expenditures. The third and fourth models assess the effect of mental health treatment on asthma-related use and expenditures.;General findings suggest asthma care for those with anxiety is costly with high utilization across all asthma-related outcomes, indicative of poor coordination. Comorbid depression was associated with greater inpatient service use, but generally less asthma medication fills, suggesting poor asthma adherence and coordination. Comorbid ADHD was associated with lower inpatient use and expenditures, and higher asthma related medication fills and medical claims suggesting better coordination and adherence to medication regimen and coordination of asthma management. Generally, mental health treatment tended to mediate the inpatient utilization for those with mental health conditions towards similar utilization to those without the condition. Depression treatment suggested better adherence, whereas anxiety treatment suggested more inpatient care. Better coordination of asthma management is indicated for those with comorbid anxiety and depression, as pediatricians tend to refer these patients to psychiatric services.