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Internationally and in the United States, health care has been increasingly perceived and codified as a human right, and the violation of this right through being uninsured may contribute to the development of depression. Studies in several countries with markedly different healthcare structures than the United States have linked health insurance and depression both causally and associatively. However, it is unclear how this association may manifest in the United States given the unique healthcare system. Therefore, this study examined the association between being uninsured and clinical depression in the United States. Using a cross-sectional sample of 17,284 participants (57.9% female) from the CDC's 2015 Behavioral Risk Factors Surveillance System survey, we conducted a weighted multiple logistic regression analysis examining the association between health insurance and clinical depression. Several demographics and risk factors were controlled for. Being uninsured was associated with higher odds of having depression (aOR= 1.71), which was similar to common risk factors, such as being obese (1.43) and being an occasional smoker (1.91). Being uninsured may be a risk factor for depression. This association has implications for health insurance policy and clinical mental health practice., Author(s): Phillip M Hughes [sup.1] [sup.2] , Megan S Hughes [sup.3] Author Affiliations: (1) grid.10698.36, 0000000122483208, UNC Health Sciences at MAHEC, , Chapel Hill, NC, USA (2) grid.10698.36, 0000000122483208, Division [...]

This study aimed to describe the beliefs associated with the intention to become licensed to prescribe among psychologists in Pennsylvania using the theory of planned behavior. We conducted a survey (March–May 2023) of attitudes, subjective norms, and perceived control among members of the Pennsylvania Psychological Association, generating a response rate of 24.2% (n = 284). The primary outcome was how likely the respondent was to become licensed to prescribe if authorizing legislation passes in Pennsylvania, followed by an open-ended question about their rationale. The association between the likelihood of becoming a prescriber and the attitudes, subjective norms, and perceived control about prescribing was estimated using logistic regression, adjusting for demographic and professional information. Results were calculated as average marginal effects (AME) and corresponding 95% confidence interval. Open-ended responses were assessed using inductive thematic coding. Approximately 35% of psychologists reported being likely to become a prescriber. Direct social norms were associated with a 15.4 percentage-point increase ([0.12, 0.19]) in the probability of becoming a prescriber, and indirect attitudes were associated with a 9.7 percentage-point increase ([0.06, 0.14]). These results were supported by the qualitative themes that emerged: Personal Reasons, Professional Reasons, and Improving Patient Care. These themes included concerns about age, changing professional psychology, medication, increasing access to care, and licensure requirements. Psychologists' attitudes and social norms about prescribing psychology are key indicators of their intention to become licensed to prescribe. These findings could inform interventions to improve licensure rates and policymakers considering the adoption of psychologist prescriptive authority. Public Significance Statement: This study suggests that the intention of psychologists in Pennsylvania to become licensed prescribers is motivated by their attitudes about prescribing and if they believe most people think prescribing would be good. Psychologists were primarily concerned about a mix of personal, professional, and patient issues related to prescribing. These findings could (1) inform the development of an educational intervention to improve prescribing licensure rates and (2) provide additional considerations for policymakers exploring the adoption of prescriptive authority for psychologists in their state. [ABSTRACT FROM AUTHOR]

Introduction Interconception care (ICC) is recommended to reduce maternal risk factors for poor birth outcomes between pregnancies. The IMPLICIT ICC model includes screening and brief intervention for mothers at well child visits (WCVs) for smoking, depression, multivitamin use, and family planning. Prior studies demonstrate feasibility and acceptability among providers and mothers, but not whether mothers recall receipt of targeted messages. Methods Mothers accompanying their child at 12- and 24-month WCVs at four sites of a family medicine academic practice were surveyed pre (2012) and post (2018) ICC model implementation. Survey items assessed health history, behaviors, and report of whether their child's physician addressed maternal depression, tobacco use, family planning, and folic acid supplementation during WCVs. Pre and post results are compared using logistic regression adjusting for demographics and insurance. Results Our sample included 307 distinct mothers with 108 and 199 respondents in the pre and post periods, respectively. Mothers were more likely to report discussions with their child's doctor post-intervention for family planning (31% pre to 86% post; aOR 18.65), depression screening (63-85%; aOR 5.22), and taking a folic acid supplement (53-68%; aOR 2.54). Among mothers who smoked, the percentage that reported their child's doctor recommended cessation increased from 56 to 75% (aOR = 3.66). Discussion The IMPLICIT ICC model resulted in increased reported health care provider discussions of four key areas of interconception health by mothers attending WCVs. This model holds promise as a primary care strategy to systematically address maternal risks associated with poor pregnancy outcomes., Author(s): Daniel Frayne [sup.1] , Phillip Hughes [sup.1] , Brunilda Lugo [sup.1] , Kathy Foley [sup.1] , Stephanie Rosener [sup.2] , Wendy B. Barr [sup.3] [sup.4] , Scott A. Davis [...]

The authors sought to provide updated estimates of the proportion of psychotropic medications prescribed by different medical providers. This pooled cross-sectional study used data from the Medical Expenditure Panel Survey (2016–2019). Nationally representative estimates of the percentages of all psychotropic medications prescribed by each provider type were calculated, and analyses stratified by medication type, insurance type, and age were conducted. Data from 58,547 psychotropic prescriptions reported by 7,693 unique individuals were analyzed. More than 60% of psychotropic medications were prescribed by providers other than psychiatrists (33.5%) or psychologists (2.2%), such as general practitioners, nurse practitioners, and physician assistants. This distribution varied significantly by medication, insurance, and patient age. Most psychotropic medication prescribing occurs in primary care; however, notable differences by medication, insurance, and age were observed, suggesting areas for future research. [ABSTRACT FROM AUTHOR]

This study simulated the impact of granting prescriptive authority to licensed psychologists on shortages of mental health providers with prescriptive authority. We used national and state-level secondary data to construct a policy simulation. Mental health prescribing need and the number of mental health prescribers were estimated at the national and state levels, and the provider shortage was calculated as the difference between these two values. The simulated policy intervention added 10% of psychologists to the prescriber group to estimate the associated reduction in prescriber shortages. Probabilistic uncertainty and sensitivity analyses were conducted using 10,000 Markov trials in which all model parameters varied randomly based on their associated uncertainty. The simulated policy value was allowed to vary between 5% and 15%. The prescriber shortage was predicted to fall by 4.34% (95% CI [0.75%, 16.58%]) nationally, though this varied widely by state, ranging from 1.10% [0.20%, 3.82%] in North Dakota to 26.44% [2.89%, 570.29%] in Washington, DC. Uncertainty and sensitivity analyses demonstrated that variability in the provider shortage reduction was primarily driven by the percentage of psychologists becoming licensed to prescribe. Our results suggest that granting prescriptive authority to licensed psychologists would reduce the shortage of mental health professionals with prescriptive authority. Further work is needed to examine the potential implications for other mental health providers. [ABSTRACT FROM AUTHOR]

Six states (New Mexico, Louisiana, Illinois, Iowa, Idaho, and Colorado) grant prescriptive authority to qualified psychologists, and research has shown that these policies are associated with a reduction in suicides. In this study, we assess the cost-effectiveness of these policies in reducing suicide rates. This study used a Markov model with a time horizon of 20 years to estimate the incremental net monetary benefit (INMB) of the policy from the societal perspective with a simulated cohort of 100,000 people. Transition probabilities and utilities were collected from the literature, and costs were assessed using a mixed macro- and microcosting approach. Using this approach, we found that the 20-year INMB for the policy was estimated to be $12.81 million (U.S. dollars) per quality-adjusted life year (QALY). The probability of cost-effectiveness was greater than 50% at a willingness-to-pay threshold as low as $10,000 per QALY. The probability of cost-effectiveness was only modestly associated with the implementation costs of the policy but was sensitive to the estimated effect of the policy intervention. The models estimated in this study support prescriptive authority for psychologists as a cost-effective strategy for reducing state-level suicide rates. A considerable amount of research is needed to understand the impact of this policy with finer granularity. Public Significance Statement: Prescriptive authority for psychologists may be a cost-effective means to reduce suicide deaths at the policy level. However, this study also highlights several important knowledge gaps that should be addressed regarding the patient outcomes associated with psychologist prescriptive authority. [ABSTRACT FROM AUTHOR]