WASHINGTON, DC (June 4, 2025)—Psychotherapy is a recommended first-line treatment for mild-to-moderate perinatal mood and anxiety disorders (PMADs), but relatively few people with these diagnoses receive treatment. In a study selected as the Editor’s Choice for the May/June Women’s Health Issues, the authors used claims data to examine whether out-of-pocket cost (OOPC) levels were associated with the number of psychotherapy visits in insured individuals with PMADs.
Women’s Health Issues is the official journal of the Jacobs Institute of Women’s Health, which is based at the Milken Institute School of Public Health (Milken Institute SPH) at the George Washington University.
Stephanie V. Hall, of the University of Michigan Medical School, and colleagues used 2016-2020 claims data for enrollees in employer-sponsored insurance plans. They focused on more than 200,000 enrollees who gave birth during that time period, were enrolled continuously during the 12 months before and after they gave birth, and had mental health coverage through their plans. To categorize enrollees as having PMADs or not, the authors looked for one inpatient or two outpatient claims containing a PMAD diagnosis during the 24-month period surrounding the birth. They also categorized enrollees as having lower or higher income (having household income below vs. at or above 400% of the federal poverty level) and plans as having low or high OOPCs.
Hall and colleagues found that enrollees in low OOPC plans were more likely to have at least one psychotherapy visit than those in high OOPC plans. Enrollees with lower incomes attended a median of five psychotherapy visits regardless of whether their plans had high or low OOPCs. Among those with higher incomes, though, enrollees in low OOPC plans attended a median of seven psychotherapy visits, whereas those in high OOPC plans attended only six.
“These findings suggest that reducing cost-related barriers to care, including OOPCs, may improve treatment utilization particularly for lower-income birthing people with PMADs,” the authors write.
“Improving perinatal mental health is especially important given how much mood and anxiety disorders can affect birthing parents and their families during this crucial stage,” said Karen McDonnell, Editor-in-Chief of Women's Health Issues and associate professor of prevention and community health at Milken Institute SPH. “Insurers should consider eliminating cost-sharing for perinatal mental health treatment to ensure that all new parents can access the care they need.”
“Association Between Out-of-Pocket Insurance Costs and Psychotherapy Utilization Among Commercially Insured Birthing Individuals” has been published in the May/June 2025 issue of Women’s Health Issues.