Epidemiology and Biostatistics Dissertation Defense: Meghan Carey
Wednesday, August 7, 2024
10:00 AM-12:00 PM
Meghan Carey, MS, will present
"Understanding follow-up care trajectories and quality for depression
among Medicaid enrolled autistic young people."
Depression is a major contributor to disability. 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 further complicate providers’ ability to make mental health
diagnoses and therefore delay condition management. Depression tends to arise
during adolescence or early adulthood, 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. In line with the multiple minority theory, studies of depression
suggest prevalence may be higher among already vulnerable groups. 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, such as the
increased suicide rate among autistic people.
The dissertation followed >1.8
million 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 diagnostic
subgroups, with a particular focus on autistic people, and important 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.
Meghan is a PhD candidate in Epidemiology working under the supervision of
Dr. Kristen Lyall. Her research is broadly focused on the systemic factors that
influence healthcare delivery and outcomes for autistic individuals.
Dissertation committee members:
Kristen Lyall (chair), ScD, Lindsay Shea, DrPH, Brian Lee, PhD, Diana
Schendel, PhD, Laura Graham Holmes, PhD.
Zoom link
Contact Information
Nancy Colon-Anderson
nanderson@drexel.edu