Depression Medication Adherence Varies Among Medicaid Youth

Poor medication adherence increases risk of persistent depression, suicide and self-harm.

A national study of nearly 200,000 Medicaid- enrolled youth ages 9 to 24 found major gaps in the quality of antidepressant treatment and adherence for a new major depressive episode. Researchers analyzed Medicaid claims from 2016 to 2019 to assess consistency with Healthcare Effectiveness Data and Information Set (HEDIS) measures and guidelines from American Academy of Pediatrics and American Academy of Child and Adolescent Psychiatry.

Researchers evaluated whether participants remained on antidepressants for at least 84 days, completed three follow-up visits in the acute phase and continued medication for at least 180 days in the continuation phase. Cynthia A. Fontanella, PhD, principal investigator in the Center for Suicide Prevention and Research at Nationwide Children’s, led the work, published in Journal of the American Academy of Child & Adolescent Psychiatry.

About 49.6% of youth adhered to medication management and 55.2% had at least three follow-up visits during the acute phase of treatment. Only 26.5% met measures for the continuation phase.  Poor adherence increases the risk of persistent depression, relapse, self-harm and suicide. Older teens, young adults, racial and ethnic minority youth and those with substance use disorders (SUDs) were least likely to meet quality measures.

Cynthia A Fontanella, PhD

“Several factors may contribute, including shifts in Medicaid eligibility, health plan changes and less parental involvement as youth gain independence. Medicaid and minority patients often face limited access to care and transportation. Concerns about medication side effects, limited trust in providers, communication challenges and structural barriers can further hinder engagement. Youth with SUDs may also struggle with low motivation, forgetfulness and higher dropout rates,” says Dr. Fontanella.

Youth with chronic medical conditions, experience taking medications or involvement with foster care systems were more likely to adhere to treatment. Researchers suggest these patients may be more familiar with navigating healthcare systems, communicating with providers and attending regular follow-ups.

For pediatric providers, the study highlights clear opportunities for improvement. Dr. Fontanella emphasizes educating families about antidepressant benefits, addressing concerns about side effects and reinforcing the need for ongoing medication and follow-up. Regular monitoring, patient-centered communication and culturally sensitive approaches may help improve engagement, particularly among underserved populations.

Primary care visits are key to assessing depression, substance use and social determinants of health. Because these clinicians often initiate treatment, pediatric practices are well positioned to identify barriers, support adherence and ensure consistent follow up.

Despite well-established treatment guidelines, a gap remains between recommended depression care and what many people receive in the community. Closing that gap will require greater attention to education, follow-up and targeted support for the youth most at risk of falling out of care.

This article appeared in the 2026 Fall/Winter print issue. Download the issue here.

Reference:

Fontanella CA, Hyer JM, Steelesmith DL, Campo JV, Fristad MA, Bridge JA, dos Reis S, Brock GN, Olfson M. Antidepressant Treatment Quality of Depressed Youth: A National Evaluation of Medicaid Patients. Journal of the American Academy of Child and Adolescent Psychiatry. 2026;65(5):685-696.

Image Credit: Nationwide Children’s