Relationship between mental health coverage and outcomes for privately insured women with perinatal mood and anxiety disorders (PMAD)

本研究直接响应特别关注通知（NOSI）：NIH赠款的行政补充， 增加或扩大以孕产妇死亡率为重点的研究（NOT-OD-20-104）。美国的表现最差， 发达国家在预防与怀孕有关的死亡方面的作用;在过去二十年中， 美国，而其他地方则有所下降。每有一名产妇死亡，就有超过100名妇女经历严重的孕产妇死亡。 发病率，危及生命的诊断，或在分娩住院期间接受挽救生命的手术。 严重孕产妇发病率和死亡率方面的显著差异持续存在，尽管三分之二的 SMMM病例是可以预防的。非西班牙裔黑人和低收入妇女的发病率明显较高 与他们的同行相比，行为健康（BH）状况，如自杀，药物过量， 凶杀和非故意伤害是SMMM的主要贡献者，但这些死亡被排除在外 基于人口的妊娠相关死亡统计数据，可能导致低估SMMM。在 除了BH引起的SMMM之外，BH条件还可能因其他原因而使SMMM恶化。 2008年《精神健康平等和成瘾平等法》（MHPAEA）以及随后的联邦立法 影响心理健康和物质使用障碍的好处，提供了一个最大的扩展行为 通过增加覆盖率和将联邦均等保护扩大到60多岁， 数百万美国人大多数健康计划，包括商业性的、基于雇主的计划，必须涵盖BH护理， 不能提供相对于医疗/手术护理而言较少的BH覆盖范围。超过一半的孕妇 私人保险，以及由于BH政策变化而提高的覆盖范围可能会影响他们的BH服务接收。 拟议的研究利用了R 01 MH 120124，该研究考察了联邦BH政策变化如何影响 围产期情绪和焦虑障碍（PMAD）的结果。本研究将全面检查SMMM， 高危人群。它将使用一个大的，经济，种族多样化的国家样本的登记者在雇主- 基于保险，Optum，2005-2018年。这项为期一年的研究将使用患者和计划水平的分析 提供妇女审查协会的授权联邦波黑政策的变化：1）在SMMM的变化 在围产期（例如，21项严重孕产妇发病率指标，药物过量，自杀， 原因在怀孕期间，分娩住院，并长达一年产后; 2）在SMMM的变化， 高危亚组。对于每个目标1的结果，我们将研究变化如何变化：1）对于那些有和没有 共同发生的PMAD和物质使用障碍; 2）按种族/民族，3）按收入，4）在强与 原有的平等法律薄弱，5）受新平等法律约束的计划与不受法律约束的计划。 尽管人们越来越意识到妇女面临的致命后果，但我们对BH贡献者知之甚少 这些结果。为了使NIH有效地实施孕产妇健康和妊娠结局愿景， 每个人（改善），我们不能忽视BH条件，治疗和覆盖政策的影响。

This study directly responds to Notice of Special Interest (NOSI): Administrative supplements for NIH grants to add or expand research focused on maternal mortality (NOT-OD-20-104). The United States fares worst among developed nations in preventing pregnancy-related deaths; over the past two decades, mortality rates doubled in the US while decreasing elsewhere. For every maternal death, >100 women experience severe maternal morbidity, a life-threatening diagnosis, or undergo a life-saving procedure during delivery hospitalization. Striking disparities in severe maternal morbidity and mortality (SMMM) persist even though two-thirds of SMMM cases may be preventable. Non-Hispanic Black and low-income women have significantly higher rates of SMMM compared to their counterparts. Behavioral Health (BH) conditions such as suicide, drug overdose, homicide, and unintentional injury are among leading contributors to SMMM, yet these deaths are excluded from population-based pregnancy-related death statistics, likely leading to underestimates of SMMM. In addition to BH causes of SMMM, BH conditions may exacerbate SMMM from other causes. The Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA), and subsequent federal legislation affecting mental health and substance use disorder benefits, provided one of the largest expansions of behavioral health (BH) coverage in a generation by increasing coverage and extending federal parity protections to over 60 million Americans. Most health plans, including commercial, employer-based plans must cover BH care and cannot provide less generous BH coverage relative to medical/surgical care. Over half of pregnant women are privately insured, and improved coverage due to BH policy changes could affect their BH service receipt. The proposed study capitalizes on R01MH120124, which examines how federal BH policy changes affect outcomes for perinatal mood and anxiety disorders (PMAD). This study will examine SMMM overall and among high-risk populations. It will use a large, economically, racially diverse national sample of enrollees in employer- based insurance, Optum, from 2005-2018. This proposed one-year study will use patient- and plan-level analyses of delivering women to examine associations of mandated federal BH policy changes with: 1) changes in SMMM in the perinatal period (e.g., 21 severe maternal morbidity indicators, overdose, suicidality, and death from any cause during pregnancy, delivery hospitalization, and up to one year postpartum; 2) changes in SMMM within high-risk subgroups. For each Aim 1 outcome, we will examine how changes vary: 1) for those with and without co-occurring PMAD and substance use disorders; 2) by race/ethnicity, 3) by income, 4) in states with strong vs. weak pre-existing parity laws, and 5) in plans subject to new parity laws vs. those not subject to the laws. Despite growing awareness of lethal consequences delivering women face, we know little about BH contributors to these outcomes. For NIH to effectively Implement a Maternal health and PRegnancy Outcomes Vision for Everyone (IMPROVE), we must not ignore the impact of BH conditions, treatments, and coverage policies.