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

这项研究直接回应了特殊利益通知(NOSI)：NIH拨款的行政补充资金 增加或扩大侧重于孕产妇死亡率的研究(非OD-20-104)。美国的票价是最差的 发达国家在预防与怀孕有关的死亡方面；在过去20年中，死亡率翻了一番 在美国，而在其他地方则在下降。每一例产妇死亡，100名妇女都会经历严重的产妇死亡。 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程序。 在严重的孕产妇发病率和死亡率(SMMM)方面仍然存在显著差异，即使三分之二的 SMMM病例可能是可以预防的。非西班牙裔黑人和低收入女性的比例要高得多 SMMM与他们的同行相比。行为健康(BH)状况，如自杀、吸毒过量、 他杀和意外伤害是SMMM的主要因素，但这些死亡被排除在外 根据基于人口的怀孕相关死亡统计数据，可能会导致低估SMMM。在……里面 除了SMMM的BH原因外，BH条件可能会因其他原因加重SMMM。 《2008年精神健康平等和成瘾平等法》(MHPAEA)，以及随后的联邦立法 影响精神健康和物质使用障碍的好处，提供了最大的行为扩展之一 通过增加覆盖范围并将联邦平价保护扩展到60以上，在一代人的医疗(BH)覆盖范围内 百万美国人。大多数健康计划，包括商业的、以雇主为基础的计划，必须涵盖BH护理和 与医疗/外科护理相比，不能提供不那么慷慨的医疗保险。超过一半的孕妇是 私人参保，以及由于BH政策变化而改善的覆盖范围可能会影响他们的BH服务收入。 这项拟议的研究利用了R01MH120124，它检查了联邦BH政策的变化如何影响 围产期情绪和焦虑症(PMAD)的结局。这项研究将全面审查SMMM，并在 高危人群。它将使用一个大的、经济的、不同种族的国家样本，在雇主- 以保险为基础的Optom，从2005年到2018年。这项拟议的为期一年的研究将使用患者和计划水平的分析 检查强制联邦保健政策变化与以下方面的关联：1)SMMM的变化 在围产期(例如，21个严重孕产妇发病率指标、服药过量、自杀和死于任何 怀孕期间、分娩住院期间和产后一年内的原因；2)在以下情况下SMMM的变化 高危亚组。对于每个目标1的结果，我们将检查如何变化：1)对于那些有和没有的结果 共同发生的PMAD和药物使用障碍；2)按种族/民族划分，3)按收入划分，4)在较强与 薄弱的预先存在的平价法律，以及5)受新平价法律约束的计划与不受该法律约束的计划。 尽管人们越来越意识到女性面临的致命后果，但我们对BH的贡献者知之甚少 对这些结果的反应。为NIH有效实施孕产妇健康和妊娠结局远景 每个人(改善)，我们不能忽视BH条件、治疗和保险政策的影响。

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.