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

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This study directly responds to the NIMH Notice of Special Interest: Helping to end addiction long-term (HEAL) supplements to improve the treatment and management of common co-occurring conditions and suicide risk in people affected by the opioid crisis (NOT-MH-20-025). Paralleling overall population trends, opioid use has escalated among delivering women. Untreated opioid use disorder (OUD) during the year before and after delivery leads to poor maternal and infant outcomes, including pregnancy-related overdose, suicide, and neonatal abstinence syndrome (NAS). Perinatal women treated for chronic pain my experience similar adverse outcomes if their opioid-managed pain is not handled effectively. 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 two-year study capitalizes on R01 MH120124, which examines how federal BH policy changes influence outcomes for perinatal mood and anxiety disorders (PMAD). This study will examine opioid and pain- related outcomes among delivering women. It will use a large national sample of women enrolled in employer- based insurance using Optum Clinformatics Data Mart with linked mother-infant data. We will use patient-level analyses of delivering women with opioid prescriptions to examine associations of mandated federal BH policy changes with: 1) changes in opioid prescriptions, OUD, MOUD, chronic pain, and suicidality in the perinatal period; 2) changes in delivery-related maternal outcomes including caesarean delivery and severe maternal morbidity, and infant outcomes including preterm birth, NAS neonatal intensive care unit (NICU) admission, respiratory distress and 3) changes in maternal and infant utilization and expenditures in the perinatal period. For each aim, we will examine how changes vary: 1) for those with and without co-occurring PMAD; 2) in states with strong compared to weak pre-existing parity laws, and 3) in plans subject to new parity laws compared to those exempted from the laws. Despite growing awareness of negative consequences of perinatal opioid use and chronic pain, we know little about impacts of BH policies on related perinatal outcomes. Given high, inter-generational costs for mother and baby of perinatal opioid use and untreated OUD, especially among those with PMAD, this innovative, large-scale investigation will provide evidence necessary for future policymaking and clinical intervention efforts, and could influence delivery-related and downstream clinical and economic outcomes for this costly, high-risk population. This study is part of the NIH’s Helping to End Addiction Long-term (HEAL) initiative to speed scientific solutions to the national opioid public health crisis. The NIH HEAL Initiative bolsters research across NIH to improve treatment for opioid misuse and addiction.