Disparities in utilization and delivery outcomes for women with perinatal mood and anxiety disorders (PMAD): groundwork for state policymaking

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Project Summary/Abstract This study directly responds to NIMHD Program Announcement for Health Services Research on Minority Health and Health Disparities (PAR-20-310). Perinatal mood and anxiety disorders (PMAD), which include depression and/or anxiety in the year before and/or after delivery, are common complications of pregnancy, affecting up to one in four women, with costs over $15 billion per year in the US. PMAD can negatively affect mothers, babies, and families beyond the perinatal period, and have lasting clinical and economic effects. PMAD treatment can improve maternal and neonatal health outcomes, yet mental health services are rarely used. No comprehensive data source documents the: 1) magnitude, 2) predictors, and 3) variation in disparities by race and ethnicity, socioeconomic status, and geography in healthcare utilization or obstetric delivery outcomes among women with PMAD. Almost no evidence documents the impact of community characteristics on these outcomes. There is no national plan for how best to address PMAD, overall, or within high-risk subgroups. Using data from publicly (Medicaid) and privately (Optum) insured women with PMAD, state survey data, input from a panel of perinatal mental health services and policy experts, and interviews with state maternal and infant health (MIH) and MH policy makers, we will: 1) identify patient-level clinical characteristics associated with MH and overall perinatal utilization and delivery-related outcomes among women with diagnosed PMAD, and establish accurate national and state-level estimates of disparities in care patterns and outcomes, including MH utilization, overall utilization, and delivery-outcomes; 2) determine contributions of community-level characteristics to perinatal utilization and delivery outcomes among women with PMAD using data from Pregnancy Risk Assessment Monitoring System (PRAMS), Area Health Resource File (AHRF), and National Mental Health Services Survey (N-MHSS); and 3) collaborate with an expert panel to develop an evidence-based policymaking guide for PMAD, which we will use to interview state maternal and infant health and mental health policy officials. Using Aim 1-2 findings and expert panel input, we will develop an EBP guide for PMAD. This guide will provide structure for interviews with state maternal and infant health and mental health policy officials from states with high and low relative performance on PMAD treatment and outcomes to help interpret quantitative findings, tailor recommendations, and assist in future PMAD policymaking initiatives. Given the dearth of research on disparities in addressing PMAD and associated utilization and delivery outcomes, and the high, inter-generational costs for mother and baby of ineffectively managed PMAD, this innovative, large-scale investigation will provide evidence for future policymaking and clinical interventions. Our findings and policy guidance could address disparities in outcomes for high cost, high risk subpopulations.