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NIMH特别关注的通知：帮助结束成瘾，长期(Hear)补充剂，以改善受阿片类药物危机影响的人常见共生条件和自杀风险的治疗和管理(非-MH-20-025)。与总体人口趋势平行的是，分娩妇女中阿片类药物的使用有所上升。在分娩前和分娩后一年内未经治疗的阿片类药物使用障碍(OUD)会导致不良的母婴结局，包括妊娠相关的过量用药、自杀和新生儿禁欲综合征(NAS)。如果阿片类药物治疗的疼痛得不到有效的处理，接受慢性疼痛治疗的围产期妇女也会经历类似的不良后果。 2008年的《精神健康平等和成瘾平等法》(MHPAEA)，以及随后影响精神健康和药物使用障碍福利的联邦立法，通过增加覆盖范围并将联邦平等保护扩大到6000多万美国人，提供了一代人以来最大规模的行为健康(BH)覆盖范围之一。大多数健康计划，包括商业的、雇主为基础的计划，必须涵盖BH护理，并且不能提供与医疗/外科护理相比不那么慷慨的BH保险。超过一半的孕妇参加了私人保险，由于妇幼保健政策变化而改善的覆盖范围可能会影响她们的妇幼保健服务收入。 这项拟议的为期两年的研究利用了R01 MH120124，该研究考察了联邦BH政策的变化如何影响围产期情绪和焦虑症(PMAD)的结局。这项研究将检查分娩妇女中阿片类药物和疼痛相关的结果。它将使用在全国范围内登记参加雇主保险的妇女的大样本，使用Optom Clinformatics Data Mart和关联的母婴数据。我们将使用患者层面的分析，以检查强制联邦BH政策变化与以下方面的关系：1)围产期阿片类药物处方、OUD、Moud、慢性疼痛和自杀的变化；2)与分娩相关的孕产妇结局的变化，包括剖腹产和严重的孕产妇发病率；以及婴儿结局，包括早产、NAS新生儿重症监护病房(NICU)入院、呼吸窘迫，以及3)围产期母婴利用和支出的变化。对于每个目标，我们将检查变化如何：1)对于那些有和没有同时出现PMAD的人；2)在与先前存在的弱的平价法律相比更强的州；以及3)在受新的平价法律约束的计划中与那些不受法律约束的计划相比。 尽管人们越来越意识到围产期使用阿片类药物和慢性疼痛的负面后果，但我们对BH政策对相关围产期结局的影响知之甚少。鉴于围产期阿片类药物使用和未得到治疗的母婴代际成本很高，特别是在患有PMAD的人中，这项创新的大规模调查将为未来的政策制定和临床干预努力提供必要的证据，并可能影响这一昂贵的高危人群与分娩相关的下游临床和经济结果。 这项研究是NIH帮助结束成瘾长期(Hear)倡议的一部分，该倡议旨在加快科学解决国家阿片类药物公共健康危机的速度。NIH Hear Initiative支持整个NIH的研究，以改善阿片类药物滥用和成瘾的治疗。

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.