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

患有围产期情绪和焦虑症 (PMAD) 的私人受保女性的心理健康保险与结果之间的关系

• 批准号: 10409775
• 负责人: Kara Zivin
• 金额: $ 40.77万
• 依托单位: UNIVERSITY OF MICHIGAN AT ANN ARBOR
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-08-08 至 2024-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10409775
• 关键词: Address; Admission activity; Affect; American; Anxiety; Anxiety Disorders; Area; Awareness; Caring; Cesarean section; Child; Clinical; Data; Data Mart; Detection; Diagnosis; Disease; Economics; Emergency department visit; Enrollment; Ethnic Origin; Expenditure; Family; Feeling suicidal; Funding; Future; Generations; Health Benefit; Health Expenditures; Health Insurance; Health Legislation; Health Personnel; Health Policy; Health Services; Health Services Research; Healthcare; Helping to End Addiction Long-term; Income; Infant; Inpatients; Insurance; Insurance Coverage; Intervention; Investigation; Laws; Link; Maternal Health; Maternal Mortality; Medical; Mental Depression; Mental Health; Mental Health Services; Mood Disorders; Mothers; National Institute of Mental Health; Natural experiment; Neonatal Abstinence Syndrome; Neonatal Intensive Care Units; Operative Surgical Procedures; Opiate Addiction; Opioid; Outcome; Outpatients; Overdose; Pain; Patients; Pattern; Perinatal; Perinatal Care; Persons; Pharmaceutical Preparations; Policies; Population; Population trends; Postpartum Period; Pregnancy; Pregnancy Complications; Pregnant Women; Premature Birth; Provider; Psychotherapy; Public Health; Race; Research; Respiratory distress; Sampling; Self-Injurious Behavior; Speed; Statutes and Laws; Subgroup; Substance Use Disorder; Suicide; Suicide attempt; Treatment outcome; United States National Institutes of Health; Visit; Woman; Work; addiction; adverse birth outcomes; adverse outcome; base; behavioral health; chronic pain; chronic pain management; cost; cost outcomes; economic impact; economic outcome; experience; health care delivery; health plan; high risk population; hospital readmission; improved; infant outcome; innovation; interest; intergenerational; maternal outcome; negative affect; neonatal health; opioid epidemic; opioid misuse; opioid use; opioid use disorder; parity; perinatal mental health; perinatal outcomes; perinatal period; perinatal women; pregnancy related death; prescription opioid; self diagnosis; severe maternal morbidity; suicidal risk; treatment of anxiety disorders

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.

本研究直接回应了NIMH特别关注通知：帮助结束成瘾长期（HEAL）补充剂，以改善受阿片类药物危机影响的人群中常见共存疾病和自杀风险的治疗和管理（NOT-MH-20-025）。与总体人口趋势平行，在分娩妇女中，阿片类药物的使用也在增加。在分娩前后一年内未经治疗的阿片类药物使用障碍（OUD）会导致孕产妇和婴儿预后不良，包括与妊娠有关的过量用药、自杀和新生儿戒断综合征（NAS）。围产期妇女治疗慢性疼痛我的经验类似的不良后果，如果他们的阿片类药物管理的疼痛没有得到有效处理。

项目成果

Perinatal insurance coverage and behavioural health-related maternal mortality.

• DOI: 10.1080/09540261.2021.1903843
• 发表时间: 2021-09
• 期刊: INTERNATIONAL REVIEW OF PSYCHIATRY
• 影响因子: 2.8
• 作者: Admon, Lindsay K.;Zivin, Kara;Kozhimannil, Katy B.
• 通讯作者: Kozhimannil, Katy B.

Trends In Primary Cesarean Section Rates Among Women With And Without Perinatal Mood And Anxiety Disorders.

• DOI: 10.1377/hlthaff.2021.00780
• 发表时间: 2021-10
• 期刊: HEALTH AFFAIRS
• 影响因子: 9.7
• 作者: Zochowski, Melissa K.;Kolenic, Giselle E.;Zivin, Kara;Tilea, Anca;Admon, Lindsay K.;Hall, Stephanie, V;Advincula, Agatha;Dalton, Vanessa K.
• 通讯作者: Dalton, Vanessa K.