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（HEAL）补充剂，以改善受阿片类药物危机影响的人群中常见并发症和自杀风险的治疗和管理（NOT-MH-20-025）。与总体人口趋势相反，阿片类药物的使用在分娩妇女中有所升级。在分娩前后一年内未经治疗的阿片类药物使用障碍（OUD）会导致母婴结局不良，包括妊娠相关的过量用药、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。 2008年的《精神健康平等和成瘾平等法案》（MHPAEA）以及随后影响精神健康和物质使用障碍福利的联邦立法，通过增加覆盖面和将联邦平等保护扩大到6000多万美国人，提供了一代人中行为健康（BH）覆盖面最大的扩展之一。大多数健康计划，包括商业、基于雇主的计划，必须涵盖BH护理，并且不能提供相对于医疗/手术护理而言较不慷慨的BH覆盖范围。一半以上的孕妇有私人保险，由于生育保险政策的变化，保险范围的扩大可能会影响她们获得生育保险服务。 这项为期两年的研究利用了R 01 MH 120124，研究了联邦BH政策的变化如何影响围产期情绪和焦虑障碍（PMAD）的结果。这项研究将检查分娩女性中阿片类药物和疼痛相关的结果。它将利用Optum Clinformatics Data Mart与母婴数据相关联，对参加雇主保险的妇女进行大规模的全国抽样。我们将对使用阿片类药物处方分娩的妇女进行患者水平的分析，以检查强制性联邦BH政策变化与以下因素的关联：1）阿片类药物处方、OUD、MOUD、慢性疼痛和围产期自杀倾向的变化; 2）与分娩相关的孕产妇结局（包括剖腹产和严重孕产妇发病率）和婴儿结局（包括早产）的变化，NAS新生儿重症监护室（NICU）入院、呼吸窘迫和3）围产期母婴利用和支出的变化。对于每一个目标，我们将研究变化如何变化：1）对于那些有和没有共同发生的PMAD; 2）在国家与弱相比，现有的平价法律强，3）在计划受新的平价法律相比，从法律豁免。 尽管人们越来越认识到围产期阿片类药物使用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经治疗的OUD的母亲和婴儿的高代际成本，特别是在PMAD患者中，这项创新的大规模调查将为未来的政策制定和临床干预工作提供必要的证据，并可能影响分娩相关和下游临床和经济结果。 这项研究是NIH帮助结束长期成瘾（HEAL）计划的一部分，旨在加速科学解决国家阿片类药物公共卫生危机。NIH HEAL倡议支持整个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.