Reducing Racial Disparities and Maternal Mortality Associated with Untreated Peripartum Substance Use and Mental Health Disorders

1.摘要 美国的孕产妇死亡率高于其他任何发达国家和非西班牙裔黑人 女性的死亡率是非西班牙裔白色女性的2.5倍，是西班牙裔女性的3.1倍。 妇女调查孕产妇死亡时间和病因的研究之间的方法学差异 不同，但研究，包括自我伤害，并延长到产后一整年表明，药物过量， 和自杀加在一起是孕产妇死亡的主要原因。虽然发现率和治疗率 物质使用障碍（SUD）和精神健康障碍（MHD）在怀孕期间和一年 产后[即，围产期]是低的所有妇女，有明显的种族不平等，需要 作为降低孕产妇死亡率和实现保健公平的总体战略的一部分。与支撑 国家药物滥用研究所（NIDA）家长奖（R34 DA 04673），我们开发了倾听 妇女（LTW）;一项基于移动的电话的计划，旨在改善围产期SUD和MHD筛查，以及 以及加强妇女、产科和戒毒/精神病治疗提供者之间的沟通 在怀孕期间和产后一年。初步数据显示， 在筛查，短暂干预和转诊治疗（SBIRT）与LTW相比，在人SBIRT。 我们还发现了与人SBIRT的种族差异，这是不存在与LTW。长期 该提案的目标是为制定有效的、患者知情的干预措施提供信息，以减少种族歧视。 与未经治疗的围产期SUD和MHD相关的差异以及发病率和死亡率。目标 当前应用程序的一部分是与社区合作伙伴、同行领导的SUD和MHD恢复组织合作 和围产期黑人妇女：1）更好地了解识别和治疗围产期SUD的障碍， MHD;以及2）基于该反馈修改LTW。这项研究将导致一个关键的进展， 制定一项方案，以减少种族差异和因围产期未经治疗而造成的孕产妇死亡率; SUD和MHD以及加强医疗保健提供者之间的沟通和协调。 此外，本研究将生成LTW项目进一步有效性测试所需的初步数据。

1. ABSTRACT Maternal mortality in the United States is higher than any other developed country and non-Hispanic black women are dying at 2.5 times the rate of non-Hispanic white women, and 3.1 times the rate of Hispanic women. Methodological differences between studies investigating the timing and etiology of maternal mortality vary, but studies including self-harm and extending to the full year postpartum demonstrate that drug overdose and suicide combined are the leading cause of maternal mortality. While rates of detection and treatment of Substance Use Disorder (SUDs) and Mental Health Disorders (MHD) during pregnancy and the year postpartum [i.e., peripartum period] are low for all women, there are clear racial inequities that need to be addressed as part of an overall strategy to reduce maternal mortality and create health equity. With the support of the National Institute on Drug Abuse (NIDA) parent award (R34 DA04673) we developed Listening to Women (LTW); a mobile phone-based program designed to improve peripartum SUD and MHD screening, and treatment as well as enhance communication between women, obstetric and addiction/psychiatric providers during pregnancy and throughout the postpartum year. Preliminary data demonstrate significant improvements in Screening, Brief Intervention, and Referral to Treatment (SBIRT) with LTW, compared to in-person SBIRT. We also identified racial disparities with in-person SBIRT, which were not present with LTW. The long-term goal of this proposal is to inform the development of an effective, patient-informed intervention to reduce racial disparities and morbidity and mortality associated with untreated peripartum SUDs and MHDs. The objectives of the current application are to work with community partners, peer-led SUD and MHD recovery organizations and peripartum black women to: 1) better understand barriers to identifying, and treating peripartum SUDs and MHDs; and 2) modify LTW based on this feedback. This research will result in a critical advance in the development of a program to reduce racial disparities and maternal mortality due to untreated peripartum SUDs and MHDs as well as enhance communication and coordination of care between healthcare providers. In addition, this study will generate preliminary data necessary for further efficacy testing of the LTW program.