Assessing maternal mental health needs with our state partners
Our state of Michigan research focuses on mental health diagnoses and health care utilization during pregnancy and postpartum.
Our research program also partners with Michigan Department of Health & Human Services and Michigan Pregnancy Risk Assessment Monitoring System through the Michigan Mental Health Integration Partnership program. In this partnership, our team explores mental health conditions in the Michigan Medicaid population of women who delivered babies.
Visual abstract depicting study findings. In this study titled "Racial Disparities in Diagnosis of Postpartum Mood and Anxiety Disorders (PMAD) Among Symptomatic Michigan Medicaid Enrollees, 2012-15," we found that only about 20% of patients reporting PMAD symptoms received a diagnosis. White patients with PMAD were three times more likely than Black patients to receive a PMAD diagnosis, even after adjusting for other factors. White respondents had no factors significantly associated with diagnosis, while Black respondents with multiple comorbidities and life stressors were more likely to be diagnosed. Racial disparities in PMAD diagnosis receipt and documentation require tailored interventions.
Racial Disparities in Diagnosis of Postpartum Mood and Anxiety Disorders Among Symptomatic Michigan Medicaid Enrollees, 2012-15
Dr. Stephanie V. Hall utilized self-reported patient survey responses from the Phase 7 Michigan Pregnancy Risk Assessment Monitoring System (MI-PRAMS), linked at the individual level with Michigan Medicaid administrative claims, to quantify the prevalence of PMAD diagnoses among symptomatic patients. She then explored factors associated with receiving a diagnosis.
Findings: For Michigan Medicaid enrollees from 2012-15, only 19.8% of respondents with symptoms of PMAD had a PMAD diagnosis between delivery and 3 months afterward. Black respondents were three times less likely to have PMAD diagnoses (adjusted odds ratio [AOR]=0.23, 95% CI=0.11-0.49) compared with White respondents. Among White respondents, no covariates were significantly associated with having a diagnosis. However, among Black respondents, more comorbid conditions and more life stressors were statistically significantly associated with having a diagnosis (AOR=3.18, 95% CI=1.27-7.96 and AOR=3.12, 95% CI=1.10-8.88, respectively).
Meaning: Rate of PMAD diagnosis receipt differed by race and was low overall. Black respondents were less likely than White respondents to receive a diagnosis. Patient characteristics influencing diagnosis receipt also differed by race, indicating that strategies to improve detection of these disorders require a tailored approach.
Visual abstract depicting study findings. In this study titled "Factors associated with mental health treatment among Michigan Medicaid enrollees with perinatal mood and anxiety disorders, 2012–2015," we found that 28% of pregnant patients with perinatal mood and anxiety disorders (PMAD) receive treatment of both psychotherapy and prescription medication. Of these patients, patients satisfied with prenatal care and patients experiencing life stressors are more likely to receive treatment. We also found that 18% of postpartum PMAD patients receive treatment of both psychotherapy and medication. Of these patients, Black patients and patients with more comorbidities are less likely to receive treatment. Race, comorbidities, and stress are crucial factors in treating PMAD. Satisfaction with perinatal healthcare can improve access to care.
Factors associated with mental health treatment among Michigan Medicaid enrollees with perinatal mood and anxiety disorders, 2012–2015
Dr. Stephanie V. Hall led this project to identify factors associated with receipt of prenatal and postpartum mental health treatment, defined here as prescription medication and psychotherapy utilization.
Findings: Medicaid enrollees with PMAD were more likely to fill prescription medication than attend psychotherapy. Black Medicaid enrollees with PMAD were 0.33 (95%CI: 0.13–0.85, p = 0.022) times less likely to fill prescription medications during pregnancy than white enrollees. More comorbidities were associated with receipt of both treatments (adjRR = 1.31, 95%CI: 1.02–1.70, p = 0.036). In the first three months postpartum, respondents with four or more stressors were 6.52 times more likely to receive both treatments (95%CI: 1.62–26.24, p = 0.008) and those satisfied with prenatal care were 16.25 times more likely to receive both treatments (95%CI: 3.35–78.85, p = 0.001).
Meaning: Race, comorbidities, and stress are critical factors in PMAD treatment. Satisfaction with perinatal healthcare may facilitate access to care.
Visual abstract depicting study findings. In this study titled "The impact of the affordable care act (ACA) on perinatal mood and anxiety disorder (PMAD) diagnosis and treatment rates among Michigan Medicaid enrollees 2012-2018," we found that PMAD diagnosis rates increased but PMAD treatment rates did not changed after the ACA increased access to pregnancy, postpartum, and mental health care in 2014. The ACA may have improved PMAD detection, but more work needs to be done to increase access to treatment.
The impact of the affordable care act on perinatal mood and anxiety disorder diagnosis and treatment rates among Michigan Medicaid enrollees 2012-2018
Dr. Stephanie V. Hall led this paper with the goal of quantifying whether the Patient Protection Affordable Care Act (ACA) improved PMAD diagnosis and treatment rates among Michigan Medicaid enrollees.
Findings: ACA implementation was associated with a statistically significant 0.76% point increase in PMAD diagnosis rates (95% CI: 0.01 to 1.52). However, there were no statistically significant changes in treatment rates among enrollees with a PMAD diagnosis.
Meaning: The ACA may have improved PMAD detection and documentation in clinical settings. While a higher rate of PMAD cases were identified after ACA Implementation, Post-ACA cases were treated at similar rates as Pre-ACA cases.
Visual abstract depicting key study findings. In this study titled "Relationship between Depression and Anxiety during Pregnancy (DAP), Delivery-Related Outcomes, and Healthcare Utilization in Michigan Medicaid, 2012–2021," we found that DAP had significant associations with adverse delivery-related outcomes and increased healthcare use. Individuals with DAP were more likely to be White, lower income, rural-dwelling, and living with comorbidities. Deliveries with DAP had higher odds of cesarean and preterm delivery, postpartum readmission, severe maternal morbidity, and more healthcare encounters.
Relationship between Depression and Anxiety during Pregnancy, Delivery-Related Outcomes, and Healthcare Utilization in Michigan Medicaid, 2012–2021
Dr. Kara Zivin led this paper to evaluate associations between depression and/or anxiety disorders during pregnancy (DAP), delivery-related outcomes, and healthcare utilization among individuals with Michigan Medicaid-funded deliveries.
Findings: Among 170,002 Michigan Medicaid enrollees with 218,890 deliveries, 29,665 (13.6%) had diagnoses of DAP. Compared to those without DAP, individuals with DAP were more often White, rural dwelling, had lower income, and had more comorbidities. In adjusted models, deliveries with DAP had higher odds of cesarean and preterm delivery OR = 1.02, 95% CI: [1.00, 1.05] and OR = 1.15, 95% CI: [1.11, 1.19] respectively), readmission within 30 days postpartum (OR = 1.14, 95% CI: [1.07, 1.22]), SMM within 42 days (OR = 1.27, 95% CI: [1.18, 1.38]), and utilization compared to those without DAP diagnoses (ambulatory: OR = 7.75, 95% CI: [6.75, 8.88], inpatient: OR = 1.13, 95% CI: [1.11, 1.15], ED: OR = 1.86, 95% CI: [1.80, 1.92], psychotherapy: OR = 172.8, 95% CI: [160.10, 186.58], and SUD: OR = 5.6, 95% CI: [5.37, 5.85]).
Meaning: Among deliveries in Michigan Medicaid, DAP had significant associations with adverse delivery-related outcomes and greater healthcare use. Early detection and intervention to address mental illness during pregnancy may help mitigate burdens of these complex yet treatable disorders.
Link: https://www.mdpi.com/2227-9032/11/22/2921
