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Principal Investigator: Kara Zivin
Organization: UNIVERSITY OF MICHIGAN AT ANN ARBOR
Fiscal Year: 2024
Award: $633,159
Funding agency: National Institute on Minority Health and Health Disparities
Project Summary/Abstract
This study directly responds to NIMHD Program Announcement for Health Services Research on Minority
Health and Health Disparities (PAR-20-310). Perinatal mood and anxiety disorders (PMAD), which include
depression and/or anxiety in the year before and/or after delivery, are common complications of pregnancy,
affecting up to one in four women, with costs over $15 billion per year in the US. PMAD can negatively affect
mothers, babies, and families beyond the perinatal period, and have lasting clinical and economic effects. PMAD
treatment can improve maternal and neonatal health outcomes, yet mental health services are rarely used.
No comprehensive data source documents the: 1) magnitude, 2) predictors, and 3) variation in disparities by
race and ethnicity, socioeconomic status, and geography in healthcare utilization or obstetric delivery outcomes
among women with PMAD. Almost no evidence documents the impact of community characteristics on these
outcomes. There is no national plan for how best to address PMAD, overall, or within high-risk subgroups.
Using data from publicly (Medicaid) and privately (Optum) insured women with PMAD, state survey data,
input from a panel of perinatal mental health services and policy experts, and interviews with state maternal and
infant health (MIH) and MH policy makers, we will: 1) identify patient-level clinical characteristics
associated with MH and overall perinatal utilization and delivery-related outcomes among
women with diagnosed PMAD, and establish accurate national and state-level estimates of
disparities in care patterns and outcomes, including MH utilization, overall utilization, and
delivery-outcomes; 2) determine contributions of community-level characteristics to perinatal
utilization and delivery outcomes among women with PMAD using data from Pregnancy Risk
Assessment Monitoring System (PRAMS), Area Health Resource File (AHRF), and National Mental Health
Services Survey (N-MHSS); and 3) collaborate with an expert panel to develop an evidence-based
policymaking guide for PMAD, which we will use to interview state maternal and infant health
and mental health policy officials. Using Aim 1-2 findings and expert panel input, we will develop an EBP
guide for PMAD. This guide will provide structure for interviews with state maternal and infant health and
mental health policy officials from states with high and low relative performance on PMAD treatment and
outcomes to help interpret quantitative findings, tailor recommendations, and assist in future PMAD
policymaking initiatives.
Given the dearth of research on disparities in addressing PMAD and associated utilization and delivery
outcomes, and the high, inter-generational costs for mother and baby of ineffectively managed PMAD, this
innovative, large-scale investigation will provide evidence for future policymaking and clinical interventions. Our
findings and policy guidance could address disparities in outcomes for high cost, high risk subpopulations.
Terms: <Abdominal Delivery><Address><Affect><Affective Disorders><Ambulatory Surgery><Ambulatory Surgical Procedures><Anxiety><Anxiety Disorders><Area><Asian><Black><Black race><Budgets><C section><COVID crisis><COVID epidemic><COVID pandemic><COVID-19><COVID-19 crisis><COVID-19 epidemic><COVID-19 era><COVID-19 global health crisis><COVID-19 global pandemic><COVID-19 health crisis><COVID-19 pandemic><COVID-19 period><COVID-19 public health crisis><COVID-19 years><CV-19><Caring><Cesarean><Cesarean section><Characteristics><Clinical><Collaborations><Communities><Coronavirus Infectious Disease 2019><County><Data><Data Sources><Development><Diagnosis><Disease remission><Disparities><Disparity><Disparity population><Drugs><ED visit><ER visit><Economic Income><Economical Income><Economics><Education><Educational aspects><Emergency care visit><Emergency department visit><Emergency hospital visit><Emergency room visit><Ethnic Origin><Ethnicity><Evaluation><Family><Future><Geography><Gestation><Groups at risk><Health Care Utilization><Health Policy><Health Resources><Health Services Evaluation><Health Services Research><High Risk Woman><Hispanic><Income><Individual><Infant Health><Inpatients><Insurance><Intervention><Intervention Strategies><Interview><Investigation><Light><Low income><Maternal Health><Maternal Mortality><Medicaid><Medical><Medical Care Research><Medication><Mental Depression><Mental Health><Mental Health Services><Mental Hygiene><Mental Hygiene Services><Minority Health Research><Minority research><Monitor><Mood Disorders><Mothers><NCMHD><NIH Program Announcements><NIMHD><National Center on Minority Health and Health Disparities><National Institute of Minority Health and Health Disparities><National Institute on Minority Health and Health Disparities><Obstetric Delivery><Outcome><Outpatient Surgery><Patients><Patterns of Care><People at risk><Performance><Perinatal><Peripartum><Persons at risk><Pharmaceutical Preparations><Photoradiation><Policies><Policy Maker><Policy Making><Populations at Risk><Postpartum Period><Pregnancy><Pregnancy Complications><Premature Birth><Prematurely delivering><Preterm Birth><Privatization><Program Announcement><Provider><Psychological Health><Psychotherapy><Race><Races><Recommendation><Remission><Research><Research Resources><Resources><Risk Assessment><Rural><SARS-CoV-2 epidemic><SARS-CoV-2 global health crisis><SARS-CoV-2 global pandemic><SARS-CoV-2 pandemic><SARS-coronavirus-2 epidemic><SARS-coronavirus-2 pandemic><Severe Acute Respiratory Syndrome CoV 2 epidemic><Severe Acute Respiratory Syndrome CoV 2 pandemic><Severe acute respiratory syndrome coronavirus 2 epidemic><Severe acute respiratory syndrome coronavirus 2 pandemic><Socio-economic status><Socioeconomic Status><Structure><Subgroup><Suicide><Survey Instrument><Surveys><System><Variant><Variation><Visit><Woman><adherence rate><adverse birth outcomes><at-risk females><at-risk women><barrier to care><barrier to health care><barrier to healthcare><barrier to treatment><clinical care><community factor><community-level factor><complications during pregnancy><coronavirus disease 2019><coronavirus disease 2019 crisis><coronavirus disease 2019 epidemic><coronavirus disease 2019 global health crisis><coronavirus disease 2019 global pandemic><coronavirus disease 2019 health crisis><coronavirus disease 2019 pandemic><coronavirus disease 2019 public health crisis><coronavirus disease crisis><coronavirus disease epidemic><coronavirus disease pandemic><coronavirus disease-19><coronavirus disease-19 global pandemic><coronavirus disease-19 pandemic><coronavirus infectious disease-19><cost><depression><developmental><disadvantaged group><disadvantaged individual><disadvantaged people><disadvantaged population><disadvantaged subgroup><disparities across groups><disparities in race><disparity across subgroups><disparity among groups><disparity among subgroups><disparity between groups><disparity between subgroups><disparity due to race><disparity in care><disparity in ethnic><disparity in healthcare><drug/agent><economic><economic impact><ethnic based disparity><ethnic disadvantage><ethnic disparity><ethnic inequality><ethnic inequity><ethnicity disparity><evidence base><fatal attempt><fatal suicide><female outcomes><females at high risk><group disparity><group inequality><group inequity><health care disparity><health care inequality><health care inequity><health care policy><health care service use><health care service utilization><healthcare disparity><healthcare inequality><healthcare inequity><healthcare policy><healthcare service use><healthcare service utilization><healthcare utilization><high risk><high risk females><hospital re-admission><hospital readmission><improved><incomes><inequalities among populations><inequalities between populations><inequalities in populations><inequality across populations><inequality among groups><inequality between groups><inequality due to race><inequality in groups><inequities among populations><inequities between populations><inequities in populations><inequity across groups><inequity across populations><inequity between groups><inequity due to race><inequity in groups><innovate><innovation><innovative><intent to die><intergenerational><interventional strategy><maternal death><mental health care><mental health policy><mental healthcare><methods to study multiple-level influences><minority health><minority health disparity><multi-level analysis><multi-level model><multilevel analysis><multilevel model><multilevel modeling><neonatal health><newborn health><obstacle to care><obstacle to healthcare><outcomes among females><outcomes among women><outcomes in females><outcomes in women><perinatal mental health><perinatal period><perinatal phase><population inequality><population inequity><post-partum><pregnancy associated death><pregnancy associated mortality><pregnancy related death><pregnancy-related complications><premature childbirth><premature delivery><preterm delivery><programs><psychiatric co-morbidity><psychiatric comorbidity><race based disparity><race based inequality><race based inequity><race disparity><race related disparity><race related inequality><race related inequity><racial><racial background><racial disparity><racial inequality><racial inequity><racial origin><racially unequal><re-admission><re-hospitalization><readmission><rehospitalization><research in minorities><research on minorities><research related to minorities><research with minorities><retention rate><retention strategy><services research><severe acute respiratory syndrome coronavirus 2 global health crisis><severe acute respiratory syndrome coronavirus 2 global pandemic><severe maternal morbidity><socio-economic position><socioeconomic position><subgroup disparity><suicides><treatment and outcome><treatment of anxiety disorders><unequal group><unequal population><urban area><urban location><urban region><women at high risk><women's outcomes>