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To estimate the cost of maternal morbidity for all 2019 pregnancies and births in the United States. Using data from 2010 to 2020, we developed a cost analysis model that calculated the excess cases of outcomes attributed to nine maternal morbidity conditions with evidence of outcomes in the literature. We then modeled the associated medical and nonmedical costs of each outcome incurred by birthing people and their children in 2019, projected through five years postpartum. We estimated that the total cost of nine maternal morbidity conditions for all pregnancies and births in 2019 was $32.3 billion from conception to five years postpartum, amounting to $8,624 in societal costs per birthing person. We found only nine maternal morbidity conditions with sufficient supporting evidence of linkages to outcomes and costs. The lack of comprehensive data for other conditions suggests that maternal morbidity exacts a higher toll on society than we found. Although this study likely provides lower bound cost estimates, it establishes the substantial adverse societal impact of maternal morbidity and suggests further opportunities to invest in maternal health.

Background Maternal mental health conditions (MMHCs), which include depression and anxiety disorders during pregnancy and through five years postpartum, are among the most common obstetric complications in the United States overall and in Texas in particular. In the context of potential expansion of postpartum Medicaid coverage from 60 days to one year, we sought to capture the societal, financial burden of untreated MMHCs. Methods We estimated the economic impact of untreated maternal mental health conditions (MMHCs) among births in Texas in 2019 using a cost-of-illness model. Results We found that MMHCs affected 13.2% of mothers and, when left untreated, cost $2.2 billion among mothers and children born in Texas in 2019 when following the birth cohort from conception through five years postpartum. We found that MMHCs affected 17.2% of mothers enrolled in Texas’ Medicaid for Pregnant Women and cost $962 million. In addition, the prevalence of MMHCs and resulting costs varied considerably among women of different races and ethnicities. Employers and health care payers, including Medicaid, bore most of these costs. Conclusions The Texas Health and Human Services Commission’s (HHSC) efforts to increase awareness about MMHCs and increase access to care represent an important step toward improving maternal and child health and maximizing benefits to Texas HHSC, employers, and insurers.

Background National estimates of perinatal mood and anxiety disorders (PMAD) and serious mental illness (SMI) among delivering women over time, as well as associated outcomes and costs, are lacking. The prevalence of perinatal mood and anxiety disorders and serious mental illness from 2006 to 2015 were estimated as well as associated risk of adverse obstetric outcomes, including severe maternal morbidity and mortality (SMMM), and delivery costs. Methods The study was a serial, cross-sectional analysis of National Inpatient Sample data. The prevalence of PMAD and SMI was estimated among delivering women as well as obstetric outcomes, healthcare utilization, and delivery costs using adjusted weighted logistic with predictive margins and generalized linear regression models, respectively. Results The study included an estimated 39,025,974 delivery hospitalizations from 2006 to 2015 in the U.S. PMAD increased from 18.4 (95% CI 16.4–20.0) to 40.4 (95% CI 39.3–41.6) per 1000 deliveries. SMI also increased among delivering women over time, from 4.2 (95% CI 3.9–4.6) to 8.1 (95% CI 7.9–8.4) per 1000 deliveries. Medicaid covered 72% (95% CI 71.2–72.9) of deliveries complicated by SMI compared to 44% (95% CI 43.1–45.0) and 43.5% (95% CI 42.5–44.5) among PMAD and all other deliveries, respectively. Women with PMAD and SMI experienced higher incidence of SMMM, and increased hospital transfers, lengths of stay, and delivery-related costs compared to other deliveries ( P  < .001 for all). Conclusion Over the past decade, the prevalence of both PMAD and SMI among delivering women increased substantially across the United States, and affected women had more adverse obstetric outcomes and delivery-related costs compared to other deliveries.

Spouse caregivers have an increased risk of mental and physical illness during caregiving and widowhood. The authors sought to evaluate whether partners of an ill spouse have a higher likelihood of developing mental health or substance abuse (MHSA) disorders than partners who have healthy spouses, accounting for both spousal illness and death. The authors used Medicare claims from 1993–2001 for 474,228 married couples. The authors used Cox models to determine the effect of spouse illness on partner MHSA diagnosis, controlling for demographic and clinical characteristics. A wife's hospitalization increased the husband's risk of MHSA diagnosis by 1.29 (95% confidence interval [CI]: 1.28–1.29) and his risk of depression by 1.49 (95% CI: 1.48–1.51). A husband's hospitalization increased the risk of a wife's MHSA diagnosis by 1.33 (95% CI: 1.32–1.33) and her risk of depression by 1.41 (95% CI: 1.39–1.42). A wife's death increased the risk of the husband's MHSA diagnosis by 1.12 (95% CI: 1.11–1.13) and increased his risk of depression by 1.49 (95% CI: 1.46–1.51). A husband's death increased the risk of the wife's MHSA diagnosis by 1.14 (95% CI: 1.14–1.15) and increased her risk of depression by 1.41 (95% CI: 1.39–1.42). Spouse hospitalizations and spouse death independently increase the risk for partner MHSA and depression diagnoses. These findings can identify which individuals are at greatest risk for emotional distress and should be targeted for interventions to relieve caregiver burden that can arise separately and additively from both spousal illness and death.

To describe and explore variation in 'pandemic-related circumstances' among suicide decedents during the first year of the COVID-19 pandemic. We identified pandemic-related circumstances using decedents' text narratives in the 2020 National Violent Death Reporting System. We use time-series analysis to compare other psychosocial characteristics (e.g., mental health history, interpersonal difficulties, financial strain) of decedents pre-pandemic (2017/2018: n = 56,968 suicide and n = 7,551 undetermined deaths) to those in 2020 (n = 31,887 suicide and n = 4,100 undetermined). We characterize common themes in the narratives with pandemic-related circumstances using topic modeling, and explore variation in topics by age and other psychosocial circumstances. In 2020, n = 2,502 (6.98%) narratives described pandemic-related circumstances. Compared to other deaths in 2020 and to the pre-pandemic period, decedents with pandemic-related circumstances were older and more highly educated. Common themes of pandemic-related circumstances narratives included: concerns about shutdown restrictions, financial losses, and infection risk. Relative to decedents of the same age that did not have pandemic-related circumstances in 2020, those with pandemic-related circumstances were more likely to also have financial (e.g., for 25-44 years, 43% vs. 12%) and mental health (76% vs. 66%) psychosocial circumstances, but had similar or lower prevalence of substance abuse (47% vs. 49%) and interpersonal (40% vs. 42%) circumstances. While descriptive, these findings help contextualize suicide mortality during the acute phase of the COVID-19 pandemic and can inform mental health promotion efforts during similar public health emergencies.

Background Promoting appropriate pharmacotherapy requires understanding the factors that influence how clinicians prescribe medications. While prior work has focused on patient and clinician factors, features of the organizational setting have received less attention, though identifying sources of variation in prescribing may help identify opportunities to improve patient safety and outcomes. Objective To evaluate the relationship between the number of clinicians who prescribe medications in a facility and facility prescribing intensity of six individual medication classes by clinician specialty: benzodiazepines, antipsychotics, antiepileptics, and antidepressants by psychiatrists and antibiotics, opioids, antiepileptics, and antidepressants by primary care clinicians (PCPs). Design We used 2017 Veterans Health Administration (VHA) administrative data. Subjects We included patient-clinician dyads of older patients (> 55 years) with an outpatient encounter with a clinician in 2017. Patient-clinician data from 140 VHA facilities were included ( n  = 13,347,658). Analysis was repeated for years 2014 to 2016. Main measures For each medication, facility prescribing intensity measures were calculated as clinician prescribing intensity averaged over all clinicians at each facility. Clinician prescribing intensity measures included percentage of each clinician’s patients prescribed the medication and mean number of days supply per patient among all patients of each clinician. Key results As the number of prescribing clinicians in a facility increased, the intensity of prescribing decreased. Every increase of 10 facility clinicians was associated with a significant decline in prescribing intensity for both specialties for different medication classes: for psychiatrists, declines ranged from 6 to 11%, and for PCPs, from 2 to 3%. The pattern of more clinicians less prescribing was significant across all years. Conclusion Future work should explore the mechanisms that link the number of facility clinicians with prescribing intensity for benzodiazepines, antipsychotics, antiepileptics, antidepressants, antibiotics, and opioids. Facilities with fewer clinicians may need additional resources to avoid unwanted prescribing of potentially harmful or unnecessary medications.

ObjectiveTo estimate the cost of maternal morbidity for all 2019 pregnancies and births in the United States.MethodsUsing data from 2010 to 2020, we developed a cost analysis model that calculated the excess cases of outcomes attributed to nine maternal morbidity conditions with evidence of outcomes in the literature. We then modeled the associated medical and nonmedical costs of each outcome incurred by birthing people and their children in 2019, projected through five years postpartum.ResultsWe estimated that the total cost of nine maternal morbidity conditions for all pregnancies and births in 2019 was32.3 billion from conception to five years postpartum, amounting to 8,624 in societal costs per birthing person.ConclusionWe found only nine maternal morbidity conditions with sufficient supporting evidence of linkages to outcomes and costs. The lack of comprehensive data for other conditions suggests that maternal morbidity exacts a higher toll on society than we found.Policy implicationsAlthough this study likely provides lower bound cost estimates, it establishes the substantial adverse societal impact of maternal morbidity and suggests further opportunities to invest in maternal health.

Background Observational research frequently uses administrative codes for mental health or substance use diagnoses and for important behaviours such as suicide attempts. We sought to validate codes ( International Classification of Diseases, 9 th edition, clinical modification diagnostic and E-codes) entered in Veterans Health Administration administrative data for patients with depression versus a gold standard of electronic medical record text (\"chart notation\"). Methods Three random samples of patients were selected, each stratified by geographic region, gender, and year of cohort entry, from a VHA depression treatment cohort from April 1, 1999 to September 30, 2004. The first sample was selected from patients who died by suicide, the second from patients who remained alive on the date of death of suicide cases, and the third from patients with a new start of a commonly used antidepressant medication. Four variables were assessed using administrative codes in the year prior to the index date: suicide attempt, alcohol abuse/dependence, drug abuse/dependence and tobacco use. Results Specificity was high (≥ 90%) for all four administrative codes, regardless of the sample. Sensitivity was ≤75% and was particularly low for suicide attempt (≤ 17%). Positive predictive values for alcohol dependence/abuse and tobacco use were high, but barely better than flipping a coin for illicit drug abuse/dependence. Sensitivity differed across the three samples, but was highest in the suicide death sample. Conclusions Administrative data-based diagnoses among VHA records have high specificity, but low sensitivity. The accuracy level varies by different diagnosis and by different patient subgroup.

A psychiatry professor's recovery from perinatal depression drives her research to facilitate practice and policy change.A psychiatry professor's recovery from perinatal depression drives her research to facilitate practice and policy change.

Purpose To examine the association between maternal perinatal mood and anxiety disorder (PMAD) treatment status and infant outcomes. Methods We used a US-based, geographically diverse administrative dataset of commercially insured birthing individuals with newly diagnosed PMAD in the 12-months prior to delivery 2016–2020, with a live linked newborn in Optum’s Clinformatics ® Data Mart Database. Our independent variable of interest was evidence of treatment for PMAD diagnosis. Our outcomes of interest were preterm birth (PTB), neonatal intensive care unit (NICU) admission, and neonatal abstinence syndrome (NAS). Results Treatment with psychotherapy only was significantly associated with 21% lower odds of PTB compared to no evidence of treatment (aOR: 0.79). Medication-only treatment and combined treatment were not associated with increased risk of PTB. Individuals in the combined treatment group had 24% greater odds of infant NICU admission (aOR: 1.24) compared to those without treatment. Individuals in the medication-only group had 4.18 times the odds of having an infant diagnosed with NAS compared to individuals without treatment (4.4% vs. 1%), while individuals in the combined treatment group had 4.32 times the odds (4.5% vs. 1%), respectively (aOR: 4.18, 4.32). Conclusions Pharmacotherapy use and combination treatments for PMAD may indicate higher disease severity, a risk factor for poor infant outcomes. Discussion of risks associated with pharmacotherapy use must also include a discussion of risks associated with untreated perinatal mental health conditions for birthing individuals and their infants. Clinical trial number Not applicable.