# Relationship between mental health coverage and outcomes for privately insured women with perinatal mood and anxiety disorders (PMAD)

> **NIH NIH R01** · UNIVERSITY OF MICHIGAN AT ANN ARBOR · 2020 · $233,774

## Abstract

This study directly responds to Notice of Special Interest (NOSI): Administrative supplements for NIH grants to
add or expand research focused on maternal mortality (NOT-OD-20-104). The United States fares worst among
developed nations in preventing pregnancy-related deaths; over the past two decades, mortality rates doubled in
the US while decreasing elsewhere. For every maternal death, >100 women experience severe maternal
morbidity, a life-threatening diagnosis, or undergo a life-saving procedure during delivery hospitalization.
Striking disparities in severe maternal morbidity and mortality (SMMM) persist even though two-thirds of
SMMM cases may be preventable. Non-Hispanic Black and low-income women have significantly higher rates
of SMMM compared to their counterparts. Behavioral Health (BH) conditions such as suicide, drug overdose,
homicide, and unintentional injury are among leading contributors to SMMM, yet these deaths are excluded
from population-based pregnancy-related death statistics, likely leading to underestimates of SMMM. In
addition to BH causes of SMMM, BH conditions may exacerbate SMMM from other causes.
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 study capitalizes on R01MH120124, which examines how federal BH policy changes affect
outcomes for perinatal mood and anxiety disorders (PMAD). This study will examine SMMM overall and among
high-risk populations. It will use a large, economically, racially diverse national sample of enrollees in employer-
based insurance, Optum, from 2005-2018. This proposed one-year study will use patient- and plan-level analyses
of delivering women to examine associations of mandated federal BH policy changes with: 1) changes in SMMM
in the perinatal period (e.g., 21 severe maternal morbidity indicators, overdose, suicidality, and death from any
cause during pregnancy, delivery hospitalization, and up to one year postpartum; 2) changes in SMMM within
high-risk subgroups. For each Aim 1 outcome, we will examine how changes vary: 1) for those with and without
co-occurring PMAD and substance use disorders; 2) by race/ethnicity, 3) by income, 4) in states with strong vs.
weak pre-existing parity laws, and 5) in plans subject to new parity laws vs. those not subject to the laws.
Despite growing awareness of lethal consequences delivering women face, we know little about BH contributors
to these ou...

## Key facts

- **NIH application ID:** 10197277
- **Project number:** 3R01MH120124-02S1
- **Recipient organization:** UNIVERSITY OF MICHIGAN AT ANN ARBOR
- **Principal Investigator:** Kara Zivin
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2020
- **Award amount:** $233,774
- **Award type:** 3
- **Project period:** 2019-08-08 → 2023-05-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10197277

## Citation

> US National Institutes of Health, RePORTER application 10197277, Relationship between mental health coverage and outcomes for privately insured women with perinatal mood and anxiety disorders (PMAD) (3R01MH120124-02S1). Retrieved via AI Analytics 2026-05-23 from https://api.ai-analytics.org/grant/nih/10197277. Licensed CC0.

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