# 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 · $458,050

## Abstract

This study directly responds to the NIMH Notice of Information on High-Priority Areas for Research on
Women's Mental Health During Pregnancy and the Postpartum Period (NOT-MH-15-013). Perinatal mood and
anxiety disorders (PMAD), which includes depression and/or anxiety in the year before or after delivery, are
common complications of pregnancy, affecting up to one in five 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 (MH) services are rarely used.
 Over the past decade, federal health legislation, such as the Mental Health Parity and Addiction Equity Act
of 2008 (MHPAEA), and subsequent federal legislation affecting MH benefits (henceforth, MH policy changes),
provided one of the largest expansions of MH coverage in a generation, by increasing coverage and extending
federal parity protections to more than 60 million Americans. The MH policy changes require that all
commercial, employer-based health plans cover MH services, and prevent higher levels of cost-sharing for MH
relative to medical/surgical care. To inform future policy and clinical interventions, it is imperative to understand
the clinical and economic effects of unprecedented extensions of MH coverage during the perinatal period.
 This study will take advantage of the natural experiments of federal MH policy changes. We propose to study
the impact of MH policy changes in a large and diverse national sample of women during the perinatal period
enrolled in employer-based insurance using Optum™ Clinformatics™ Data Mart (Optum). In this proposed
four-year study, we will use patient-level analyses of women with diagnosed PMAD to examine the association
of mandated federal MH policy changes with: 1) changes in MH utilization and outcomes (psychiatric
assessment, psychotherapy, psychotropic medication use, diagnosed self-harm, suicide attempts, and/or suicidal
ideation) and overall utilization (outpatient visits, inpatient stays, emergency department visits, and
readmissions) in the year before and year after delivery; 2) changes in delivery outcomes (severe maternal
morbidity, preterm birth, and caesarean delivery rates); and 3) changes in MH expenditures and overall
expenditures in the year before and year after delivery. For each aim, we will conduct subgroup analyses to
examine the differential effects of MH policy changes on: 1) women in states with stronger vs. weaker pre-existing
parity laws, 2) self-insured plans vs. fully insured plans, 3) income subgroups, and 4) race and ethnicity groups.
 Given the dearth of perinatal MH services research, and the high, inter-generational costs of ineffectively
managed PMAD, this innovative, large scale investigation will provide necessary evidence for future
policymaking and clinical intervention efforts that could influenc...

## Key facts

- **NIH application ID:** 9991929
- **Project number:** 5R01MH120124-02
- **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:** $458,050
- **Award type:** 5
- **Project period:** 2019-08-08 → 2023-05-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/9991929

## Citation

> US National Institutes of Health, RePORTER application 9991929, Relationship between mental health coverage and outcomes for privately insured women with perinatal mood and anxiety disorders (PMAD) (5R01MH120124-02). Retrieved via AI Analytics 2026-05-23 from https://api.ai-analytics.org/grant/nih/9991929. Licensed CC0.

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