Every year, the U.S. healthcare system spends $102 million more on hospitalizations for pregnant people with mental health disorders than those without.
A new study published in Health Affairs found that the presence of mental health disorders during pregnancy coincided with a 50% rise in unexpected severe complications for the mother, including heart failure, hysterectomy or being put on a ventilator. These complications, in turn, increase the cost per delivery by $458.
According to the study’s lead author, Clare Brown, Ph.D., an associate professor at the University of Arkansas for Medical Sciences and a senior research fellow at the Institute for Medicaid Innovation, the link between mental health and severe complications is not unexpected, but the size of the increase is eye-opening.
“When you’re talking about 50% higher, that’s a big difference,” she told Fierce Healthcare. “And severe maternal morbidity often leads to additional severe outcomes throughout a year post-partum and often are also related to adverse infant outcomes.”
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The study found an even stronger correlation between people diagnosed with trauma- or stress-related mental health disorders and severe complications, which produced 87% higher rates of severe maternal morbidity and increased costs of $825 per delivery. And these findings may only be the tip of the iceberg. Brown notes that healthcare providers have begun to pay attention to perinatal mental health in relation to postnatal depression. “We’re gaining recognition that mental health is important, and that it can impact your health, your quality of life and your children’s quality of life,” she says.
Because most healthcare providers currently don’t screen for trauma- and stress-related issues during pregnancy, the numbers in the study are likely low estimates. To address the issue, the study’s authors recommend expanding screening tools to identify these issues more broadly.
Given the increased likelihood of trauma and stress among disadvantaged and minority populations, the study’s authors note that tackling this issue also could help reduce inequities of care. “A key piece of this is breaking down the stigmas and issues with discussing these types of mental health conditions with your provider,” Brown says. For providers, this caveat requires attention to culturally sensitive care, particularly among populations where these topics can be difficult to broach.
In addition to expanded screening, the study recommends additional policy considerations such as expanding Medicaid coverage of postnatal care beyond six weeks and expanding insurance coverage of innovative care models that could improve social support, such as group prenatal care and care teams that include midwives and doulas.
The benefits to care providers in terms of potentially reducing complications and improving quality of care are easily apparent. Brown points out that this issue should be on payers’ radar as well, since it’s typically less expensive to treat mental health than it is to deal with complications, particularly in areas like pregnancy.
“A large percentage of adverse maternal outcomes are theoretically preventable,” says Brown. “This should be a good, happy, healthy experience, but it’s not the case for many women—and we are growing our recognition that it’s not the case, and that it’s even worse among minority populations.”