Mental Health Conditions Increase Severe Maternal Morbidity By 50 Percent And Cost $102 Million Yearly In The United States

Abstract

Perinatal mental health disorders are increasingly acknowledged as contributors to adverse maternal outcomes. We analyzed data from the Healthcare Cost and Utilization Project National Inpatient Sample (2016 and 2017) to estimate hospitalization cost, length-of-stay, and severe maternal morbidity associated with perinatal mental health disorders overall, as well as stratified by payer and by specific mental health category. We found that people with mental health disorders had $458 higher costs per delivery hospitalization and 50 percent higher rates of severe maternal morbidity compared with people without mental health disorders. We estimated increased annual delivery hospitalization costs of $102 million in the US among people with perinatal mental health conditions compared with those without. Furthermore, people diagnosed with trauma- or stress-related mental health disorders had even higher rates of hospitalization costs-$825 higher per delivery-and 87 percent higher rates of severe maternal morbidity compared with people without those diagnoses. These findings provide important information for perinatal mental health program feasibility and cost-effectiveness analyses and suggest the need for increased focus on trauma- and stress-related disorders.

EXHIBIT 1

Average Adjusted Hospitalization Costs, by Mental Health Status Designations (n=1,460,826; weighted n=7,304,122) SOURCE: Authors’ analysis of data from the Healthcare Cost and Utilization Project, National Inpatient Sample, years 2016 and 2017. NOTES: Adjusted costs determined using generalized linear models with gamma distribution and log link, adjusting for age, race, primary payer, number of other (i.e., non-mental health or substance use-related) clinical comorbidities, presence of a substance use disorder, having a cesarean vs vaginal delivery, median income in the patient’s zip code of residence, hospital census region, hospital ownership, hospital teach status and rural/urban designation, safety net hospital designation, and minority hospital designation. All difference in means are statistically significant (p<0.001) using Wald tests to test for differences between average adjusted hospitalization costs between categories of each mental health grouping.

EXHIBIT 2

Average Adjusted Hospital Length of Stay, by Mental Health Status Designations (n=1,460,826; weighted n=7,304,122) SOURCE: Authors’ analysis of data from the Healthcare Cost and Utilization Project, National Inpatient Sample, years 2016 and 2017. NOTES: Adjusted lengths of stay determined using generalized linear models with gamma distribution and log link, adjusting for age, race, primary payer, number of other (i.e., non-mental health or substance-use related) clinical comorbidities, presence of a substance use disorder, having a cesarean vs vaginal delivery, median income in the patient’s zip code of residence, hospital census region, hospital ownership, hospital teach status and rural/urban designation, safety net hospital designation, and minority hospital designation. All difference in means are statistically significant (p<0.001) using Wald tests to test for differences between average adjusted lengths of stay between categories of each mental health grouping.

EXHIBIT 3

Average Adjusted Rates of Severe Maternal Morbidity, by Mental Health Status Designations (n=1,460,826; weighted n=7,304,122) SOURCE: Authors’ analysis of data from the Healthcare Cost and Utilization Project, National Inpatient Sample, years 2016 and 2017. NOTES: Adjusted rates of severe maternal morbidity per 10,000 deliveries determined using predicted probabilities based on logistic regressions, adjusting for age, race, primary payer, number of other (i.e., non-mental health or substance use-related) clinical comorbidities, presence of a substance use disorder, having a cesarean vs vaginal delivery, median income in the patient’s zip code of residence, hospital census region, hospital ownership, hospital teach status and rural/urban designation, safety net hospital designation, and minority hospital designation. All differences in means are statistically significant (p<0.001) using Wald tests to test for differences between average adjusted rates of severe maternal morbidity between categories of each mental health analysis grouping.