What We’re Reading
By Joy Burkhard, MBA
Founder and Executive Director, 2020 Mom
Here are the articles and reports that caught my eye in May and June. Highlights include two new reports - one by Rand making new policy recommendations to solve the mental health care delivery crisis, another from Well Being Trust, its annual report on deaths of despair. On a related note, a discussion on how the “pregnancy check box” on the death certificate has ‘conflated’ the U.S. maternal mortality rate. Additionally, new research suggests that screening for early breastfeeding struggles may help identify mothers who may be at risk for maternal mental health disorders. Finally, more articles below illustrate yet more heart-wrenching evidence surrounding maternal disparities among Black mothers.
Role of Maternal Daily Perceived Stress On the Mental Health of Children During The Pandemic
A recent study, published in Child and Adolescent Psychiatry and Mental Health assessed the role of maternal daily perceived stress on children’s mental health during the pandemic. They found that maternal perceived everyday stress significantly impacted children’s emotional issues during the pandemic.
There's Only 1 Drug for Postpartum Depression.
Why Does Kaiser Permanente Make It So Hard to Get?
Miriam McDonald suffered from postpartum anxiety & depression after giving birth to her son, Nicholas. She said it made her feel sad, disconnected, and indifferent. She never got brexanolone and was the perfect candidate. She said Kaiser Permanente, her health care provider, put her on a merry-go-round of medication trials. When she called Kaiser’s grievance department to complain about her treatment, Kaiser sent the cops to her house for a welfare check. They refused to approve expensive treatment with the first and only drug designed for postpartum depression.
Studies Explore Links Between Stress, Choline Deficiency, Preterm Births, and Mental Health Issues
Researchers say the data points to a health care disparity in caring for Black mothers and their children in the U.S.
Postpartum Mental Illness Increased in Frequency During the Covid-19 Pandemic
Postpartum mental illness affects approximately 1 in 5 mothers and can present as anxiety, depression, bipolar disorder, psychotic disorders, alcohol and or substance abuse. This emotional burden on mothers also represents a clinical burden on the health care system with increasing rates due to the COVID-19 pandemic. Elevated rate differences in postpartum mental health visits peaked between 0-90 days after birth, with the highest rate difference in April 2020. This study also broke out rates by race/ethnicity.
One in Six Families Face Over $5K in Out-of-Pocket Childbirth Costs
Costs were even higher for births that required admission to the neonatal ICU (NICU). One in 11 of those families paid more than $10,000 for the birth of their baby, the researchers wrote in Pediatrics. Among all of the births included in the study, the mean out-of-pocket expense was $2,281 for delivery hospitalization and $788 for newborn hospitalization. In total, the average out-of-pocket cost for childbirth was $3,068, composed of deductibles ($1,292) , coinsurance ($1,711), and copayments ($66). Around 95% of all births covered by private insurance required some out-of-pocket payment.
How to Transform the U.S. Mental Health System: Evidence-Based Recommendations
Recently released, the Rand Corporation shares its research report, “How to Transform the U.S. Mental Health System: Evidence-Based Recommendations”
The authors broadly examined three questions:
How can policy changes at all levels of government affect broad transformational change to improve the lives of millions of Americans living with mental illness?
What are the best practices and recent innovations in the mental health sector?
What are opportunities for change in the mental health care system supported by the research literature?
The authors conclude that politicians, public administrators, advocates, and policy experts need to coalesce around a focused set of objectives for change to occur. To this end, the authors provide analysis and recommendations in 15 areas where there is potential for transformative change that can improve the lives of the more than 60 million Americans affected by mental illness.
Calling Mental Health Workers, Not Police, to Deal With Mental Health Crises
The effort to enhance mobile response efforts dovetails with another federal law passed in 2020 that creates a nationwide, three-digit suicide prevention and mental health crisis phone line — 988 — to take the place of the 10-digit suicide prevention line.
Zuranolone Wins for Quick Depression Fix; Laughing Gas for Tx-Resistant Depression?
The phase III WATERFALL study found that 50 mg of zuranolone (SAGE-217/BIIB125)-- a once-daily investigational oral agent given for two weeks -- significantly reduced depressive symptoms by day 15 versus placebo in patients with major depressive disorder.
A phase II trial found that just a single 1-hour treatment of breathing in a combination of oxygen and laughing gas improved depressive symptoms in people with treatment-resistant depression.
Early Exclusive Breastfeeding Cessation and Postpartum Depression: Assessing the Mediating and Moderating Role of Maternal Stress and Social Support
Early termination of exclusive breastfeeding and postpartum depression (PPD) are both recognized as global health problems. The study explores the comparative risk for PPD among new mothers who terminated EBF before the six-month mark, compared to those who did not, and test whether maternal stress and social support operate to mediate and/or moderate the relationship between EBF and PPD. Current evidence suggests that concurrent screening for EBF difficulties and maternal stress are critical red flags that might hint at complications even before a mother screens positive for PPD. Support and care from family members can assist in overcoming this issue.
The Wall Street Journal: Why Is ACA Still Controversial 11 Years After Healthcare Law Known As Obamacare Was Passed?
Republicans have argued that the law’s government-backed coverage expansion is too costly. Indeed, some Republican-led states, including Texas and Florida, have declined to expand their Medicaid programs under the ACA. They have also opposed some of the ACA’s prescriptive rules, saying that consumers should have more freedom to choose the types of plans they want, even if those are limited or don’t cover certain things.
Black Mental Health Matters
Black Emotional And Mental Health Collective shares that “Black people are seven times more likely to live in areas with limited access to mental health care. There is a shortage of black mental health providers, and only a third of Black people who need mental health services receive treatment.” Learn about Maternal Health Resources created for and by Black people.
It Took a Pandemic, but the U.S. Finally Has (Some) Centralized Medical Data
Covid exposed the fragmented reality of U.S. health records. Now an effort to bring together data from millions of patients is starting to show results.
Maternal Mortality in the United States
Rigorous studies carried out by the National Center for Health Statistics show that previously reported increases in maternal mortality rates in the United States were an artifact of changes in surveillance. The pregnancy checkbox, introduced in the revised 2003 death certificate and implemented by the states in a staggered manner, resulted in increased identification of maternal deaths and in reported maternal mortality rates. This article shares the findings of the National Center for Health Statistics reports, describes temporal trends and the current status of maternal mortality in the United States.
Mental Health Among Pregnant Women with COVID-19-Related Stressors and Worries in the United States
This study evaluated the associations between COVID-19–related experiences and mental health outcomes among pregnant women in the United States. Researchers found that at the height of the stay-at-home lockdown in the United States during the COVID-19 pandemic, at least two out of five respondents in a sample of U.S. pregnant women had either depression and/or anxiety, which was at least 2.5 times higher than the pre-pandemic prevalence among pregnant women. Furthermore, the prevalence of depression was higher than that among United States adults aged ≥18 based on online surveys conducted during June 24-30, 2020. This indicates that pregnant women in the United States were particularly at risk for mood disorders and poor mental health during the COVID-19 pandemic.
Promising Policies: Multi-Solving for Mental Well-being and Equitable Economies
We are facing dual, interconnected crises of rising economic inequality and poor mental health that have been exacerbated under COVID-19. This legacy moment demands that we transform the systems that have given rise to social and economic inequities, so that we can thrive together. This guide identifies promising policies from the Advancing Equitable Economies Library that multisolve for population mental well-being and more equitable economies.
Latest Pain in the Nation Report
The Well Being Trust Pain in the Nation report series has tracked the nation’s deaths of despair crisis since 2017. This latest report includes newly released data showing that 156,242 Americans died due to alcohol, drugs, or suicide in 2019, a record number of such deaths in a single year. Broken out by category, during 2019, alcohol and drug-induced deaths increased, while suicide rates were slightly lower. Over the last decade, 2009 – 2019, the number of alcohol, drug, and suicide deaths nationally increased by 52 percent. It also includes a special section examining the effects of trauma and the COVID-19 pandemic as they relate to mental health, substance use, and Americans' overall well-being.
Bridging the Chasm Between Pregnancy and Health Over the Life Course: A National Agenda for Research and Action
Many pregnant people find no bridge to ongoing specialty or primary care after giving birth, even when clinical and social complications of pregnancy signal need. Black, indigenous, and all other women of color are especially harmed by fragmented care and access disparities, coupled with impacts of racism over the life course and in health care.
Racial Disparities Persist with Mental Health Diagnoses, New Data Show
A new analysis from Athenahealth finds that there are racial disparities in mental health diagnoses in the U.S. The analysis was based on data collected between May and December 2020, and includes more than 24 million patients. Overall, the study found that white patients were most likely to discuss their mental health with providers compared to those belonging to other racial groups. The largest gap was between white and Asian patients: white patients were 227% more likely to be diagnosed with anxiety and 213% more likely to have a depression diagnosis compared to Asian patients.
Closing the Mental Health Gap for Women of Color
More people of color are seeking mental health services, but finding a therapist of color can be difficult.
CMS Data Shows Vulnerable Americans Forgoing Mental Health Care During COVID-19 Pandemic
The Centers for Medicare & Medicaid Services (CMS) released data highlighting the continued impact the COVID-19 Public Health Emergency (PHE) is having on Medicaid and Children’s Health Insurance Program (CHIP) beneficiaries the and utilization of health services. The data shows that, from March through October 2020, beneficiaries have foregone millions of primary, preventive, and mental health care visits due to the COVID-19 PHE, compared to the same time period in 2019. Although utilization rates for some treatments have rebounded to pre-pandemic levels, mental health services show the slowest rebound.
A Conversation About Peer Support and Peer Support Specialists
In this episode of the Depression and Bipolar Support Alliance (DBSA) Podcast series, learn what peer support means, what peer support specialists do, and where they work. Hear from Jennifer, a Peer Support Specialist, who talks about her journey to become a certified specialist, where she works, and how her role impacts peers.
Strategies for the Physical-Behavioral Healthcare Integration Puzzle
empowering primary care is at the heart of physical and behavioral healthcare integration. In order to push forward physical-behavioral healthcare integration, private payers will have to integrate mental health and substance use disorder treatment strategies, accurately assess the role of technology, leverage value-based care, and empower primary care providers.
Perceived Stress May Mediate the Relationship Between Antenatal Depressive Symptoms and Preterm Birth
Screening for changes in pregnancy-related anxiety and depressive symptoms during pregnancy may further our understanding of the relationship between these two variables and preterm birth. The objective of this study was to determine whether changes in pregnancy-related anxiety and depressive symptoms during pregnancy influence the risk of preterm birth among Pakistani women, explore whether perceived stress moderates or mediates this relationship, and examine the relationship between the various components of pregnancy-related anxiety and preterm birth. Among six different dimensions of pregnancy-related anxiety, mother’s concerns about fetal health showed a trend towards being predictive of preterm birth.
Let’s Banish the Term ‘Patient’ from the Health Care Lexicon
Imagine what would happen if clinicians called the people they treat “clients” or “activated consumers” or “partners.” With that mindset, they move away from implying what they will do to or for them, and instead describe what they will do with them as proactive partners.