Predictors and Consequences of Poor Health Trajectories Among US Adults Ages 50-64: A Latent Class Growth Analysis.

Background: US middle-aged adults have experienced concerning declines in health and life expectancy since 2010.

Objective: To investigate which groups of middle-aged adults are at risk of poor health trajectories, identify predictors of unhealthy aging, and assess potential consequences on health care utilization, costs, and mortality after these adults age into older adulthood.

Design: We used longitudinal survey data from the nationally representative, biennial Health and Retirement Study (HRS) to follow a representative sample of adults age 51 and older.

Health Care Utilization and Costs for Older Adults Aging Into Medicare After the Affordable Care Act.

Importance: The Affordable Care Act (ACA) expanded Medicaid and Marketplace insurance to nonelderly adults in 2014, but whether these policies improved outcomes later in life is unknown.

Objective: To examine whether exposure to ACA expansions during middle age (50-64 years) was associated with changes in health, utilization, and spending after these adults entered Medicare at 65 years of age.

Design, Setting, And Participants: This serial analysis of the Health and Retirement Study cohort linked to Medicare enrollment and claims data from January 1, 2010, to December 31, 2018.

Autonomy in work location decision and burnout in behavioral health providers: Lessons learned from COVID-19.

Objective: The ability to choose one's work-location can influence burnout from employment. We sought to evaluate potential associations between autonomy in work-location decision and burnout.

Methods: We used 2020 Veterans Health Administration Annual All Employee Survey data from behavioral health providers at 129 medical facilities.

Different types of greenspace within urban parks and depressive symptoms among older U.S. adults living in urban areas.

Access to greenspace in the form of urban parks is frequently used to study the mental health benefits of nature and may alleviate depression. However, there is a lack of research that considers the different types of vegetated and non-vegetated spaces that parks can provide. Our aim was to investigate whether different types of accessible park area, grassy; tree covered; and non-vegetated, were associated with depressive symptoms among older (≥50 years) urban US adults.

Perinatal attention-deficit/hyperactivity disorder diagnosis rates among commercially insured delivering women 2008-2020.

Objectives: Cognitive impairment and decreased executing functioning represent common symptoms of both ADHD and pregnancy. This study aimed to characterize temporal trends and racial/ethnic disparities in ADHD diagnosis during the perinatal period.

Methods: In this serial cross-sectional study, we used administrative claims to create a cohort of commercially insured women with a documented live birth between 2008 and 2020 and identified those with an ADHD diagnosis in the year before or after delivery.

Perinatal Psychotherapy Use and Costs Before and After Federally Mandated Health Insurance Coverage.

Importance: Insurance coverage affects health care access for many delivering women diagnosed with perinatal mood and anxiety disorders (PMADs). The Mental Health Parity and Addiction Equity Act (MHPAEA; passed in 2008) and the Patient Protection and Affordable Care Act (ACA; passed in 2010) aimed to improve health care access.

Objective: To assess associations between MHPAEA and ACA implementation and psychotherapy use and costs among delivering women overall and with PMADs.

PERSPECTIVE: Implications of Recent Health Policies for Women's Reproductive Mental Health.

Background: The economic cost of perinatal mood and anxiety disorders (PMADs) is high and includes the cost of reduced maternal economic productivity, more preterm births, and increases in other maternal mental health expenditures. PMADs also substantially contribute the cost of maternal morbidity. This paper offers a discussion of the quality-of-care cascade model of PMADs, which outlines care pathways that people typically face as well as gaps and unmet needs that frequently happen along the way.

Disparities in Utilization and Delivery Outcomes for Women with Perinatal Mood and Anxiety Disorders.

Perinatal mood and anxiety disorders (PMAD), which include depression and/or anxiety in the year before and/or after delivery, are common complications of pregnancy, affecting up to one in four perinatal individuals, with costs of over $15 billion per year in the US. In this paper, we provide an overview of the disparities in utilization and delivery outcomes for individuals with perinatal mood and anxiety disorders in the US. In addition, we discuss the current US screening and treatment guidelines as well as the high societal costs of illness of PMAD for both perinatal individuals and children.

Antidepressant Prescriptions Increased For Privately Insured People With Perinatal Mood And Anxiety Disorder, 2008-20.

We aimed to determine whether antidepressant prescriptions for perinatal mood and anxiety disorder (PMAD) increased after several professional organizations issued clinical recommendations in 2015 and 2016. This serial, cross-sectional, logistic regression analysis evaluated changes in antenatal and postpartum antidepressant prescriptions among commercially insured people who had a live-birth delivery as well as a PMAD diagnosis during the period 2008-20. For people with antenatal PMAD, the odds of an antenatal antidepressant prescription decreased 3 percent annually from 2008 to 2016 and increased by 32 percent in 2017, and the annual rate of change increased 5 percent for 2017-20 compared with 2008-16.

Perinatal Posttraumatic Stress Disorder Diagnoses Among Commercially Insured People Increased, 2008-20.

Posttraumatic stress disorder (PTSD) is a burdensome disorder, affecting 3-4 percent of delivering people in the US, with higher rates seen among Black and Hispanic people. The extent of clinical diagnosis remains unknown. We describe the temporal and racial and ethnic trends in perinatal PTSD diagnoses among commercially insured people with live-birth deliveries during the period 2008-20, using administrative claims from Optum's Clinformatics Data Mart Database.

The Importance of Autonomy and Performance Goals in Perceived Workload Among Behavioral Health Providers.

Objective: The authors sought to assess workplace characteristics associated with perceived reasonable workload among behavioral health care providers in the Veterans Health Administration.

Methods: The authors evaluated perceived reasonable workload and workplace characteristics from the 2019 All Employee Survey (AES; N=14,824) and 2019 Mental Health Provider Survey (MHPS; N=10,490) and facility-level staffing ratios from Mental Health Onboard Clinical Dashboard data. Nine AES and 15 MHPS workplace predictors of perceived reasonable workload, 11 AES and six MHPS demographic predictors, and facility-level staffing ratios were included in mixed-effects logistic regression models.

Diagnosed behavioral health conditions during the perinatal period among a commercially insured population by race/ethnicity, 2008-2020.

Objective: We sought to examine trends in diagnosed behavioral health (BH) conditions [mental health (MH) disorders or substance use disorders (SUD)] among pregnant and postpartum individuals between 2008-2020. We then explored the relationship between BH conditions and race/ethnicity, acknowledging race/ethnicity as a social construct that influences health disparities.

Methods: This study included delivering individuals, aged 15-44 years, and continuously enrolled in a single commercial health insurance plan for 1 year before and 1 year following delivery between 2008-2020.

Perinatal Mood And Anxiety Disorders Rose Among Privately Insured People, 2008-20.

Nationwide, perinatal mood and anxiety disorder (PMAD) diagnoses among privately insured people increased by 93.3 percent from 2008 to 2020, growing faster in 2015-20 than in 2008-14. Most states and demographic subgroups experienced increases, suggesting worsening morbidity in maternal mental health nationwide.

Assessing trends and variability in outpatient dual testing for chronic kidney disease with urine albumin and serum creatinine, 2009-2018: a retrospective cohort study in the Veterans Health Administration System.

Background: Simultaneous urine testing for albumin (UAlb) and serum creatinine (SCr), that is, 'dual testing,' is an accepted quality measure in the management of diabetes. As chronic kidney disease (CKD) is defined by both UAlb and SCr testing, this approach could be more widely adopted in kidney care.

Objective: We assessed time trends and facility-level variation in the performance of outpatient dual testing in the integrated Veterans Health Administration (VHA) system.

Societal costs of untreated perinatal mood and anxiety disorders in Vermont.

Purpose: To estimate the societal costs of untreated perinatal mood and anxiety disorders (PMADs) in Vermont for the 2018-2020 average annual birth cohort from conception through five years postpartum.

Methods: We developed a cost analysis model to calculate the excess cases of outcomes attributed to PMADs in the state of Vermont. Then, we modeled the associated costs of each outcome incurred by birthing parents and their children, projected five years for birthing parents who do not achieve remission by the end of the first year postpartum.

The impact of the affordable care act on perinatal mood and anxiety disorder diagnosis and treatment rates among Michigan Medicaid enrollees 2012-2018.

Background: Perinatal Mood and Anxiety Disorders (PMADs) affect one in five birthing individuals and represent a leading cause of maternal mortality. While these disorders are associated with a variety of poor outcomes and generate significant societal burden, underdiagnosis and undertreatment remain significant barriers to improved outcomes. We aimed to quantify whether the Patient Protection Affordable Care Act (ACA) improved PMAD diagnosis and treatment rates among Michigan Medicaid enrollees.

Racial and ethnic disparities in medication for opioid use disorder access, use, and treatment outcomes in Medicare.

Introduction: Overdose deaths are increasing disproportionately for minoritized populations in the United States. Disparities in substance use disorder treatment access and use have been a key contributor to this phenomenon. However, little is known about the magnitude of these disparities and the role of social determinants of health (SDOH) and provider characteristics in driving them.