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Article ; Online: Perinatal Mental Illness Nearly Ended My Life.

Zivin, Kara

2021 Volume 40, Issue 10, Page(s) 1663–1666

Abstract: A psychiatry professor's recovery from perinatal depression drives her research to facilitate practice and policy change. ...

Abstract	A psychiatry professor's recovery from perinatal depression drives her research to facilitate practice and policy change.
MeSH term(s)	Female ; Humans ; Mental Disorders/therapy ; Parturition ; Pregnancy ; Psychiatry
Language	English
Publishing date	2021-10-05
Publishing country	United States
Document type	Journal Article
ZDB-ID	632712-6
ISSN	1544-5208 ; 0278-2715
ISSN (online)	1544-5208
ISSN	0278-2715
DOI	10.1377/hlthaff.2021.00706
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Zs.A 2118: Show issues

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Article ; Online: Burnout and Perceived Workload Among Behavioral Health Providers During the COVID-19 Pandemic: Importance of Supervisory, Leadership, and Organizational Support.

Burgess, Jennifer / Kim, Hyungjin Myra / Porath, Brittany R / Zivin, Kara

American journal of health promotion : AJHP

2024 , Page(s) 8901171241236240

Abstract: Purpose: To assess the relationship between behavioral health provider (BHP) perceptions of support during COVID-19 and burnout and self-reported workload.: Design: We conducted a cross-sectional analysis of provider-level data collected from the ... ...

Abstract	Purpose: To assess the relationship between behavioral health provider (BHP) perceptions of support during COVID-19 and burnout and self-reported workload. Design: We conducted a cross-sectional analysis of provider-level data collected from the 2020 and 2021 All Employee Survey (AES). Setting: The Veterans Health Administration. Subjects: 36,541 (10,332 [28.28%] with missing data) respondents in 2020 and 2021 combined. Measures: Main outcomes were self-reported burnout and self-reported workload. Main predictors were 6 COVID-19-related provider-perceived support domains. Covariates were 11 AES demographic predictors. Analysis: We conducted mixed-effects logistic regression modeling for each domain and outcome pairing. We summarized our results using average marginal effects (AMEs) and odds ratios (ORs). Results: All 6 domains of feeling prepared, heard, protected, cared for, honored, and having flexible policies were significantly negatively associated with burnout (AMEs -.20 to -.10, ORs .38-.63, Conclusion: Creating a work environment with flexible policies and where staff feel prepared, heard, protected, cared for, and honored could support BHPs in feeling less burned out and that their workload is reasonable.
Language	English
Publishing date	2024-02-28
Publishing country	United States
Document type	Journal Article
ZDB-ID	645160-3
ISSN	2168-6602 ; 0890-1171
ISSN (online)	2168-6602
ISSN	0890-1171
DOI	10.1177/08901171241236240
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Zs.A 2531: Show issues

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Article ; Online: A Response to the President's Call to Support Public Mental Health.

Mezuk, Briana / Maust, Donovan / Zivin, Kara

American journal of preventive medicine

2022 Volume 63, Issue 4, Page(s) 660–663

MeSH term(s)	Humans ; Mental Health ; Public Health
Language	English
Publishing date	2022-07-06
Publishing country	Netherlands
Document type	Journal Article ; Research Support, Non-U.S. Gov't ; Research Support, N.I.H., Extramural
ZDB-ID	632646-8
ISSN	1873-2607 ; 0749-3797
ISSN (online)	1873-2607
ISSN	0749-3797
DOI	10.1016/j.amepre.2022.05.009
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Zs.A 2096: Show issues

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

Hall, Stephanie V / Pangori, Andrea / Tilea, Anca / Schroeder, Amy / Admon, Lindsay K / Zivin, Kara

Health affairs (Project Hope)

2024 Volume 43, Issue 4, Page(s) 514–522

Abstract: 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 ... ...

Abstract	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. For people with postpartum PMAD, the odds of a postpartum antidepressant prescription decreased 2 percent annually from 2008 to 2016 and experienced no significant change in 2017, but the annual rate of change increased 3 percent for 2017-20 compared with 2008-16. The clinical recommendations issued in 2015 and 2016 were associated with increased antidepressant prescriptions for PMAD, particularly for antenatal PMAD. These findings indicate that clinical recommendations represent an effective tool for changing prescribing patterns.
MeSH term(s)	Humans ; Female ; Pregnancy ; Cross-Sectional Studies ; Antidepressive Agents/therapeutic use ; Anxiety Disorders/drug therapy ; Drug Prescriptions ; Insurance, Health
Chemical Substances	Antidepressive Agents
Language	English
Publishing date	2024-03-07
Publishing country	United States
Document type	Journal Article
ZDB-ID	632712-6
ISSN	1544-5208 ; 0278-2715
ISSN (online)	1544-5208
ISSN	0278-2715
DOI	10.1377/hlthaff.2023.01448
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Zs.A 2118: Show issues

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Article ; Online: Perinatal Posttraumatic Stress Disorder Diagnoses Among Commercially Insured People Increased, 2008-20.

Hall, Stephanie V / Bell, Sarah / Courant, Anna / Admon, Lindsay K / Zivin, Kara

Health affairs (Project Hope)

2024 Volume 43, Issue 4, Page(s) 504–513

Abstract: 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 ... ...

Abstract	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. Predicted probabilities from our logistic regression analysis showed a 394 percent increase in perinatal PTSD diagnoses, from 37.7 per 10,000 deliveries in 2008 to 186.3 per 10,000 deliveries in 2020. White people had the highest diagnosis rate at all time points (208.0 per 10,000 deliveries in 2020), followed by Black people, people with unknown race, Hispanic people, and Asian people (188.7, 171.9, 146.9, and 79.8 per 10,000 deliveries in 2020, respectively). The significant growth in perinatal PTSD diagnosis rates may reflect increased awareness, diagnosis, or prevalence of the disorder. However, these rates fall well below the estimated prevalence of PTSD in the perinatal population.
MeSH term(s)	Pregnancy ; Female ; Humans ; United States/epidemiology ; Stress Disorders, Post-Traumatic/diagnosis ; Stress Disorders, Post-Traumatic/epidemiology ; Hispanic or Latino ; Asian ; Parturition ; White
Language	English
Publishing date	2024-03-07
Publishing country	United States
Document type	Journal Article
ZDB-ID	632712-6
ISSN	1544-5208 ; 0278-2715
ISSN (online)	1544-5208
ISSN	0278-2715
DOI	10.1377/hlthaff.2023.01447
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Zs.A 2118: Show issues

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Article ; Online: Relationship between facility number of clinicians and prescribing intensity of psychotropic medications, opioids, and antibiotics in ambulatory practice.

Kim, Hyungjin Myra / Strominger, Julie / Zivin, Kara / Van, Tony / Maust, Donovan T

BMC health services research

2024 Volume 24, Issue 1, Page(s) 217

Abstract: Background: Promoting appropriate pharmacotherapy requires understanding the factors that influence how clinicians prescribe medications. While prior work has focused on patient and clinician factors, features of the organizational setting have received ...

Abstract	Background: Promoting appropriate pharmacotherapy requires understanding the factors that influence how clinicians prescribe medications. While prior work has focused on patient and clinician factors, features of the organizational setting have received less attention, though identifying sources of variation in prescribing may help identify opportunities to improve patient safety and outcomes. Objective: To evaluate the relationship between the number of clinicians who prescribe medications in a facility and facility prescribing intensity of six individual medication classes by clinician specialty: benzodiazepines, antipsychotics, antiepileptics, and antidepressants by psychiatrists and antibiotics, opioids, antiepileptics, and antidepressants by primary care clinicians (PCPs). Design: We used 2017 Veterans Health Administration (VHA) administrative data. Subjects: We included patient-clinician dyads of older patients (> 55 years) with an outpatient encounter with a clinician in 2017. Patient-clinician data from 140 VHA facilities were included (n = 13,347,658). Analysis was repeated for years 2014 to 2016. Main measures: For each medication, facility prescribing intensity measures were calculated as clinician prescribing intensity averaged over all clinicians at each facility. Clinician prescribing intensity measures included percentage of each clinician's patients prescribed the medication and mean number of days supply per patient among all patients of each clinician. Key results: As the number of prescribing clinicians in a facility increased, the intensity of prescribing decreased. Every increase of 10 facility clinicians was associated with a significant decline in prescribing intensity for both specialties for different medication classes: for psychiatrists, declines ranged from 6 to 11%, and for PCPs, from 2 to 3%. The pattern of more clinicians less prescribing was significant across all years. Conclusion: Future work should explore the mechanisms that link the number of facility clinicians with prescribing intensity for benzodiazepines, antipsychotics, antiepileptics, antidepressants, antibiotics, and opioids. Facilities with fewer clinicians may need additional resources to avoid unwanted prescribing of potentially harmful or unnecessary medications.
MeSH term(s)	Humans ; Analgesics, Opioid/therapeutic use ; Anticonvulsants/therapeutic use ; Anti-Bacterial Agents/therapeutic use ; Psychotropic Drugs/therapeutic use ; Benzodiazepines/therapeutic use ; Antidepressive Agents ; Practice Patterns, Physicians'
Chemical Substances	Analgesics, Opioid ; Anticonvulsants ; Anti-Bacterial Agents ; Psychotropic Drugs ; Benzodiazepines (12794-10-4) ; Antidepressive Agents
Language	English
Publishing date	2024-02-16
Publishing country	England
Document type	Journal Article
ZDB-ID	2050434-2
ISSN	1472-6963 ; 1472-6963
ISSN (online)	1472-6963
ISSN	1472-6963
DOI	10.1186/s12913-024-10613-z
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Article ; Online: Pregnant Women with Substance Use Disorders - The Harm Associated with Punitive Approaches.

Haffajee, Rebecca L / Faherty, Laura J / Zivin, Kara

The New England journal of medicine

2021 Volume 384, Issue 25, Page(s) 2364–2367

MeSH term(s)	Behavior Therapy ; Female ; Health Policy ; Humans ; Infant, Newborn ; Mandatory Reporting ; Mandatory Testing/legislation & jurisprudence ; Pregnancy ; Pregnancy Complications/diagnosis ; Pregnancy Complications/therapy ; Pregnant Women ; Prenatal Care ; Punishment ; Social Control, Formal ; State Government ; Substance Abuse Detection/legislation & jurisprudence ; Substance-Related Disorders/diagnosis ; Substance-Related Disorders/therapy ; United States
Language	English
Publishing date	2021-06-19
Publishing country	United States
Document type	Journal Article
ZDB-ID	207154-x
ISSN	1533-4406 ; 0028-4793
ISSN (online)	1533-4406
ISSN	0028-4793
DOI	10.1056/NEJMp2101051
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Article ; Online: Societal costs of untreated perinatal mood and anxiety disorders in Vermont.

Platt, Isabel S / Pendl-Robinson, Emma L / Dehus, Eric / O'Neil, Sasigant So / Vohra, Divya / Kenny, Michael / Pentenrieder, Laura / Zivin, Kara

Archives of women's mental health

2024

Abstract: 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 ... ...

Abstract	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. Results: We estimated that the total societal cost of untreated PMADs in Vermont could reach $48 million for an annual birth cohort from conception to five years postpartum, amounting to $35,910 in excess societal costs per birthing parent with an untreated PMAD and their child. Conclusion: Our model provides evidence of the high costs of untreated PMADs for birthing parents and their children in Vermont. Our estimates for Vermont are slightly higher but comparable to national estimates, which are $35,500 per birthing parent-child pair, adjusted to 2021 US dollars. Investing in perinatal mental health prevention and treatment could improve health outcomes and reduce economic burden of PMADs on individuals, families, employers, and the state.
Language	English
Publishing date	2024-02-07
Publishing country	Austria
Document type	Journal Article
ZDB-ID	1463529-X
ISSN	1435-1102 ; 1434-1816
ISSN (online)	1435-1102
ISSN	1434-1816
DOI	10.1007/s00737-024-01429-1
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Zs.A 5115: Show issues

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

Hall, Stephanie V / Zivin, Kara / Piatt, Gretchen A / Weaver, Addie / Tilea, Anca / Zhang, Xiaosong / Moyer, Cheryl A

BMC health services research

2024 Volume 24, Issue 1, Page(s) 149

Abstract: 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 ... ...

Abstract	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. Methods: We applied an interrupted time series framework to administrative Michigan Medicaid claims data to determine if PMAD monthly diagnosis or treatment rates changed after ACA implementation for births 2012 through 2018. We evaluated three treatment types, including psychotherapy, prescription medication, and either psychotherapy or prescription medication. Participants included the 170,690 Medicaid enrollees who had at least one live birth between 2012 and 2018, with continuous enrollment from 9 months before birth through 3 months postpartum. Results: ACA implementation was associated with a statistically significant 0.76% point increase in PMAD diagnosis rates (95% CI: 0.01 to 1.52). However, there were no statistically significant changes in treatment rates among enrollees with a PMAD diagnosis. Conclusion: The ACA may have improved PMAD detection and documentation in clinical settings. While a higher rate of PMAD cases were identified after ACA Implementation, Post-ACA cases were treated at similar rates as Pre-ACA cases.
MeSH term(s)	Pregnancy ; Female ; United States/epidemiology ; Humans ; Medicaid ; Patient Protection and Affordable Care Act ; Michigan/epidemiology ; Interrupted Time Series Analysis ; Anxiety Disorders/diagnosis ; Anxiety Disorders/epidemiology ; Anxiety Disorders/therapy ; Insurance Coverage
Language	English
Publishing date	2024-01-30
Publishing country	England
Document type	Journal Article
ZDB-ID	2050434-2
ISSN	1472-6963 ; 1472-6963
ISSN (online)	1472-6963
ISSN	1472-6963
DOI	10.1186/s12913-023-10539-y
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Article ; Online: Diagnosed behavioral health conditions during the perinatal period among a commercially insured population by race/ethnicity, 2008-2020.

Beck, Dana C / Tabb, Karen / Tilea, Anca / Vance, Ashlee J / Hall, Stephanie / Schroeder, Amy / Zivin, Kara

Frontiers in public health

2024 Volume 12, Page(s) 1345442

Abstract: 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 ... ...

Abstract	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. We used BH conditions as our outcome based on relevant ICD 9/10 codes documented during pregnancy or the postpartum year. Results: In adjusted analyses, white individuals experienced the highest rates of BH conditions, followed by Black, Hispanic, and Asian individuals, respectively. Asian individuals had the largest increase in BH rates, increasing 292%. White individuals had the smallest increase of 192%. The trend remained unchanged even after adjusting for age and Bateman comorbidity score, the trend remained unchanged. Conclusions: The prevalence of diagnosed BH conditions among individuals in the perinatal and postpartum periods increased over time. As national efforts continue to work toward improving perinatal BH, solutions must incorporate the needs of diverse populations to avert preventable morbidity and mortality.
MeSH term(s)	Pregnancy ; Female ; Humans ; Ethnicity ; Hispanic or Latino ; White People ; Morbidity ; Black People
Language	English
Publishing date	2024-03-07
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2711781-9
ISSN	2296-2565 ; 2296-2565
ISSN (online)	2296-2565
ISSN	2296-2565
DOI	10.3389/fpubh.2024.1345442
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