Mental Health Disorders Linked to Higher Childbirth Costs

Women with mental health disorders during pregnancy incurred higher childbirth costs and a greater risk for severe illness during gestation, researchers found.

Pregnant women who had at least one mental health diagnosis spent an average of 9% more on their delivery hospitalizations than those without a mental health diagnosis ($5,473 vs $5,015), reported Clare Brown, PhD, of the University of Arkansas for Medical Sciences in Little Rock, and colleagues.

Patients with a mental health disorder also had a 50% higher risk of severe maternal morbidity (206.3 vs 135.0 cases per 10,000 deliveries), the researchers wrote in Health Affairs.

“A 50% higher rate for any mental health condition in this category, that’s a significant increase,” Brown told MedPage Today. “That’s a large difference in something that is theoretically going to impact the health of the mother throughout postpartum, and the health of the infant as well.”

Patients who had trauma- or stress-related mental health conditions had the most costly delivery hospitalizations — paying $825 more on average for childbirth. Most strikingly, pregnant women in this group also faced an 87% increased risk of severe maternal morbidity (259.6 vs 138.8 events per 10,000 deliveries), the researchers found.

The magnitude of financial strain placed on women with perinatal mental health disorders was surprising, said Sheryl Kingsberg, PhD, division chief of ob/gyn behavioral medicine at University Hospitals Cleveland Medical Center, who was not involved with this study. But, she added, these costs are likely an underestimation, as the rates of perinatal mental illness were very low. This was especially evident among patients in minority groups, whose conditions may go unrecognized.

“This was certainly a wake-up call for me of the importance of screening and treating mental health concerns,” Kingsberg told MedPage Today, adding that physicians may be unaware of the economic toll that an absence of these services can have on their patients. “The cost-savings of behavioral health services hugely outweighs the burden of not having it available.”

In this study, Brown and colleagues analyzed hospital discharge data from the Healthcare Cost and Utilization Project (HCUP) National Inpatient Sample. They evaluated hospitalization cost, length of stay, and severe maternal morbidity for deliveries that took place between 2016 and 2017, comparing outcomes of women with mental health disorders to those without them. The study included 11 mental health categories, but the four most common were anxiety, depressive, bipolar, and trauma or stress-related disorders.

The analysis included approximately 1.5 million people who had 7.3 million delivery hospitalizations. Around 4% of women included in the study had at least one mental health condition at delivery. People with substance use disorder were more likely to have a mental health diagnosis (23.1% vs 5.5%, respectively), as were those covered by Medicaid (6.3% vs 5.5%, respectively). Around 8% of white women had a mental health diagnosis, compared with 5% of Black women and 3% of Hispanic women.

Women who had comorbid conditions such as diabetes or HIV/AIDS were also more likely to have a mental illness. There was a dose-responsive relationship between mental health illness risk and comorbidities, and risk increased with each additional comorbidity.

People with perinatal mental health disorders together spent $102 million more each year on childbirth hospitalizations than those without a mental health diagnosis, Brown’s group estimated.

Pregnant women with a mental health diagnosis also had longer hospitalizations than those without. Those with any mental health condition stayed in the hospital for around 0.2 days longer, and those with trauma- or stress-related conditions stayed for 0.3 days longer.

Women who had more than one diagnosed mental health condition had higher costs, longer hospital stays, and a greater risk of severe maternal morbidity than those with a single diagnosis.

Brown’s group acknowledged that data from HCUP’s National Inpatient Sample is observational and did not capture care that occurs outside of the inpatient setting. Additionally, mental health disorders that were not indicated as a diagnosis on the hospitalization record were not included in this study, so the frequency of perinatal mental health conditions might have been underestimated. Finally, the group noted that the database did not include patient information such as the number of prenatal visits, household income, access to housing, and other social determinants that could affect these results.

Because women with trauma- or stress-related illnesses were more likely to endure greater costs, have longer hospital stays, and have severe maternal morbidity, Kingsberg said it is critical to universally screen pregnant patients for mental health conditions and to promote the use of trauma-informed care.

“We need to teach practitioners that trauma-informed care is not just some pie in the sky psychobabble,” she said. “It is evidence-based, and it can reduce the trauma that something like pregnancy and delivery can impose.”