Mental Health and Substance Use Disorder Hospitalizations and Disorder-identified Deliveries in Illinois

Mental health and substance use (MH/SU) disorders pose a significant risk to the health and well-being of women, pregnant people, and infants. The opioid epidemic and the mental health impacts of the COVID-19 epidemic have drawn national attention to MH/SU disorders among women and children and concerns about long term impact of these disorders on individuals and communities. Identification and treatment of MH/SU disorders among women of reproductive age (WRA) and pregnant people must be effective and responsive to the unique needs of this population and their children. This study utilized hospital discharge data and birth certificate data to estimate rates of hospitalizations for MH/SU disorders among WRA and MH/SU disorders documented at live deliveries in Illinois from 2016-2017. For the analysis on deliveries with MH/SU disorders documented, the hospital discharge data were linked to the birth certificate using a probabilistic match and the dataset was deduplicated to include only the first delivery per birthing person during the study period. There were three aims of this analysis: 1). Identify hospitalizations for mental health (MH), substance use (SU), and MH and SU co-diagnosed disorders among WRA in Illinois in 2016-2017, 2). Identify live deliveries with MH, SU, co-diagnosed disorders documented on the delivery record in Illinois in 2016-2017, and 3). Assess the association between MH/SU disorders documented at delivery and chronic health and perinatal outcomes. This analysis demonstrated that hospitalizations for MH/SU disorders occurred frequently among WRA in Illinois. Further, these disorders were commonly documented on delivery records. Severe diagnoses occurred made up the majority of diagnoses in both hospitalizations and disorder-documented deliveries. Rates of both MH/SU hospitalizations and disorder-documented deliveries demonstrated important inequities, with people living in rural counties and people with public insurance more likely to be affected. Among live deliveries, people with MH/SU disorders documented were significantly more likely to experience chronic health conditions originating before pregnancy, obstetric co-morbidities during pregnancy, severe maternal morbidity, and preterm birth. Despite the higher rate of chronic and obstetric co-morbidities and the adverse perinatal outcomes experienced, patients with MH/SU disorders were significantly less likely to receive adequate prenatal care. This study suggests several important public health and clinical implications. Increased access to outpatient MH/SU services, especially in rural areas, may improve health throughout the life course for women and children. Prenatal care should be accessible and affirming for patients with SU disorder and may help to address some of the poor outcomes experienced by patients with SU disorder. Effective treatments for MH/SU disorders exist and have been shown to mitigate harm to patients and families.