AOD Use and Mental Health Disparities during Pregnancy and Postpartum

1. AOD Use and Mental Health Disparities during Pregnancy and Postpartum Victoria H. Coleman, Ph.D. & Michael L. Dennis, Ph.D. Chestnut Health Systems, Bloomington, IL Introduction Definitions Results • Pregnancy is recognized as presenting significant biological, psychological, and social stressors in a woman’s life (Goebert, Morland, Frattarelli, Onoye, & Matsu, 2007; Huizink, Mulder, Robles de Medina, Visser, & Buitelaar, 2004). Typically, alcohol and other drug (AOD) use decreases during pregnancy (SAMHSA, 2008), however certain populations exhibit relatively higher rates of AOD use during this time. • Illicit drug use during pregnancy has been found to vary by race/ethnicity, with American Indians, individuals of two or more races, and African-Americans reporting the highest rates of current use during pregnancy in 2007 (SAMHSA, 2008). • Pregnant adolescents (aged 15-17) reported a higher rate of current illicit drug use (22.6%) than non-pregnant adolescents (13.3%), which is a trend that is reversed for women aged 18-44 (SAMHSA, 2008). • It is widely known that substance use during pregnancy can contribute to perinatal complications and poor neonatal outcomes (Havens, Simmons, Shannon, & Hansen, in press), thus identifying any disparity in substance abuse treatment received is of the utmost importance. Substance abuse treatment is believed to be more effective during pregnancy given the motivation for a mother to change for the sake of her unborn child (Jones, 2004). • Need of mental health treatment defined as: high on IMDS (scale score > 23), high on BCS (scale score > 18), or endorsing suicidal thoughts. • Need of substance abuse treatment defined as any past year dependence or abuse. • Need of legal intervention defined as: high on GCS (scale score > 3). • Disparity defined as low treatment received in the past 90 days, given treatment need. The figures below display significant disparity in substance abuse treatment received when comparing a minority group with the majority group, after weighting. Specifically, pregnant African-American and Mixed females were significantly more likely to have had no substance abuse treatment received in the past 90 days, despite having a need for treatment. No other disparity in the areas of mental health treatment received or legal intervention were found with these two groups, and no disparity was found with the Hispanic group for any substance, mental, or legal treatment received. Figure 1: Substance Abuse Treatment Disparity (AA, White) Methods n=58 n=62 • Trained and certified GAIN administrators collected intake data from treatment clients at 10 sites during a one- on-one interview. Individual sites sent data to a central data management system at Chestnut Health Systems. • Demographic profiles were created to determine group differences. To help control for spurious results, White females’ responses were weighted via propensity scores predicting membership in the minority race groups, thus producing 3 paired groups with equal sample sizes. • The propensity score was based on age, lifetime victimization, past year substance use-related problems, past year internalizing mental distress, past year externalizing behavior problems, and the pattern of multi- morbidity. χ2(2)=11.69, p<.01 Figure 2: Substance Abuse Treatment Disparity (Mixed, White) Purpose of the Study • The purpose of this study is to examine Global Appraisal of Individual Needs (GAIN; Dennis et al., 2003) data collected from pregnant adults and adolescents upon entry into substance abuse treatment, in an effort to identify any disparity in treatment received that exists across groups by race/ethnicity, then in a second analysis by age, after controlling for baseline differences, mental health and substance problem severity, and pattern of multi-morbidity. n=41 n=44 Sample Demographics • Total N=4509 females presenting to treatment. • Pregnant sample N=328 (7%) Weighted by race Data Set Used χ2(2)=13.77, p<.01 • Data used in this study is from a collection of 10 adolescent and adult treatment studies. All data reported is intake data collected with GAIN instruments. • The dataset was limited to cases for which pregnancy status was available. When analyzing by age, there is significant difference in need, with adolescents needing treatment more than adults. Though need is greater, no disparity was apparent in treatment received by age. GAIN Instruments & Scales Unweighted by age Summary and Implications The GAIN is a collection of comprehensive biopsychosocial assessments used in substance abuse treatment. • When matched on age and clinical severity, pregnant African-American and Mixed women are not receiving the substance abuse treatment that they need, as compared with pregnant White women. • Targeted interventions for pregnant African-American and Mixed females are indicated. • Pregnant adolescents have greater need for treatment than adults, though disparity in treatment received was not observed. • Staff-administered in about 60-90 minutes • Yield DSM/ICD diagnoses and ASAM information • Strong history of psychometric integrity Measures at Intake: Substance Problems Scale (SPSy), Internal Mental Distress Scale (IMDS), Behavioral Complexity Scale (BCS), General Crime Scale (GCS), General Victimization Scale (GVS) References Due to the significant difference by age in substance severity, mental distress, and pattern of multi-morbidity, weighting could not be utilized in age analyses. • Available from author on separate sheet. Acknowledgement - Analysis of the GAIN data reported in this presentation was supported by Substance Abuse and Mental Health Services Administration's (SAMHSA's) Center for Substance Abuse Treatment (CSAT) under Contracts 207-98-7047, 277-00-6500, 270-03-00006, and 270-07-0191 using data provided by 10 grantees. The opinions expressed here belong to the author and are not official positions of the government. For more information, please contact Victoria H. Coleman, Ph.D. * Chestnut Health Systems * 448 Wylie Drive * Normal, IL 61761 * 309-451-7797 *vhcoleman@chestnut.org