Rider University and National Bureau of Economic Research, Department of Economics, Rider University, Lawrenceville, NJ 08648, USA.
Matern Child Health J. 2010 Jan;14(1):36-46. doi: 10.1007/s10995-008-0424-3. Epub 2008 Nov 7.
The objective of this study was to assess the extent to which maternal prenatal mental illness is associated with mothers' health insurance status 12-18 months after giving birth. The sample consisted of 2,956 urban, mostly unwed, mothers who gave birth in 20 large U.S. cities between 1998 and 2000 and participated in the Fragile Families and Child Wellbeing birth cohort study. Multinomial logistic regression models were used to assess associations between maternal prenatal mental illness and whether the mother had private, public, or no insurance one year after the birth. Covariates included the mother's and child's physical health status, the father's physical and mental health status, and numerous other maternal, paternal, and family characteristics. Potential mediating factors were explored. The results showed that mothers with prenatal diagnosed mental illness were almost half as likely as those without mental illness diagnoses to have private insurance (vs. no insurance) one year after the birth. Among mothers who did not have a subsequent pregnancy, those with prenatal mental illness were less likely than those without mental illness diagnoses to have public insurance than to be uninsured. Screening positive for depression or anxiety at one year decreased the likelihood that the mother had either type of insurance. Policies to improve private mental health care coverage and public mental health services among mothers with young children may yield both private and social benefits. Encounters with the health care and social service systems experienced by pregnant and postpartum women present opportunities for connecting mothers to needed mental health services and facilitating their maintenance of health insurance.
本研究旨在评估产妇产前精神疾病与母亲产后 12-18 个月的健康保险状况之间的关联程度。该样本由 2956 名生活在城市、多数未婚的母亲组成，她们于 1998 年至 2000 年间在美国 20 个大城市分娩，并参与了脆弱家庭和儿童福利出生队列研究。采用多项逻辑回归模型评估了产妇产前精神疾病与母亲在产后一年内是否拥有私人、公共或无保险之间的关联。协变量包括母亲和孩子的身体健康状况、父亲的身心健康状况以及许多其他母亲、父亲和家庭特征。还探讨了潜在的中介因素。结果表明，产前被诊断出患有精神疾病的母亲在产后一年内拥有私人保险（而非无保险）的可能性比没有精神疾病诊断的母亲低近一半。在没有后续怀孕的母亲中，与没有精神疾病诊断的母亲相比，患有产前精神疾病的母亲更有可能没有公共保险，而不是没有保险。在产后一年时，抑郁或焦虑筛查阳性使母亲获得任何一种保险的可能性降低。改善有幼儿的母亲的私人精神保健覆盖范围和公共精神卫生服务的政策可能会带来私人和社会效益。孕妇和产后妇女接触医疗保健和社会服务系统为将母亲与所需的精神卫生服务联系起来并促进其维持医疗保险提供了机会。
