The Problems No One Wants to See: Mental Illness and Substance Abuse Among Women of Reproductive Age in North Carolina

Abstract

igh rates of infant mortality and morbidity persist in North Carolina despite efforts at the state and federal level to improve women's physical health and access to prenatal care in order to promote healthy birth outcomes. While infant mortality and low birth weight rates have declined over the past decade, more focused attention to women's behavioral health, specifically mental illness and substance use disorders, is needed to further close this gap. Women's mental health and substance use are often overlooked as determinants of both preconceptional health and pregnancy outcomes. This is regrettably shortsighted: addiction and mental illness not only pose risks to prenatal development and birth outcomes but also impair women's ability to be safe and sober mothers. Promoting positive birth outcomes requires that health care providers, policymakers, and communities in North Carolina collaborate to create a system of comprehensive care in order to support women's recovery from mental illness and substance abuse. PrevalenceThough overall rates of having any mental disorder are similar for men and women, the prevalence of specific disorders vary greatly by gender. According to the National Household Survey on Drug Use and Health, in 2007 the prevalence of serious mental illness (defined as a diagnosable mental, behavioral, or emotional disorder with substantial functional impairment) was higher in women, particularly those of reproductive age, than in men: 13.5% in women versus 10% in men for ages 18-25 and 10.1% versus 5.5% for ages 26-49.1 More women, 11.6% versus 7.7%, suffered mood disorders. 1 Substance use disorders are less common among women, with overall prevalence of substance use disorders of 5.7% among women as compared to 12.3% among men. 1Mental illness and substance use disorders are associated with significant morbidity, mortality, and disability. One in four individuals visiting a health care provider has at least one mental or behavioral disorder, yet these often go undiagnosed and untreated. 2 In the United States, only about one in four individuals who need substance abuse treatment receive it. 3 Failure to diagnose and treat has serious negative consequences. Mental illnesses are associated with increased risk of cardiovascular disease and diabetes and an increase of high-risk behaviors associated with substance abuse or HIV transmission. 2 Women who abuse substances are at increased risk for a variety of adverse health outcomes, including breast cancer, infertility, mental illness, unintentional injuries, suicide, and intimate partner violence. 4-9 This relationship between mental health, and substance use disorders, and risk behaviors is supported by data from the North Carolina Treatment Outcomes and Program Performance System (NC-TOPPS), a state reporting system that captures service and

Predicting Co-Occurring Mental Health and Substance Use Disorders in Women: An Automated Machine Learning Approach

“…The super learning model comprised two base learners: a Random Forest model and an XGBoost model, and it outperformed the individual base learners.The super learning model's accuracy in identification would enable early identification of women at risk of co-occurring mental health and substance use disorders. Women who receive substance use treatment that is tailored to their gender experience a longer duration of stay in treatment and have a higher probability of maintaining abstinence after completing treatment [1]. The emergence of more accurate and timely diagnosis has significant consequences for the development of improved treatment techniques, aimed at reducing the complications, illness, and death associated with these disorders [26].…”

“…An association between co-occurring substance use disorders (SUDs) and various mental health disorders is linked to substantial levels of sickness, death, and impairment [1]. Twenty-five percent of patients seeking medical care have at least one mental or behavioural issue; however, these conditions frequently remain undetected and untreated [2].…”

“…The implications of these interconnected issues have broader consequences, as substance use disorders (SUDs) have been linked to increased risks of suicide and aggressiveness [7,8]. Women grappling with co-occurring disorders often navigate a multitude of hurdles, spanning familial conflicts, depression, educational barriers, economic hardships, past trauma, physical health concerns, reproductive health complications, infertility, early onset of menopause, and complications during pregnancy, breastfeeding, childbirth, unemployment, and more, highlighting the multifaceted nature of their challenges [1,9,10].…”