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Chapman M, Bandoli G, Goldenberg SM. The association between depression and alcohol use among pregnant adults in the USA. Arch Womens Ment Health 2024; 27:425-433. [PMID: 38195994 PMCID: PMC11116222 DOI: 10.1007/s00737-023-01417-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 12/20/2023] [Indexed: 01/11/2024]
Abstract
BACKGROUND The prevalence of alcohol use among pregnant women aged 18-44 years old increased in recent years. The influence of mental health issues on an individual's likelihood to use alcohol during pregnancy has not been thoroughly investigated. This study will examine the association between experiencing a major depressive episode (MDE) in the past year and past-month alcohol use among pregnant women using the 2011-2020 National Survey on Drug Use and Health (NSDUH). METHODS Pregnant women between the ages of 18 and 44 years old were included in the study for analysis. Multivariable logistic regression analysis was used to examine the association between past-year MDE and past-month alcohol use adjusting for age, race/ethnicity, marital status, and employment status. Additional logistic regression analysis was performed to investigate whether this relationship differed by trimester of pregnancy. RESULTS A total of 6745 participants were included in the analytic sample. The prevalence of past-year MDE and past-month alcohol use was 7.67% and 9.15% respectively. Logistic regression analysis showed past-year MDE was significantly associated with past-month alcohol use in pregnant women adjusting for age, race/ethnicity, marital status, and employment status (aOR = 1.96; 95% CI, 1.34-2.87). This relationship became stronger in second and third trimesters of pregnancy. CONCLUSIONS This study showed a positive association between MDE and past-month alcohol use among pregnant women, with strongest effect estimates in the third trimester. These findings may inform approaches for improved screening guidelines and health education for individuals who may be at higher risk of prenatal alcohol use.
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Affiliation(s)
- Madison Chapman
- Department of Pediatrics, University of California San Diego, La Jolla, CA, USA.
- Division of Epidemiology and Biostatistics, School of Public Health, San Diego State University, San Diego, USA.
| | - Gretchen Bandoli
- Department of Pediatrics, University of California San Diego, La Jolla, CA, USA
- Division of Epidemiology and Biostatistics, School of Public Health, San Diego State University, San Diego, USA
| | - Shira M Goldenberg
- Department of Pediatrics, University of California San Diego, La Jolla, CA, USA
- Division of Epidemiology and Biostatistics, School of Public Health, San Diego State University, San Diego, USA
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2
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Nagle-Yang S, Miller ES, Lebin LG, Blissett G, Dossett EC. Perinatal Psychopharmacology: Innovative Approaches to Care Delivery. Clin Obstet Gynecol 2024; 67:186-199. [PMID: 38281175 DOI: 10.1097/grf.0000000000000839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2024]
Abstract
Perinatal mental health conditions are the most common complications of childbirth and have well-established enduring negative effects. Obstetric (Ob) clinicians care for patients with perinatal mental health conditions across a spectrum of acuity, severity, and complexity. Ob and psychiatric clinicians can collaborate to create a cohesive continuum of psychopharmacologic care for perinatal patients. This chapter provides an overall framework for Ob-psychiatric clinician collaboration with examples of innovation in care delivery.
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Affiliation(s)
- Sarah Nagle-Yang
- Department of Psychiatry, University of Colorado, Aurora, Colorado
| | - Emily S Miller
- Department of Obstetrics and Gynecology, Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Lindsay G Lebin
- Department of Psychiatry, University of Colorado, Aurora, Colorado
| | | | - Emily C Dossett
- Department of Psychiatry and Behavioral Sciences and Obstetrics and Gynecology at the Keck School of Medicine, University of Southern California, Los Angeles, California
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3
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Tato Fernandes F, de Almeida AB, Fernandes M, Correia R, Magalhães R, Buchner G, Braga J, Freitas P. Perinatal depression and mental health uptake referral rate in an obstetric service. Sci Rep 2023; 13:10987. [PMID: 37419918 PMCID: PMC10328992 DOI: 10.1038/s41598-023-33832-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Accepted: 04/19/2023] [Indexed: 07/09/2023] Open
Abstract
Perinatal depression is an important indicator of mothers' mental health. Studies have been carried out to identify and characterize women at risk of such affective disorder. The aim of this study is to assess mothers' adherence to our perinatal depression screening and eventual follow-up by a multidisciplinary team, including mental health and obstetrics professionals. Ultimately, a risk profile for the uptake rate of referral was described to psychological support. Pregnant women from a maternity of a tertiary center with on-site assessment and treatment (n = 2163) were included in this study. The identification of women at risk for depression was based on a two-question screening and the EPDS scale. Demographic and obstetric data were obtained from medical records. The number of screening evaluations, the uptake referral rate and the compliance to treatment were analyzed. Logistic regression was used to predict a risk profile for adherence. Among 2163 enrolled in the protocol, 10.2% screened positive for depression. Of these, 51.8% accepted referral for mental health assistance. 74.9% were compliant to Psychology appointments and 74.1% to Psychiatry appointments. Women who had a previous history of depression were more likely to accept referral for mental health support. With this study, we were able to understand the behaviour of this population towards the screening protocol we offer. Women with a previous history of depression are more likely to accept mental health assistance.
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Affiliation(s)
| | - Ana Beatriz de Almeida
- Gynaecology and Obstetrics Department, Cento Materno Infantil do Norte, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - Mónica Fernandes
- Clinical Psychology, Cento Materno Infantil do Norte, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - Rosa Correia
- Clinical Psychology, Cento Materno Infantil do Norte, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - Rui Magalhães
- Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto, Porto, Portugal
| | - Graça Buchner
- Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto, Porto, Portugal
- Gynaecology and Obstetrics Department, Cento Materno Infantil do Norte, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - Jorge Braga
- Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto, Porto, Portugal
- Gynaecology and Obstetrics Department, Cento Materno Infantil do Norte, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - Paula Freitas
- Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto, Porto, Portugal
- Psychiatric Department, Cento Materno Infantil do Norte, Centro Hospitalar Universitário do Porto, Porto, Portugal
- CINTESIS, Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto, Porto, Portugal
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4
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Silverio SA, Memtsa M, Barrett G, Goodhart V, Stephenson J, Jurković D, Hall JA. Emotional experiences of women who access early pregnancy assessment units: a qualitative investigation. J Psychosom Obstet Gynaecol 2022; 43:574-584. [PMID: 36094423 DOI: 10.1080/0167482x.2022.2119958] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/14/2022] Open
Abstract
Purpose: Early pregnancy complications are common and often result in pregnancy loss, which can be emotionally challenging for women. Research on the emotional experiences of those attending Early Pregnancy Assessment Units [EPAUs] is scarce. This analysis explored the emotions which women spontaneously reported when being interviewed about their experiences of using EPAU services.Materials and methods: Semi-structured telephone interviews were conducted with a purposive sample of 38 women. Using Thematic Framework Analysis, we identified six unique emotional typologies which mapped onto women's clinical journeys.Results: Women with ongoing pregnancies were characterized as having: "Anxious Presentation" or "Sustained Anxiety due to Diagnostic Uncertainty", dependent on whether their initial scan result was inconclusive. Women with pregnancy loss had one of four emotional typologies, varying by diagnostic timing and required interventions: "Anxious-Upset"; "Anxious-Upset after Diagnostic Uncertainty"; "Anxious-Upset with Procedural Uncertainty"; "Anxious with Sustained Uncertainty".Conclusions: We provide insights into the distinct emotions associated with different clinical pathways through EPAU services. Our findings could be used to facilitate wider recognition of women's emotional journeys through early pregnancy complications and stimulate research into how best to support women and their partners, in these difficult times.
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Affiliation(s)
- Sergio A Silverio
- Department of Women & Children's Health, King's College London, London, UK.,Elizabeth Garrett Anderson Institute for Women's Health, University College London, London, UK
| | - Maria Memtsa
- Elizabeth Garrett Anderson Institute for Women's Health, University College London, London, UK.,Women's Health Services, University College London Hospitals NHS Foundation Trust, London, UK
| | - Geraldine Barrett
- Elizabeth Garrett Anderson Institute for Women's Health, University College London, London, UK
| | - Venetia Goodhart
- Elizabeth Garrett Anderson Institute for Women's Health, University College London, London, UK.,Women's Health Services, University College London Hospitals NHS Foundation Trust, London, UK
| | - Judith Stephenson
- Elizabeth Garrett Anderson Institute for Women's Health, University College London, London, UK
| | - Davor Jurković
- Elizabeth Garrett Anderson Institute for Women's Health, University College London, London, UK.,Gynaecology Diagnostic and Outpatient Treatment Unit, University College London Hospitals NHS Foundation Trust, London, UK
| | - Jennifer A Hall
- Elizabeth Garrett Anderson Institute for Women's Health, University College London, London, UK
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5
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Masters GA, Hugunin J, Xu L, Ulbricht CM, Moore Simas TA, Ko JY, Byatt N. Prevalence of Bipolar Disorder in Perinatal Women: A Systematic Review and Meta-Analysis. J Clin Psychiatry 2022; 83:21r14045. [PMID: 35830616 PMCID: PMC10849873 DOI: 10.4088/jcp.21r14045] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Objective: To estimate overall prevalence of bipolar disorder (BD) and the prevalence and timing of bipolar-spectrum mood episodes in perinatal women. Data Sources: Databases (PubMed, Scopus, PsycINFO, CINAHL, Cochrane, ClincalTrials.gov) were searched from inception to March 2020. Study Selection: Included studies were original research in English that had (1) populations of perinatal participants (pregnant or within 12 months postpartum), aged ≥ 18 years, and (2) a screening/diagnostic tool for BD. Search terms described the population (eg, perinatal), illness (eg, bipolar disorder), and detection (eg, screen, identify). Data Extraction: Study design data, rates, and timing of positive screens/diagnoses and mood episodes were extracted by 3 independent reviewers. Pooled prevalences were estimated using random-effects meta-analyses. Results: Twenty-two articles were included in qualitative review and 12 in the meta-analysis. In women with no known psychiatric illness preceding the perinatal period, pooled prevalence of BD was 2.6% (95% CI, 1.2%-4.5%) and prevalence of bipolar-spectrum mood episodes (including depressed, hypomanic/manic, mixed) during pregnancy and the postpartum period was 20.1% (95% CI, 16.0%-24.5%). In women with a prior BD diagnosis, 54.9% (95% CI, 39.2%-70.2%) were found to have at least one bipolar-spectrum mood episode occurrence in the perinatal period. Conclusions: Our review suggests that the perinatal period is associated with high rates of bipolar-spectrum mood episodes and that pregnant and postpartum women represent a special risk population. This review may help to inform clinical care recommendations, thus helping to identify those who may have.
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Affiliation(s)
- Grace A Masters
- University of Massachusetts Chan Medical School, Worcester, Massachusetts
- Corresponding author: Grace A. Masters, BS, University of Massachusetts Chan Medical School, 55 Lake Ave North, Worcester, MA 01605 (; ORCID ID: https://orcid.org/0000-0001-6064-3786)
| | - Julie Hugunin
- University of Massachusetts Chan Medical School, Worcester, Massachusetts
| | - Lulu Xu
- University of Massachusetts Chan Medical School, Worcester, Massachusetts
| | - Christine M Ulbricht
- University of Massachusetts Chan Medical School, Worcester, Massachusetts
- Now with National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland
| | | | - Jean Y Ko
- Centers for Disease Control and Prevention, Atlanta, Georgia
- US Public Health Service Commissioned Corps, Rockville, Maryland
| | - Nancy Byatt
- University of Massachusetts Chan Medical School, Worcester, Massachusetts
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6
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Masters GA, Xu L, Cooper KM, Moore Simas TA, Brenckle L, Mackie TI, Schaefer AJ, Straus J, Byatt N. Perspectives on addressing bipolar disorder in the obstetric setting. Gen Hosp Psychiatry 2022; 77:130-140. [PMID: 35640435 PMCID: PMC10858616 DOI: 10.1016/j.genhosppsych.2022.05.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 05/17/2022] [Accepted: 05/20/2022] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Perinatal Psychiatry Access Programs have emerged to help obstetric professionals meet the needs of perinatal individuals with mental health conditions, including bipolar disorder (BD). We elucidate obstetric professionals' perspectives on barriers and facilitators to managing BD in perinatal patients, and how Access Programs may affect these processes. METHODS We conducted three focus groups with obstetric professionals, two with- and one without-exposure to an Access Program, the Massachusetts Child Psychiatry Access Program (MCPAP) for Moms. Focus groups discussed experiences, barriers, facilitators, and solutions to caring for perinatal individuals with BD. Qualitative data were coded and analyzed by two independent coders; emergent themes were examined across exposure groups. RESULTS Thirty-one obstetric professionals (7 without-exposure, 24 with-exposure) participated. Identified themes included: (1) gaps in perinatal BD education; (2) challenges in patient assessment; (3) MCPAP for Moms as a facilitator for addressing BD; and (4) importance of continued outreach and destigmaization to increase care collaboration. CONCLUSIONS Barriers to obstetric professionals accessing adequate mental healthcare for their patients with BD abound. With psychiatric supports in place, it is possible to build obstetric professionals' capacity to address BD. Perinatal Psychiatry Access Programs can facilitate obstetric professionals bridging these gaps in mental health care.
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Affiliation(s)
- Grace A Masters
- University of Massachusetts Chan Medical School, Worcester, MA, United States of America.
| | - Lulu Xu
- University of Massachusetts Chan Medical School, Worcester, MA, United States of America
| | - Katherine M Cooper
- University of Massachusetts Chan Medical School, Worcester, MA, United States of America
| | - Tiffany A Moore Simas
- University of Massachusetts Chan Medical School, Worcester, MA, United States of America; UMass Memorial Health, Worcester, MA, United States of America
| | - Linda Brenckle
- University of Massachusetts Chan Medical School, Worcester, MA, United States of America
| | - Thomas I Mackie
- SUNY Downstate Health Sciences University, School of Public Health, Brooklyn, NY, United States of America
| | - Ana J Schaefer
- SUNY Downstate Health Sciences University, School of Public Health, Brooklyn, NY, United States of America
| | - John Straus
- Massachusetts Behavioral Health Partnership, Boston, MA, United States of America
| | - Nancy Byatt
- University of Massachusetts Chan Medical School, Worcester, MA, United States of America; UMass Memorial Health, Worcester, MA, United States of America
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7
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Effect of Comprehensive Nursing Intervention Under Internet-Based WeChat Platform Education on Postoperative Recovery of Puerperae Undergoing Cesarean Section. JOURNAL OF HEALTHCARE ENGINEERING 2022; 2022:5040461. [PMID: 35432841 PMCID: PMC9007654 DOI: 10.1155/2022/5040461] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Accepted: 03/22/2022] [Indexed: 12/14/2022]
Abstract
Objective. To explore the effect of comprehensive nursing intervention under internet-based WeChat platform education on postoperative recovery of puerperae undergoing cesarean section (C-section). Methods. A total of 96 patients undergoing C-section in our hospital from June 2018 to October 2021 were selected for the retrospective analysis and grouped according to the nursing intervention modes as follows: patients who received a routine nursing intervention were included in the control group, and patients who received comprehensive nursing intervention under internet-based WeChat platform education were included in the study group, with 48 cases each. After the intervention, the postoperative recovery of puerperae undergoing C-section and obstetrics nursing quality were scientifically assessed. Results. No statistical differences in general data between the two groups were observed (
). Compared with the control group, patients in the study group had obviously earlier initial time of lactation (
), significantly higher breast milk amount within 48 h after delivery (
), significantly earlier spontaneous urination time, anal exhaust time and off-bed activity time (
), obviously better mastery of health knowledge (
), and, in terms of SCL-90, remarkably lower total score, average total positive score, and the number of positive items and scores in dimensions, such as somatization, obsessive-compulsive, depression, anxiety, interpersonal sensibility, anger-hostility, phobic-anxiety, and paranoid ideation (
). At discharge, 3 months, and 6 months of follow-up, patients in the study group obtained significantly higher scores on quality of life than the control group (
). Conclusion. In the nursing of puerperae undergoing C-section, comprehensive nursing intervention measures based on the internet-based WeChat platform education can effectively improve the early lactation, mastery of health knowledge, and adverse emotions of puerpera and promote their postoperative recovery.
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8
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Lasica PA, Glangeaud-Freudenthal NMC, Falissard B, Sutter-Dallay AL, Gressier F. Bipolar disorder in the postpartum period: the impact of a prenatal mood episode on maternal improvement at postpartum discharge after joint inpatient hospitalization. Arch Womens Ment Health 2022; 25:399-409. [PMID: 34661738 DOI: 10.1007/s00737-021-01188-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 10/11/2021] [Indexed: 10/20/2022]
Abstract
Bipolar disorder (BD) is linked to a high risk of relapse in the year postpartum. The aim of this study was to search for an association of a mood episode during pregnancy with a lack of maternal improvement after a post-partum episode requiring joint hospitalization. In an observational, naturalist, and multicentric study, 261 women suffering from a BD and jointly hospitalized with their child in a Mother-Baby Unit (MBU) were assessed for risk factors associated with a lack of maternal improvement at discharge. A directed acyclic graph (DAG)-based approach was used to identify confounders to be included in a multiple regression model. In bivariate analyses, a lack of improvement (16.9%) was associated with pregnancy specificities (decompensation, psychotropic treatment, antipsychotics, and benzodiazepines intake), as well as maternal smoking during pregnancy and baby's neonatal hospitalization. In a multivariate analysis based on DAG, a lack of improvement was linked to psychiatric decompensation during pregnancy (OR = 3.31, 95%CI [1.55-7.35], p = 0.002), independently from maternal age, mother's maltreatment during childhood, low level of education, single status, low familial social support, and diagnosis of personality disorder. This study shows the critical importance of mental health during pregnancy in women with BD. Clinical screening and evaluation of the benefit/risk balance of psychotropics during pregnancy are essential.
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Affiliation(s)
- Pierre-Alexandre Lasica
- Department of Psychiatry, Bicêtre University Hospital, Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires Paris Saclay, CHU de Bicêtre (AP-HP, GH Paris Saclay), 78 rue du Général Leclerc, 94275, Le Kremlin Bicêtre, France
| | - Nine M C Glangeaud-Freudenthal
- INSERM Obstetrical, Perinatal and Pediatric Epidemiology Research Team, Center for Epidemiology and Biostatistics (U1153), Paris Descartes University, Paris, France
| | - Bruno Falissard
- Department of Biostatistics, Maison de Solenn, Université Paris-Saclay, UVSQ, CESP, INSERM U1018, 97 Bld de Port-Royal, 75679, Paris Cedex 14, France
| | - Anne-Laure Sutter-Dallay
- Charles Perrens Hospital, Perinatal Psychiatry Network, University Department of Child and Adolescent Psychiatry, Univ. Bordeaux, INSERM U1219, F-33000, Bordeaux, France
| | - Florence Gressier
- Department of Psychiatry, Bicêtre University Hospital, Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires Paris Saclay, CHU de Bicêtre (AP-HP, GH Paris Saclay), 78 rue du Général Leclerc, 94275, Le Kremlin Bicêtre, France. .,CESP, INSERM U1018, Université Paris-Saclay, Faculté de Médecine Paris Saclay, 94275, Le Kremlin Bicêtre, France.
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9
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Hutner LA, Yeaton-Massey A, Toscano M, Coulehan J, Hage B, Gopalan P, Doyle MA, Olgun M, Frew J, Nagle-Yang S, Osborne LM, Miller ES. Cultivating mental health education in obstetrics and gynecology: a call to action. Am J Obstet Gynecol MFM 2021; 3:100459. [PMID: 34403822 DOI: 10.1016/j.ajogmf.2021.100459] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Revised: 07/21/2021] [Accepted: 08/09/2021] [Indexed: 10/20/2022]
Abstract
Mental health disorders are common and have a significantly negative impact on the health and well-being of women. For example, perinatal mental health disorders such as anxiety and depression are widely understood to be the most common complications of pregnancy and childbirth. Untreated mental health disorders are associated with significant obstetrical and psychiatric sequelae and have a long-lasting impact on neonatal and childhood outcomes. As front-line providers for women during times of elevated risk of psychiatric morbidity, such as pregnancy and postpartum, obstetricians and gynecologists are compelled to have familiarity with such disorders. Yet, a wide gap exists between the level of education in mental health disorders that obstetrician and gynecologist providers receive and the clinical need thereof. The objectives of this commentary are to describe the urgent need for mental health education for obstetricians and gynecologists providers and to introduce our vision for a concise, evidence-based and accessible set of digital educational materials designed to convey core concepts in women's reproductive mental health.
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Affiliation(s)
| | - Amanda Yeaton-Massey
- Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, San Francisco, CA (Dr Yeaton-Massey).
| | - Marika Toscano
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Rochester Medical Center, Rochester, NY (Dr Toscano)
| | - Jeanne Coulehan
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Columbia University, New York, NY (Ms Coulehan)
| | - Brandon Hage
- Department of Psychiatry, Western Psychiatric Hospital, University of Pittsburgh Medical Center, Pittsburgh, PA (Drs Hage and Gopalan)
| | - Priya Gopalan
- Department of Psychiatry, Western Psychiatric Hospital, University of Pittsburgh Medical Center, Pittsburgh, PA (Drs Hage and Gopalan)
| | - Marley A Doyle
- Department of Psychiatry, University of Nebraska Medical Center, Omaha, NE (Dr Doyle)
| | - Melisa Olgun
- Wesleyan University, Middletown, CT, Yale Law (Ms Olgun)
| | - Julia Frew
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Lebanon, NH (Dr Frew)
| | - Sarah Nagle-Yang
- Department of Psychiatry, University of Colorado School of Medicine, Aurora, CO (Dr Nagle-Yang)
| | - Lauren M Osborne
- Departments of Psychiatry and Behavioral Sciences and Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, MD (Dr Osborne)
| | - Emily S Miller
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, IL (Dr Miller)
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10
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Contemplating Help-Seeking in Perinatal Psychological Distress-A Meta-Ethnography. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18105226. [PMID: 34069073 PMCID: PMC8156805 DOI: 10.3390/ijerph18105226] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 04/23/2021] [Accepted: 05/08/2021] [Indexed: 12/02/2022]
Abstract
Perinatal psychological distress (PPD) may cause delays in help-seeking in the perinatal period, which is crucial for families with small children. Help-seeking theories focus on rational processes of behavior wherein ‘help-seeking’ is viewed as a decision-making process, in which action is preceded by recognizing a problem. We identified the phase prior to actual help-seeking actions as a life situation and a phenomenon through which to gain a deeper understanding from women’s own perspectives. The aim of this study was to integrate and synthesize knowledge of women’s experiences of contemplating seeking help for PPD. We chose interpretative meta-ethnography by Noblit and Hare (1988) and implemented eMERGe guidelines in reporting. The search was performed systematically, and the 14 included studies were evaluated with Critical Appraisal Skills Programme checklist (CASP). We identified seven themes and a metaphor in a lines-of-argument synthesis, showing that contemplating help-seeking is a multidimensional phenomenon. We did not observe a straightforward and linear process (as previous research suggests) but instead a complex process of contemplating help-seeking. A clinical implication is that service providers should work with outreach and develop their tools to connect with mothers with PPD. Another suggestion is to improve training in mental health literacy prior to or during pregnancy.
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11
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Indirect psychiatric consultation for perinatal bipolar disorder: A scoping review. Gen Hosp Psychiatry 2021; 68:19-24. [PMID: 33271405 DOI: 10.1016/j.genhosppsych.2020.11.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Revised: 11/13/2020] [Accepted: 11/15/2020] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To synthesize the literature and develop guidance on supports needed for primary care and perinatal providers in screening, initial management, triage, and bridging treatment for perinatal bipolar disorder. METHODS We conducted a scoping review by searching six electronic databases using keywords related to perinatal bipolar disorder. We summarized descriptive statistics on settings and extracted information on care approaches. We synthesized the literature on indirect care models and extracted data on screening, follow-up, referrals, and management. RESULTS 1169 articles were retrieved. 51 articles were included after review. Most papers were reviews. Fewer addressed care in obstetric (n = 20, 39%), primary care (n = 10, 20%), and pediatric settings (n = 2, 4%). Most papers (n = 30, 59%) discussed using screening instruments for bipolar disorder. Articles were mixed on recommendations for bipolar disorder screening. CONCLUSIONS Varied strategies for structured assessment exist and are influenced by practice setting. There remains uncertainty about optimal strategies for screening and management of perinatal bipolar disorder. We recommend screening for bipolar disorder in the perinatal period in select circumstances (with depression screening, known bipolar disorder risk factors, and prior to starting antidepressants). If specialty mental health care is unavailable, we recommend enhancing usual care through integrated care strategies such as indirect consultation.
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12
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Abstract
Perinatal depression is common and can have deleterious effects on mothers, infants, children, partners, and families. Despite this, few women who screen positive for depression receive psychiatric treatment. A comprehensive perinatal depression care pathway includes: (1) screening, (2) assessment, (3) triage and referral, (4) treatment access, (5) treatment initiation, (6) symptom monitoring, and (7) adaptation of treatment based on measurement until symptoms remit. This depression care pathway provides a scaffold on which to frame the challenges encountered when, and the opportunities that exist for, addressing depression in obstetric settings. Comprehensive interventions that address each step on the care pathway are needed to support obstetric practices in providing high-quality, evidence-based, effective treatment including pro-active follow-up for depression management. Despite recent attention being brought to, and significant progress in the field of maternal mental health, gaps in care persist. Ultimately, depression care needs to be fully integrated into obstetric care. Additionally, more targeted maternal mental health support and structure are needed for integration to occur and ultimately be optimized. Specific areas requiring more attention include consistency of screening, evaluation of patients with a positive depression screen for bipolar disorder, anxiety or substance use disorders, and monitoring of symptom improvement.
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Affiliation(s)
- Nancy Byatt
- a Department of Obstetrics & Gynecology, Department of Psychiatry , University of Massachusetts Medical School , Worcester , MA , USA.,b Department of Quantitative Health Sciences , UMass Memorial Health Care , Worcester , MA , USA
| | - Wanlu Xu
- a Department of Obstetrics & Gynecology, Department of Psychiatry , University of Massachusetts Medical School , Worcester , MA , USA
| | - Leonard L Levin
- a Department of Obstetrics & Gynecology, Department of Psychiatry , University of Massachusetts Medical School , Worcester , MA , USA.,c Department of Pediatrics , Francis A. Countway Library of Medicine, Harvard Medical School , Boston , MA , USA
| | - Tiffany A Moore Simas
- a Department of Obstetrics & Gynecology, Department of Psychiatry , University of Massachusetts Medical School , Worcester , MA , USA.,b Department of Quantitative Health Sciences , UMass Memorial Health Care , Worcester , MA , USA
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