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Koire A, Suleiman M, Teslyar P, Liu CH. Prevalence of Community Perinatal Psychiatrists in the US. JAMA Netw Open 2024; 7:e2426465. [PMID: 39110463 PMCID: PMC11307129 DOI: 10.1001/jamanetworkopen.2024.26465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2024] [Accepted: 06/11/2024] [Indexed: 08/10/2024] Open
Abstract
This cross-sectional study identifies and quantifies state-level shortages in community-based perinatal psychiatry care in the US.
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Affiliation(s)
- Amanda Koire
- Department of Psychiatry, Brigham and Women’s Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | - Mariella Suleiman
- Department of Psychiatry, Maimonides Medical Center, Brooklyn, New York
- Now with Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Polina Teslyar
- Department of Psychiatry, Brigham and Women’s Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | - Cindy H. Liu
- Department of Psychiatry, Brigham and Women’s Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
- Department of Pediatric Newborn Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
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Eakley R, Lyndon A. Disparities in Screening and Treatment Patterns for Depression and Anxiety During Pregnancy: An Integrative Review. J Midwifery Womens Health 2024. [PMID: 39054664 DOI: 10.1111/jmwh.13679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 05/22/2024] [Indexed: 07/27/2024]
Abstract
INTRODUCTION Symptoms of untreated depression and anxiety during pregnancy are associated with serious adverse effects for the pregnant person, birth outcomes, and child development. However, pregnant persons are less likely to be screened and treated compared with nonpregnant people. In this systematic review, we aimed to explore individual, provider, and systems factors that impact screening, identification, and treatment patterns for depression and anxiety during pregnancy. METHODS Studies were eligible for inclusion if they were conducted within the United States and published in English between January 2012 and January 2023. Each study included analysis that compared rates of screening, identification, or treatment engagement and explicitly discussed disparities or health equity in marginalized groups. Fifteen articles met full inclusion criteria. RESULTS Results demonstrated variation in the screening, identification, and treatment of depression and anxiety during pregnancy among diverse groups of patients. Screening rates ranged from 51.3% in Puerto Rico to 90.7% in Alaska. Among specific clinical populations, rates were as low as 2.0%. Fewer than half of patients were referred to treatment when indicated by screening or diagnoses. Patient characteristics such as age, race, ethnicity, socioeconomic and health factors, mental health history, and obesity were associated with variation in the rates of screening, diagnoses, or treatment engagement. Language factors were the most common factor associated with lower rates of screening and treatment access. DISCUSSION Results suggest that many pregnant people are being overlooked and lack appropriate referrals or resources to access treatment. Results are consistent with previous findings that role confusion and lack of time, provider training, and interest contribute to low rates of screening and treatment. Future research must focus on system level factors to address perceived barriers to screening and treating depression and anxiety during pregnancy in a systematic and equitable way.
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Affiliation(s)
- Rachel Eakley
- New York University, Rory Meyers College of Nursing, New York, New York
| | - Audrey Lyndon
- New York University, Rory Meyers College of Nursing, New York, New York
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Sun CF, Correll CU, Trestman RL, Lin Y, Xie H, Hankey MS, Uymatiao RP, Patel RT, Metsutnan VL, McDaid EC, Saha A, Kuo C, Lewis P, Bhatt SH, Lipphard LE, Kablinger AS. Low availability, long wait times, and high geographic disparity of psychiatric outpatient care in the US. Gen Hosp Psychiatry 2023; 84:12-17. [PMID: 37290263 DOI: 10.1016/j.genhosppsych.2023.05.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 05/15/2023] [Accepted: 05/21/2023] [Indexed: 06/10/2023]
Abstract
OBJECTIVE To identify potential barriers to care, this study examined the general psychiatry outpatient new appointment availability in the US, including in-person and telepsychiatry appointments, comparing results between insurance types (Medicaid vs. private insurance), states, and urbanization levels. METHOD This mystery shopper study investigated 5 US states selected according to Mental Health America Adult Ranking and geography to represent the US mental health care system. Clinics across five selected states were stratified sampled by county urbanization levels. Calls were made during 05/2022-07/2022. Collected data included contact information accuracy, appointment availability, wait time (days), and related information. RESULTS Altogether, 948 psychiatrists were sampled in New York, California, North Dakota, Virginia, and Wyoming. Overall contact information accuracy averaged 85.3%. Altogether, 18.5% of psychiatrists were available to see new patients with a significantly longer wait time for in-person than telepsychiatry appointments (median = 67.0 days vs median = 43.0 days, p < 0.01). The most frequent reason for unavailability was provider not taking new patients (53.9%). Mental health resources were unevenly distributed, favoring urban areas. CONCLUSION Psychiatric care has been severely restricted in the US with low accessibility and long wait times. Transitioning to telepsychiatry represents a potential solution for rural disparities in access.
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Affiliation(s)
- Ching-Fang Sun
- Department of Psychiatry and Behavioral Medicine, Virginia Tech Carilion School of Medicine, Roanoke, Virginia, USA
| | - Christoph U Correll
- Department of Psychiatry, The Zucker Hillside Hospital, Northwell Health, Glen Oaks, New York, USA; Department of Psychiatry and Molecular Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA; Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Robert L Trestman
- Department of Psychiatry and Behavioral Medicine, Virginia Tech Carilion School of Medicine, Roanoke, Virginia, USA
| | - Yezhe Lin
- Department of Psychiatry and Behavioral Medicine, Virginia Tech Carilion School of Medicine, Roanoke, Virginia, USA; Clinical Research Center for Mental Disorders, Chinese-German Institute of Mental Health, Shanghai Pudong New Area Mental Health Center, School of Medicine, Tongji University, Shanghai, China; Department of Psychiatry, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Hui Xie
- Joseph J. Zilber College of Public Health, University of Wisconsin-Milwaukee, Milwaukee, WI, USA
| | - Maria Stack Hankey
- Health Analytics Research Team (HART), Carilion Clinic, Roanoke, Virginia, USA
| | | | - Riya T Patel
- Virginia Tech Carilion School of Medicine, Roanoke, Virginia, USA
| | | | | | - Atreyi Saha
- Virginia Tech Carilion School of Medicine, Roanoke, Virginia, USA
| | - Chin Kuo
- Department of Psychiatry, Maimonides Medical Center, Brooklyn, New York, USA
| | - Paula Lewis
- Virginia Tech Carilion School of Medicine, Roanoke, Virginia, USA
| | - Shyam H Bhatt
- Virginia Tech Carilion School of Medicine, Roanoke, Virginia, USA
| | | | - Anita S Kablinger
- Department of Psychiatry and Behavioral Medicine, Virginia Tech Carilion School of Medicine, Roanoke, Virginia, USA.
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Buskmiller C, Greenwood LA, Alpuing Radilla LA, Lane K, Gray LL, Ivey RT, Carrol MR, Munoz JL, Sanz Cortes M, Nassr AA, Belfort MA, Horst K, Donepudi RV. Impact of Transfer of Maternal Care for Fetal Anomalies on Maternal Depression and Anxiety Screening: A Prospective Cohort at a Tertiary Care Center. Fetal Diagn Ther 2023; 50:282-288. [PMID: 37276841 DOI: 10.1159/000531180] [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: 01/21/2023] [Accepted: 05/16/2023] [Indexed: 06/07/2023]
Abstract
INTRODUCTION Perinatal depression and anxiety are major causes of maternal morbidity, and are more common in high-risk pregnancies compared to low-risk pregnancies. This study used validated screening tools to assess the prevalence of depression and anxiety symptoms in pregnant patients who transferred their obstetric care to a specialized fetal center for fetal anomaly. METHODS This is a prospective cohort of patients with a fetal anomaly prompting transfer of obstetric care to Texas Children's Hospital Fetal Center between January 2021 and February 2022. The primary outcome was a self-assessed Edinburgh Postnatal Depression Scale score of 13 or higher, either antepartum or postpartum ("ever-positive EPDS"). Secondary outcomes included self-assessed Perinatal Anxiety Screening Scale (PASS) scores of 21 or higher ("ever-positive PASS"), obstetric outcomes, and neonatal outcomes. A frequentist analysis was performed. RESULTS Of 149 women who transferred to Texas Children's Hospital during the study period, 94 enrolled in this study. Twenty-six percent of women had an ever-positive EPDS; 20% of patients had an ever-positive PASS. Patients were more likely to have an ever-positive EPDS if they were single (46% compared to 20%, p = 0.025). Women who had an ever-positive EPDS were more likely to be referred to psychiatry (46% compared to 14%, p = 0.004) and psychotherapy (29% compared to 1%, p < 0.001). Surprisingly, patients were more likely to have an ever-positive PASS if they reported good social support (p = 0.03). Antepartum EPDS and PASS scores had no relationship with postpartum EPDS scores. CONCLUSION Women who transfer care to a tertiary setting have positive EPDS scores at double the rate of the general population, but tend to experience this either antepartum or postpartum (not both). Fetal centers should be prepared to screen for mental health symptoms before and after delivery and provide appropriate referral or treatment.
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Affiliation(s)
- Cara Buskmiller
- Texas Children's Fetal Center, Baylor College of Medicine, Houston, Texas, USA
| | - Lauren A Greenwood
- Texas Children's Fetal Center, Baylor College of Medicine, Houston, Texas, USA
| | | | - Keneshia Lane
- Texas Children's Fetal Center, Baylor College of Medicine, Houston, Texas, USA
| | - Lauren L Gray
- Texas Children's Fetal Center, Baylor College of Medicine, Houston, Texas, USA
| | - R Todd Ivey
- Texas Children's Fetal Center, Baylor College of Medicine, Houston, Texas, USA
| | - Matthew R Carrol
- Texas Children's Fetal Center, Baylor College of Medicine, Houston, Texas, USA
| | - Jessian L Munoz
- Texas Children's Fetal Center, Baylor College of Medicine, Houston, Texas, USA
| | | | - Ahmed A Nassr
- Texas Children's Fetal Center, Baylor College of Medicine, Houston, Texas, USA
| | - Michael A Belfort
- Texas Children's Fetal Center, Baylor College of Medicine, Houston, Texas, USA
| | - Karen Horst
- Texas Children's Fetal Center, Baylor College of Medicine, Houston, Texas, USA
| | - Roopali V Donepudi
- Texas Children's Fetal Center, Baylor College of Medicine, Houston, Texas, USA
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Doctor for Every Citizen: Telehealth Visits at Dubai Health Authority during COVID-19 Pandemic in Dubai, United Arab Emirates. Healthcare (Basel) 2023; 11:healthcare11030294. [PMID: 36766869 PMCID: PMC9914661 DOI: 10.3390/healthcare11030294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 01/09/2023] [Accepted: 01/12/2023] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Digital health significantly affects healthcare delivery. Moreover, empirical studies on the utilization of telehealth in Dubai are limited. Accordingly, this study examines the utilization of telehealth services in Dubai Health Authority (DHA) facilities and the factors associated with telehealth appointment completion and turnaround time. METHODS This cross-sectional study examines patients who used telehealth services in DHA from 2020 through 2021 using 241,822 records. A binary logistic regression model was constructed to investigate the association between appointment turnaround time as a dependent variable and patient and visit characteristics as independent variables. RESULTS Of the total scheduled telehealth visits, more than three-quarter (78.55%) were completed. Older patients, non-Emiratis, patients who had their visits in 2020, patients who had video visits, and those who sought family medicine as a specialty had a shorter turnaround time to receive their appointment. CONCLUSIONS This study identifies several characteristics associated with the turnaround time. Moreover, technological improvements focusing on specialties that can readily be addressed through telehealth and further research in this domain will improve service provision and support building an evidence-base in the government sector of the emirate of Dubai.
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Luciano M, Di Vincenzo M, Brandi C, Tretola L, Toricco R, Perris F, Volpicelli A, Torella M, La Verde M, Fiorillo A, Sampogna G. Does antenatal depression predict post-partum depression and obstetric complications? Results from a longitudinal, long-term, real-world study. Front Psychiatry 2022; 13:1082762. [PMID: 36590632 PMCID: PMC9795022 DOI: 10.3389/fpsyt.2022.1082762] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 11/24/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Main aims of the present paper are to: (1) assess the prevalence of antenatal depression (AD) and identify its predictors; (2) analyse the impact of AD on obstetric outcomes and on the incidence of post-partum depression. METHODS All pregnant women referring to the Gynecology and Obstetrics inpatients unit of the University of Campania "Luigi Vanvitelli" were invited to participate. Upon acceptance, women completed the Italian version of the Edinburgh Postnatal Depression Scale and an ad-hoc questionnaire on the women's sociodemographic, gynecological and peripartum characteristics as well as their psychiatric history. Women were assessed at each trimester of pregnancy, immediately after the childbirth and after one, three, 6 and 11 months. RESULTS 268 pregnant women were recruited, with a mean of 32.2 (±5.81) years. Ninety-seven women (36.2%) reported the presence of depressive symptoms during pregnancy. Predictors of AD were personal history of depression, a family history for depressive disorders and problematic relationships with the partner. The presence of AD was associated to a reduced gestational age at the time of delivery, a lower APGAR score at 1 and 5 min, labor induction and admission of the new-born into neonatal intensive care unit. Mothers with antenatal depression are less likely to natural breastfeed. Lastly, antenatal depression was a risk factor for higher EPDS scores at follow-ups. CONCLUSIONS Our results support the idea that women should be screened during pregnancy and post-partum for the presence of depressive and anxiety symptoms. Health professionals should be adequately trained to detect psychiatric symptoms during pregnancy.
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Affiliation(s)
- Mario Luciano
- Department of Psychiatry, University of Campania "L. Vanvitelli", Naples, Italy
| | - Matteo Di Vincenzo
- Department of Psychiatry, University of Campania "L. Vanvitelli", Naples, Italy
| | - Carlotta Brandi
- Department of Psychiatry, University of Campania "L. Vanvitelli", Naples, Italy
| | - Lucia Tretola
- Department of Psychiatry, University of Campania "L. Vanvitelli", Naples, Italy
| | - Rita Toricco
- Department of Psychiatry, University of Campania "L. Vanvitelli", Naples, Italy
| | - Francesco Perris
- Department of Psychiatry, University of Campania "L. Vanvitelli", Naples, Italy
| | - Antonio Volpicelli
- Department of Psychiatry, University of Campania "L. Vanvitelli", Naples, Italy
| | - Marco Torella
- Obstetrics and Gynaecology Unit, Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Marco La Verde
- Obstetrics and Gynaecology Unit, Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Andrea Fiorillo
- Department of Psychiatry, University of Campania "L. Vanvitelli", Naples, Italy
| | - Gaia Sampogna
- Department of Psychiatry, University of Campania "L. Vanvitelli", Naples, Italy
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