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Aron E, Londoño Tobón A, Finelli J, Romanowicz M. Serving Families Where They Live: Supporting Multigenerational Health During Infancy and Early Childhood Through Community-centered Approaches. Child Adolesc Psychiatr Clin N Am 2024; 33:331-342. [PMID: 38823807 DOI: 10.1016/j.chc.2024.03.007] [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] [Indexed: 06/03/2024]
Abstract
This article underscores the critical importance of addressing mental health during infancy and early childhood through a multigenerational, multicultural, community-centered approach. It highlights the unique vulnerability of this period to environmental factors and emphasizes the interconnectedness of caregiver and child mental health. The article advocates for interventions that extend beyond clinical settings, recognizing the value of community involvement and the need to address social determinants of health. It also discusses innovative strategies, such as mental health consultation in early childhood education centers and collaborative care models, to bridge gaps in access to care.
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Affiliation(s)
- Emily Aron
- Department of Psychiatry, Medstar Georgetown University Hospital, 2115 Wisconsin Avenue, NW, Suite 200, Washington, DC 20007, USA.
| | - Amalia Londoño Tobón
- Department of Psychiatry, Medstar Georgetown University Hospital, 2115 Wisconsin Avenue, NW, Suite 200, Washington, DC 20007, USA
| | - Julianna Finelli
- Department of Psychiatry and Sciences, Tulane University School of Medicine 131 S. Robertson Street, New Orleans, LA 70112, USA
| | - Magdalena Romanowicz
- Department of Psychiatry and Psychology, Mayo Clinic, 200 1st Street, NW Rochester, MN 55906, USA
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Johnson E, Moreland A, King C, Guille C. Black Pregnant and Postpartum Peoples' Perspectives on Mental Health and Substance Use Disorders. J Womens Health (Larchmt) 2024; 33:956-965. [PMID: 38529889 DOI: 10.1089/jwh.2023.0464] [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] [Indexed: 03/27/2024] Open
Abstract
Introduction: Mental health and substance use disorders in pregnant and postpartum people (PPP) are common, and most will not receive adequate treatment. In addition, Black PPP experience higher rates of mental health conditions and are less likely to receive treatment compared with White PPP. Yet, our understanding of the experience of Black PPP with respect to these conditions is limited. The goal of this study was to better understand these experiences with respect to mental health, substance use, and barriers to treatment. Methods: Semi-structured interviews were completed with 68 Black PPP who were pregnant or had been pregnant in the last 24 months to gain an understanding of mental health and substance use screening and treatment during the peripartum and postpartum period. Interview data were analyzed with qualitative software, using a qualitative content analysis method, informed by grounded theory. Results: Four main themes were identified: (1) personal beliefs and views about mental health and substance use, (2) family and community beliefs about mental health and substance use, (3) personal experience with mental health and substance use, and (4) comfort in talking to others about mental health and substance use. Subthemes evolved within each of the four themes. Black PPP indicated that maternal mental health and substance use disorders are common in the Black community, but negative stigma related to these conditions often prevents PPP from talking about these conditions or seeking support or treatment despite believing that support and treatment can be beneficial. Conclusions: Clinical practice initiatives within this population can focus on advanced training for providers to more clearly understand personal experiences and related stigma related to mental health and substance use disorders, with the goal of supporting Black PPP mental health needs.
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Affiliation(s)
- Emily Johnson
- College of Nursing, Medical University of South Carolina, Charleston, SC, USA
| | - Angela Moreland
- College of Medicine, Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Courtney King
- College of Medicine, Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Connie Guille
- College of Medicine, Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
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Ash MJ, Livingston MD, Sales JM, Woods-Jaeger B. Mental Health Treatment Utilization and Unmet Mental Health Needs Among Black Reproductive-Age Women in the United States. Psychiatr Serv 2024:appips20230464. [PMID: 38807578 DOI: 10.1176/appi.ps.20230464] [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] [Indexed: 05/30/2024]
Abstract
OBJECTIVE Black women in the United States experience increased risk for mental disorders and are less likely to have access to appropriate mental health treatment compared with White women. To develop culturally responsive strategies to improve Black women's access to mental health treatment, the authors evaluated social determinants associated with mental health treatment utilization and unmet mental health needs among Black reproductive-age women with serious psychological distress. METHODS The authors performed a secondary analysis of data from the National Survey on Drug Use and Health. Data from 2009 to 2019 were pooled and restricted to Black women ages 18-44 years with serious psychological distress (N=4,171). Logistic regressions were conducted to identify personal and social determinants (e.g., education, employment status, poverty, and insurance status) of mental health treatment utilization, alternative mental health treatment utilization (e.g., spiritual support and self-help), and perceived unmet mental health needs. RESULTS Education and employment status were significantly associated with all three outcomes. Among the women who reported unmet mental health needs, opposition to treatment and cost were the highest endorsed barriers. Differences were found by pregnancy status, with pregnant women being significantly less likely to endorse cost (p<0.001) and more likely to endorse time and transportation as barriers (p<0.01) to receiving mental health treatment. CONCLUSIONS Strategies to improve mental health outcomes for Black women should focus on reducing cost and transportation barriers and on the development of culturally responsive intervention approaches that address Black women's concerns about mental health treatment.
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Affiliation(s)
- Marcia J Ash
- Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta
| | - Melvin D Livingston
- Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta
| | - Jessica M Sales
- Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta
| | - Briana Woods-Jaeger
- Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta
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Ou C, Daly Z, Carter M, Hall WA, Zusman EZ, Russolillo A, Duffy S, Jenkins E. Developing consensus to enhance perinatal mental health through a model of integrated care: Delphi study. PLoS One 2024; 19:e0303012. [PMID: 38722862 PMCID: PMC11081323 DOI: 10.1371/journal.pone.0303012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Accepted: 04/17/2024] [Indexed: 05/13/2024] Open
Abstract
Perinatal mental illness is an important public health issue, with one in five birthing persons experiencing clinically significant symptoms of anxiety and/or depression during pregnancy or the postpartum period. The purpose of this study was to develop a consensus-based model of integrated perinatal mental health care to enhance service delivery and improve parent and family outcomes. We conducted a three-round Delphi study using online surveys to reach consensus (≥75% agreement) on key domains and indicators of integrated perinatal mental health care. We invited modifications to indicators and domains during each round and shared a summary of results with participants following rounds one and two. Descriptive statistics were generated for quantitative data and a thematic analysis of qualitative data was undertaken. Study participants included professional experts in perinatal mental health (e.g., clinicians, researchers) (n = 36) and people with lived experience of perinatal mental illness within the past 5 years from across Canada (e.g., patients, family members) (n = 11). Consensus was reached and all nine domains of the proposed model for integrated perinatal mental health care were retained. Qualitative results informed the modification of indicators and development of an additional domain and indicators capturing the need for antiracist, culturally safe care. The development of an integrated model of perinatal mental health benefitted from diverse expertise to guide the focus of included domains and indicators. Engaging in a consensus-building process helps to create the conditions for change within health services.
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Affiliation(s)
- Christine Ou
- School of Nursing, University of Victoria, Victoria, Canada
| | - Zachary Daly
- School of Nursing, University of British Columbia, Vancouver, Canada
- Wellstream: The Canadian Centre for Innovation in Child and Youth Mental Health and Substance Use, Vancouver, Canada
| | - Michelle Carter
- School of Nursing, University of British Columbia, Vancouver, Canada
- Wellstream: The Canadian Centre for Innovation in Child and Youth Mental Health and Substance Use, Vancouver, Canada
- St. Paul’s Hospital, Providence Healthcare, Vancouver, Canada
| | - Wendy A. Hall
- School of Nursing, University of British Columbia, Vancouver, Canada
| | - Enav Z. Zusman
- Department of Obstetrics & Gynaecology, University of British Columbia, Vancouver, BC, Canada
| | - Angela Russolillo
- St. Paul’s Hospital, Providence Healthcare, Vancouver, Canada
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
| | - Sheila Duffy
- Pacific Post Partum Support Society, Burnaby, BC, Canada
| | - Emily Jenkins
- School of Nursing, University of British Columbia, Vancouver, Canada
- Wellstream: The Canadian Centre for Innovation in Child and Youth Mental Health and Substance Use, Vancouver, Canada
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Altendahl MR, Xu L, Asiodu I, Boscardin WJ, Gaw SL, Flaherman VJ, Jacoby VL, Richards MC, Krakow D, Afshar Y. Patterns of peripartum depression and anxiety during the pre-vaccine COVID-19 pandemic. BMC Pregnancy Childbirth 2024; 24:310. [PMID: 38664729 PMCID: PMC11044399 DOI: 10.1186/s12884-024-06518-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Accepted: 04/15/2024] [Indexed: 04/29/2024] Open
Abstract
BACKGROUND Pregnant people are vulnerable to new or worsening mental health conditions. This study aims to describe prevalence and course of depression and anxiety symptoms in pregnancy during the pre-vaccine COVID-19 pandemic. METHODS This is a prospective cohort study of pregnant individuals with known or suspected COVID-19. Participants completed Edinburgh Postnatal Depression Scale (EPDS) and Generalized-Anxiety Disorder-7 (GAD-7) questionnaires, screening tools for depression and anxiety, at 34weeks gestational age, 6-8weeks postpartum, and 6months postpartum. Prevalence of elevated depressive and anxiety symptoms at each visit was described. Univariable logistic regression analysis was used to determine the association between demographic and clinical factors and those with elevated depression or anxiety symptoms. RESULTS 317 participants were included. The prevalence of elevated antepartum depression symptoms was 14.6%, 10.3%, and 20.6% at 34weeks gestational age, 6-8weeks postpartum, and 6months postpartum, respectively. The rate of elevated anxiety symptoms was 15.1%, 10.0%, and 17.3% at 34weeks gestational age, 6-8weeks postpartum, and 6months postpartum, respectively. A prior history of depression and/or anxiety (p's < 0.03), as well as higher EPDS and GAD-7 scores at enrollment (p's < 0.04) associated with elevated depression and anxiety symptoms throughout pregnancy and the postpartum period. Quarantining during pregnancy was associated with elevated anxiety symptoms at 34weeks gestational age in univariate (P = 0.027) analyses. COVID-19 diagnosis and hospitalization were not associated with elevated depression or anxiety symptoms. CONCLUSIONS Elevated depression and anxiety symptoms were prevalent throughout pregnancy and the postpartum period, particularly in those with prior depression and/or anxiety and who quarantined. Strategies that target social isolation may mitigate potential adverse consequences for pregnant people, and continued vigilance in recognition of depression and anxiety in pregnancy should be considered.
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Affiliation(s)
- Marie R Altendahl
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of California, 200 Medical Plaza, Suite 430, Los Angeles, CA, 90095, USA
- David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Liwen Xu
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of California, 200 Medical Plaza, Suite 430, Los Angeles, CA, 90095, USA
| | - Ifeyinwa Asiodu
- Department of Family Health Care Nursing, University of California, San Francisco, CA, USA
| | - W John Boscardin
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA
- Department of Medicine, University of California, San Francisco, CA, USA
| | - Stephanie L Gaw
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, CA, USA
| | | | - Vanessa L Jacoby
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, CA, USA
| | - Misty C Richards
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of California, 200 Medical Plaza, Suite 430, Los Angeles, CA, 90095, USA
- David Geffen School of Medicine, University of California, Los Angeles, CA, USA
- Division of Child and Adolescent Psychiatry, University of California, Los Angeles, CA, USA
| | - Deborah Krakow
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of California, 200 Medical Plaza, Suite 430, Los Angeles, CA, 90095, USA
- David Geffen School of Medicine, University of California, Los Angeles, CA, USA
- Department of Human Genetics, University of California, Los Angeles, CA, USA
- Department of Orthopaedic Surgery, University of California, Los Angeles, CA, USA
| | - Yalda Afshar
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of California, 200 Medical Plaza, Suite 430, Los Angeles, CA, 90095, USA.
- David Geffen School of Medicine, University of California, Los Angeles, CA, USA.
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Haight SC, Daw JR, Martin CL, Sheffield-Abdullah K, Verbiest S, Pence BW, Maselko J. Racial And Ethnic Inequities In Postpartum Depressive Symptoms, Diagnosis, And Care In 7 US Jurisdictions. Health Aff (Millwood) 2024; 43:486-495. [PMID: 38560804 DOI: 10.1377/hlthaff.2023.01434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
Understanding whether racial and ethnic inequities exist along the postpartum mental health care continuum is vital because inequitable identification of depression can lead to inequitable referral to and receipt of care. We aimed to expand on existing cross-sectional and single-state data documenting potential racial and ethnic disparities in postpartum depression care. Using early (from two to six months) and late (from twelve to fourteen months) postpartum survey data from seven US jurisdictions, we documented patterns of early postpartum depressive symptoms, perinatal mood and anxiety disorder (PMAD) diagnosis, and receipt of postpartum mental health care overall and by racial and ethnic identity. Of 4,542 people who delivered live births in 2020, 11.8 percent reported early postpartum depressive symptoms. Among the sample with these symptoms, only 25.4 percent reported receiving a PMAD diagnosis, and 52.8 percent reported receiving some form of postpartum mental health care. There were no significant differences in diagnosis by race and ethnicity. Respondents identifying as Asian; Native Hawaiian or Pacific Islander; Southwest Asian, Middle Eastern, or North African; Hispanic; and non-Hispanic Black were significantly less likely than non-Hispanic White respondents to receive mental health care, demonstrating stark inequities in the management of postpartum depressive symptoms. Policies mandating and reimbursing universal postpartum depression screening, facilitating connection to care, reducing insurance coverage gaps, and enhancing clinician training in culturally responsive care may promote equitable postpartum mental health care.
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Affiliation(s)
- Sarah C Haight
- Sarah C. Haight , University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Jamie R Daw
- Jamie R. Daw, Columbia University, New York, New York
| | | | | | - Sarah Verbiest
- Sarah Verbiest, University of North Carolina at Chapel Hill
| | - Brian W Pence
- Brian W. Pence, University of North Carolina at Chapel Hill
| | - Joanna Maselko
- Joanna Maselko, University of North Carolina at Chapel Hill
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Gopalan P, Spada ML, Shenai N, Kratzer I, Nichols N, Kucherer S, Chou S, Hovis E, Beck S, Glance J. An Overview for the General Psychiatrist Evaluating Patients With Obstetric and Neonatal Complications and Perinatal Loss. FOCUS (AMERICAN PSYCHIATRIC PUBLISHING) 2024; 22:35-43. [PMID: 38694157 PMCID: PMC11058915 DOI: 10.1176/appi.focus.20230021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2024]
Abstract
When neonatal and obstetrical complications occur, the identification and management of mood and anxiety disorders become complex with an ever-expanding array of psychiatric needs that include the management of grief- and trauma-related disorders. With high rates of maternal morbidity and mortality in the United States and laws in many states restricting reproductive health access, psychiatrists must be proficient in managing psychiatric sequelae in this context. High-risk groups for peripartum mood and anxiety disorders, posttraumatic stress disorder, and complicated grief include those with neonatal intensive care unit (NICU) stays and those who have experienced infertility and recurrent pregnancy loss. Groups who have been historically marginalized by the medical system (e.g., Black, Indigenous, people of color) and those from LGBTQ+ communities are at similarly high risk, and more interventions are needed to support these groups. Strategies emphasizing trauma-informed care, psychotherapeutic approaches, and using patient-centered language are recommended.
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Affiliation(s)
- Priya Gopalan
- Department of Psychiatry, University of Pittsburgh Medical Center Western Psychiatric Hospital (Gopalan, Spada, Kratzer, Kucherer, Chou, Glance); Department of Psychiatry and Psychology, Cleveland Clinic, Cleveland, Ohio (Nichols); Department of Obstetrics, Gynecology, and Reproductive Services, Magee-Womens Hospital, University of Pittsburgh Medical Center, Pittsburgh (Beck); Department of Psychiatry, University of Wisconsin-Madison (Shenai); Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, Milwaukee (Hovis)
| | - Meredith L Spada
- Department of Psychiatry, University of Pittsburgh Medical Center Western Psychiatric Hospital (Gopalan, Spada, Kratzer, Kucherer, Chou, Glance); Department of Psychiatry and Psychology, Cleveland Clinic, Cleveland, Ohio (Nichols); Department of Obstetrics, Gynecology, and Reproductive Services, Magee-Womens Hospital, University of Pittsburgh Medical Center, Pittsburgh (Beck); Department of Psychiatry, University of Wisconsin-Madison (Shenai); Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, Milwaukee (Hovis)
| | - Neeta Shenai
- Department of Psychiatry, University of Pittsburgh Medical Center Western Psychiatric Hospital (Gopalan, Spada, Kratzer, Kucherer, Chou, Glance); Department of Psychiatry and Psychology, Cleveland Clinic, Cleveland, Ohio (Nichols); Department of Obstetrics, Gynecology, and Reproductive Services, Magee-Womens Hospital, University of Pittsburgh Medical Center, Pittsburgh (Beck); Department of Psychiatry, University of Wisconsin-Madison (Shenai); Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, Milwaukee (Hovis)
| | - Isabella Kratzer
- Department of Psychiatry, University of Pittsburgh Medical Center Western Psychiatric Hospital (Gopalan, Spada, Kratzer, Kucherer, Chou, Glance); Department of Psychiatry and Psychology, Cleveland Clinic, Cleveland, Ohio (Nichols); Department of Obstetrics, Gynecology, and Reproductive Services, Magee-Womens Hospital, University of Pittsburgh Medical Center, Pittsburgh (Beck); Department of Psychiatry, University of Wisconsin-Madison (Shenai); Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, Milwaukee (Hovis)
| | - Nona Nichols
- Department of Psychiatry, University of Pittsburgh Medical Center Western Psychiatric Hospital (Gopalan, Spada, Kratzer, Kucherer, Chou, Glance); Department of Psychiatry and Psychology, Cleveland Clinic, Cleveland, Ohio (Nichols); Department of Obstetrics, Gynecology, and Reproductive Services, Magee-Womens Hospital, University of Pittsburgh Medical Center, Pittsburgh (Beck); Department of Psychiatry, University of Wisconsin-Madison (Shenai); Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, Milwaukee (Hovis)
| | - Shelly Kucherer
- Department of Psychiatry, University of Pittsburgh Medical Center Western Psychiatric Hospital (Gopalan, Spada, Kratzer, Kucherer, Chou, Glance); Department of Psychiatry and Psychology, Cleveland Clinic, Cleveland, Ohio (Nichols); Department of Obstetrics, Gynecology, and Reproductive Services, Magee-Womens Hospital, University of Pittsburgh Medical Center, Pittsburgh (Beck); Department of Psychiatry, University of Wisconsin-Madison (Shenai); Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, Milwaukee (Hovis)
| | - Shinnyi Chou
- Department of Psychiatry, University of Pittsburgh Medical Center Western Psychiatric Hospital (Gopalan, Spada, Kratzer, Kucherer, Chou, Glance); Department of Psychiatry and Psychology, Cleveland Clinic, Cleveland, Ohio (Nichols); Department of Obstetrics, Gynecology, and Reproductive Services, Magee-Womens Hospital, University of Pittsburgh Medical Center, Pittsburgh (Beck); Department of Psychiatry, University of Wisconsin-Madison (Shenai); Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, Milwaukee (Hovis)
| | - Elizabeth Hovis
- Department of Psychiatry, University of Pittsburgh Medical Center Western Psychiatric Hospital (Gopalan, Spada, Kratzer, Kucherer, Chou, Glance); Department of Psychiatry and Psychology, Cleveland Clinic, Cleveland, Ohio (Nichols); Department of Obstetrics, Gynecology, and Reproductive Services, Magee-Womens Hospital, University of Pittsburgh Medical Center, Pittsburgh (Beck); Department of Psychiatry, University of Wisconsin-Madison (Shenai); Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, Milwaukee (Hovis)
| | - Stacy Beck
- Department of Psychiatry, University of Pittsburgh Medical Center Western Psychiatric Hospital (Gopalan, Spada, Kratzer, Kucherer, Chou, Glance); Department of Psychiatry and Psychology, Cleveland Clinic, Cleveland, Ohio (Nichols); Department of Obstetrics, Gynecology, and Reproductive Services, Magee-Womens Hospital, University of Pittsburgh Medical Center, Pittsburgh (Beck); Department of Psychiatry, University of Wisconsin-Madison (Shenai); Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, Milwaukee (Hovis)
| | - Jody Glance
- Department of Psychiatry, University of Pittsburgh Medical Center Western Psychiatric Hospital (Gopalan, Spada, Kratzer, Kucherer, Chou, Glance); Department of Psychiatry and Psychology, Cleveland Clinic, Cleveland, Ohio (Nichols); Department of Obstetrics, Gynecology, and Reproductive Services, Magee-Womens Hospital, University of Pittsburgh Medical Center, Pittsburgh (Beck); Department of Psychiatry, University of Wisconsin-Madison (Shenai); Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, Milwaukee (Hovis)
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Bose-Brill S, Gillespie SL, Venkatesh KK. Can We Implement Multispecialty Mother-Infant Dyadic Care to Systematize Interpregnancy Services After a Preterm Birth? WOMEN'S HEALTH REPORTS (NEW ROCHELLE, N.Y.) 2023; 4:651-655. [PMID: 38155872 PMCID: PMC10754421 DOI: 10.1089/whr.2023.0148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/25/2023] [Indexed: 12/30/2023]
Affiliation(s)
- Seuli Bose-Brill
- Combined Internal Medicine and Pediatrics Section, Division of General Internal Medicine, Department of Internal Medicine, The Ohio State University College of Medicine, Columbus, Ohio, USA
| | - Shannon L. Gillespie
- The Martha S. Pitzer Center for Women, Children, and Youth, College of Nursing, The Ohio State University, Columbus, Ohio, USA
| | - Kartik K. Venkatesh
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, The Ohio State University College of Medicine, Columbus, Ohio, USA
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9
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James KF, Klomhaus AM, Elliott T, Mensah M, Jeffers KS, Choi KR. Structural Factors in Health Care Associated With the Mental Health Needs of Black Women in California During the Perinatal Period. J Obstet Gynecol Neonatal Nurs 2023; 52:481-490. [PMID: 37634545 DOI: 10.1016/j.jogn.2023.08.002] [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: 04/23/2023] [Revised: 08/07/2023] [Accepted: 08/08/2023] [Indexed: 08/29/2023] Open
Abstract
OBJECTIVE To identify structural factors associated with the receipt of mental health care treatment among Black women in California during pregnancy and after childbirth. DESIGN Secondary analysis of data from the population-based Listening to Mothers in California survey. PARTICIPANTS The sample included 194 non-Latina Black women in the postpartum period. METHODS We used descriptive statistics, including differences between means and logistic regression, to conduct a series of bivariate analyses. RESULTS Most respondents (84.4%, n = 163) reported symptoms of perinatal mood and anxiety disorders prenatally, and half (50% n = 97) reported symptoms of perinatal mood and anxiety disorders in the postpartum period. Only 12.3% to 14.6% of those who reported symptoms received mental health care treatment. Furthermore, 21.2% (n = 38) of respondents were not screened for postpartum depression. Respondents with private insurance coverage were more likely to report receipt of mental health care after childbirth (OR = 4.6; 95% confidence interval [1.5, 13.5]) compared to respondents with public insurance coverage. CONCLUSION Our results suggest a high prevalence of unmet mental health needs among non-Latina Black women who lived in California during the perinatal period. Practitioners in clinical settings may be more likely to make referrals to mental health care for women with private insurance coverage in the postpartum period.
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10
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Jones SL, Caccese C, Davis KP, Lew J, Elgbeili G, Herba CM, Barnwell J, Robert CH, Gavanski I, Horsley K, Fraser WD, Da Costa D, Séguin JR, Nguyen TV, Montreuil TC. Longitudinal associations between paternal mental health and child behavior and cognition in middle childhood. Front Psychol 2023; 14:1218384. [PMID: 38022974 PMCID: PMC10646505 DOI: 10.3389/fpsyg.2023.1218384] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 09/13/2023] [Indexed: 12/01/2023] Open
Abstract
Introduction Paternal mental health has been associated with adverse consequences on offspring psychosocial development, and family environmental factors may partly explain those associations. To clarify this, we need comprehensive prospective studies, particularly in middle-childhood when the child enters school and is expected to make use of behavioral and cognitive skills as part of their interactions and learning. Method Using data from a sub-sample of the prospective 3D birth cohort study comprised of mother-father-child triads, and a follow-up of the parents and the children at 6-8 years of age (n = 61; 36 boys, 25 girls), we examined whether paternal anxious and depressive symptoms measured during the pregnancy period (i.e., prenatally) or concurrently when the child was assessed at 6-8 years old were associated with children's cognition/behavior. Results In contrast to our hypotheses, we found that greater prenatal paternal depressive symptoms predicted fewer child behavioral difficulties; and that greater concurrent childhood paternal depression or anxiety symptoms were associated with higher child full-scale IQ, controlling for the equivalent maternal mental health assessment and parental education. Father parenting perception did not mediate these associations, nor were they moderated by maternal mental health at the concurrent assessment, or paternal ratings of marital relationship quality. Discussion These findings suggest that higher symptoms of paternal mental health symptoms are associated with fewer child behavioral difficulties and higher cognitive performance in middle childhood. Potential clinical implications and future research directions are discussed.
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Affiliation(s)
- Sherri Lee Jones
- Department of Psychiatry, Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada
- Department of Psychiatry, Research Institute of the McGill University Health Center, McGill University, Montreal, QC, Canada
- Department of Psychiatry, Douglas Research Center, Douglas Mental Health University Institute, McGill University, Montreal, QC, Canada
| | - Christina Caccese
- Department of Psychiatry, Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada
- Department of Psychiatry, Research Institute of the McGill University Health Center, McGill University, Montreal, QC, Canada
- Department of Psychiatry, Douglas Research Center, Douglas Mental Health University Institute, McGill University, Montreal, QC, Canada
| | - Kelsey P. Davis
- Department of Psychiatry, Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada
- Department of Psychiatry, Research Institute of the McGill University Health Center, McGill University, Montreal, QC, Canada
| | - Jimin Lew
- Department of Psychiatry, Research Institute of the McGill University Health Center, McGill University, Montreal, QC, Canada
- Department of Psychiatry, Douglas Research Center, Douglas Mental Health University Institute, McGill University, Montreal, QC, Canada
- Integrated Program in Neuroscience, Department of Psychiatry, McGill University, Montreal, QC, Canada
| | - Guillaume Elgbeili
- Department of Psychiatry, Research Institute of the McGill University Health Center, McGill University, Montreal, QC, Canada
| | - Catherine M. Herba
- Department of Psychology, Université du Québec à Montréal, Montreal, QC, Canada
- Research Center, CHU Sainte-Justine Mother and Child University Hospital Center, Montreal, QC, Canada
| | - Julia Barnwell
- Department of Psychiatry, Research Institute of the McGill University Health Center, McGill University, Montreal, QC, Canada
- Department of Pediatrics, Human Genetics and Pharmacology & Therapeutics, McGill University, Montreal, QC, Canada
| | - Cindy Hénault Robert
- Department of Psychiatry, Research Institute of the McGill University Health Center, McGill University, Montreal, QC, Canada
- Department of Psychiatry, Douglas Research Center, Douglas Mental Health University Institute, McGill University, Montreal, QC, Canada
| | | | - Kristin Horsley
- Department of Psychology, McGill University, Montreal, QC, Canada
| | - William D. Fraser
- Research Center, CHU Sainte-Justine Mother and Child University Hospital Center, Montreal, QC, Canada
- Department of Obstetrics and Gynecology, Centre de Recherche du CHU de Sherbrooke, University of Sherbrooke, Sherbrooke, QC, Canada
| | - Deborah Da Costa
- Department of Physical and Occupational Sciences, Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada
| | - Jean R. Séguin
- Research Center, CHU Sainte-Justine Mother and Child University Hospital Center, Montreal, QC, Canada
- Department of Psychiatry and Addictology, Université de Montréal, Montreal, QC, Canada
| | - Tuong-Vi Nguyen
- Department of Psychiatry, Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada
- Department of Psychiatry, Research Institute of the McGill University Health Center, McGill University, Montreal, QC, Canada
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, QC, Canada
- Reproductive Psychiatry Program, Department of Psychiatry and Obstetrics and Gynecology, McGill University Health Centre, Montreal, QC, Canada
| | - Tina C. Montreuil
- Department of Psychiatry, Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada
- Department of Psychiatry, Research Institute of the McGill University Health Center, McGill University, Montreal, QC, Canada
- Research Center, CHU Sainte-Justine Mother and Child University Hospital Center, Montreal, QC, Canada
- Department of Pediatrics, Human Genetics and Pharmacology & Therapeutics, McGill University, Montreal, QC, Canada
- Department of Educational and Counselling Psychology, Faculty of Education, McGill University, Montreal, QC, Canada
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11
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Nelson T, Tomi CL, Gebretensay SB. (Re)Framing Strength: How Superwoman Schema May Impact Perinatal Anxiety and Depression among African American Women. Womens Health Issues 2023; 33:568-572. [PMID: 37316335 DOI: 10.1016/j.whi.2023.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 04/28/2023] [Accepted: 05/05/2023] [Indexed: 06/16/2023]
Affiliation(s)
- Tamara Nelson
- Department of Psychology, Rutgers University, Camden, New Jersey.
| | - Cecelela L Tomi
- Department of Childhood Studies, Rutgers University, Camden, New Jersey
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12
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Zimmermann M, Peacock-Chambers E, Merton C, Pasciak K, Thompson A, Mackie T, Clare CA, Lemon SC, Byatt N. Equitable reach: Patient and professional recommendations for interventions to prevent perinatal depression and anxiety. Gen Hosp Psychiatry 2023; 85:95-103. [PMID: 37862962 PMCID: PMC11056209 DOI: 10.1016/j.genhosppsych.2023.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 07/14/2023] [Accepted: 10/06/2023] [Indexed: 10/22/2023]
Abstract
OBJECTIVE Perinatal depression and anxiety are the most common complications in the perinatal period and disproportionately affect those experiencing economic marginalization. Fewer than 15% of individuals at risk for perinatal depression are referred for preventative counseling. The goal of this study was to elicit patient and perinatal care professionals' perspectives on how to increase the reach of interventions to prevent perinatal depression and anxiety among economically marginalized individuals. METHODS We conducted qualitative interviews with perinatal individuals with lived experience of perinatal depression and/or anxiety who were experiencing economic marginalization (n = 12) and perinatal care professionals and paraprofessionals (e.g., obstetrician/gynecologists, midwives, doulas; n = 12) serving this population. Three study team members engaged a "a coding consensus, co-occurrence, and comparison," approach to code interviews. RESULTS Perinatal individuals and professionals identified prevention intervention delivery approaches and content to facilitate equitable reach for individuals who are economically marginalized. Factors influential included availability of mental health counselors, facilitation of prevention interventions by a trusted professional, digital health options, and options for mental health intervention delivery approaches. Content that was perceived as increasing equitable intervention reach included emphasizing stigma reduction, using cultural humility and inclusive materials, and content personalization. CONCLUSIONS Leveraging varied options for mental health intervention delivery approaches and content could reach perinatal individuals experiencing economic marginalization and address resource considerations associated with preventative interventions.
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Affiliation(s)
- Martha Zimmermann
- UMass Chan Medical School, 222 Maple Avenue - Chang Building Shrewsbury, MA 01545, United States of America.
| | - Elizabeth Peacock-Chambers
- UMass Chan Medical School, 222 Maple Avenue - Chang Building Shrewsbury, MA 01545, United States of America
| | - Catherine Merton
- UMass Chan Medical School, 222 Maple Avenue - Chang Building Shrewsbury, MA 01545, United States of America
| | - Katarzyna Pasciak
- UMass Chan Medical School, 222 Maple Avenue - Chang Building Shrewsbury, MA 01545, United States of America
| | - Azure Thompson
- SUNY Downstate Health Sciences University, 450 Clarkson Avenue, Brooklyn, NY 11203, United States of America
| | - Thomas Mackie
- SUNY Downstate Health Sciences University, 450 Clarkson Avenue, Brooklyn, NY 11203, United States of America
| | - Camille A Clare
- SUNY Downstate Health Sciences University, 450 Clarkson Avenue, Brooklyn, NY 11203, United States of America
| | - Stephenie C Lemon
- UMass Chan Medical School, 222 Maple Avenue - Chang Building Shrewsbury, MA 01545, United States of America
| | - Nancy Byatt
- UMass Chan Medical School, 222 Maple Avenue - Chang Building Shrewsbury, MA 01545, United States of America
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13
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Zimmermann M, Julce C, Sarkar P, McNicholas E, Xu L, Carr C, Boudreaux ED, Lemon SC, Byatt N. Can psychological interventions prevent or reduce risk for perinatal anxiety disorders? A systematic review and meta-analysis. Gen Hosp Psychiatry 2023; 84:203-214. [PMID: 37619299 PMCID: PMC10569160 DOI: 10.1016/j.genhosppsych.2023.08.005] [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: 05/17/2023] [Revised: 08/07/2023] [Accepted: 08/14/2023] [Indexed: 08/26/2023]
Abstract
OBJECTIVE Little is known about the extent to which interventions can prevent perinatal anxiety disorders. We conducted a systematic review and meta-analysis to examine whether interventions can decrease the onset and symptoms of perinatal anxiety among individuals without an anxiety disorder diagnosis. METHOD We conducted a comprehensive literature search across five databases related to key concepts: (1) anxiety disorders/anxiety symptom severity (2) perinatal (3) interventions (4) prevention. We included studies that examined a perinatal population without an anxiety disorder diagnosis, included a comparator group, and assessed perinatal anxiety. We included interventions focused on perinatal anxiety as well as interventions to prevent perinatal depression or influence related outcomes (e.g., physical activity). RESULTS Thirty-six studies were included. No study assessing the incidence of perinatal anxiety disorder (n = 4) found a significant effect of an intervention. Among studies assessing anxiety symptom severity and included in the quantitative analysis (n = 30), a meta-analysis suggested a small standardized mean difference of -0.31 (95% CI [-0.46, -0.16], p < .001) for anxiety at post intervention, favoring the intervention group. Both mindfulness (n = 6), and cognitive behavioral therapy approaches (n = 10) were effective. CONCLUSIONS Interventions developed for perinatal anxiety were more effective than interventions to prevent perinatal depression. Psychological interventions show promise for reducing perinatal anxiety symptom severity, though interventions specifically targeting anxiety are needed.
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Affiliation(s)
- Martha Zimmermann
- UMass Chan Medical School, 222 Maple Avenue - Chang Building, Shrewsbury, MA 01545, United States of America.
| | - Clevanne Julce
- UMass Chan Medical School, 222 Maple Avenue - Chang Building, Shrewsbury, MA 01545, United States of America
| | - Pooja Sarkar
- UMass Chan Medical School, 222 Maple Avenue - Chang Building, Shrewsbury, MA 01545, United States of America
| | - Eileen McNicholas
- UMass Chan Medical School, 222 Maple Avenue - Chang Building, Shrewsbury, MA 01545, United States of America
| | - Lulu Xu
- UMass Chan Medical School, 222 Maple Avenue - Chang Building, Shrewsbury, MA 01545, United States of America
| | - Catherine Carr
- UMass Chan Medical School, 222 Maple Avenue - Chang Building, Shrewsbury, MA 01545, United States of America
| | - Edwin D Boudreaux
- UMass Chan Medical School, 222 Maple Avenue - Chang Building, Shrewsbury, MA 01545, United States of America
| | - Stephenie C Lemon
- UMass Chan Medical School, 222 Maple Avenue - Chang Building, Shrewsbury, MA 01545, United States of America
| | - Nancy Byatt
- UMass Chan Medical School, 222 Maple Avenue - Chang Building, Shrewsbury, MA 01545, United States of America
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14
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Ponting C, Ong E, Schetter CD, Chavira DA. Exposure therapy acceptability among pregnant Latinas with anxiety: A qualitative content analysis. CULTURAL DIVERSITY & ETHNIC MINORITY PSYCHOLOGY 2023:2023-70729-001. [PMID: 37166932 PMCID: PMC10638461 DOI: 10.1037/cdp0000589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
OBJECTIVE Exposure therapy is the frontline treatment for anxiety among adults but is underutilized during pregnancy. We qualitatively assess the prospective acceptability of exposure therapy among pregnant Latinas with elevated anxiety, a group that experiences mental health disparities. METHOD Pregnant Latinas (N = 25) with elevated anxiety were interviewed regarding their acceptability of exposure therapy following the receipt of an informational clinical video vignette. Interviews were analyzed using deductive content analysis guided by the Theoretical Framework of Acceptability to understand pregnant Latinas' views about exposure therapy. RESULTS Nineteen themes were identified across seven theoretically driven subdomains of acceptability. Women expressed acceptability enhancing factors for exposure therapy including feeling hopeful about its effects, a belief that treatment could benefit their broader family, and a preference for treatment during pregnancy as opposed to the postpartum period. Women also expressed challenges to exposure therapy acceptability such as managing family reactions to prenatal psychotherapy, conflict with cultural conceptions of the maternal role, and perceived difficulty using exposure for avoidance related to prenatal health. CONCLUSION Identified themes provide insights about exposure acceptability among pregnant women and can be used to bettter engage Latinas in anxiety interventions, ultimately improving clinical outcomes. (PsycInfo Database Record (c) 2024 APA, all rights reserved).
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Affiliation(s)
- Carolyn Ponting
- University of California, Los Angeles
- University of California, San Francisco
| | - Emma Ong
- University of California, Los Angeles
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15
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Runkle JD, Risley K, Roy M, Sugg MM. Association Between Perinatal Mental Health and Pregnancy and Neonatal Complications: A Retrospective Birth Cohort Study. Womens Health Issues 2023; 33:289-299. [PMID: 36621340 PMCID: PMC10213085 DOI: 10.1016/j.whi.2022.12.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Revised: 11/30/2022] [Accepted: 12/09/2022] [Indexed: 01/09/2023]
Abstract
BACKGROUND Maternal mental health as an important precursor to reproductive and neonatal complications remains understudied in the United States, particularly in the Southeastern region, despite high medical costs, maternal morbidity, and infant burden. This study sought to estimate the incidence of perinatal mental health disorders and the associated increased risk of leading pregnancy and infant complications. METHODS A population-based retrospective birth cohort of childbirth hospitalizations and readmissions was constructed for women in South Carolina, 1999 to 2017. Prevalence rates were calculated for perinatal mood and anxiety disorders (PMAD), severe mental illness, and mental disorders of pregnancy (MDP). Poisson regression models using generalized estimating equations were used to estimate adjusted relative risks for the association between mental health conditions and severe maternal morbidity, hypertensive disorders of pregnancy, gestational diabetes, cesarean section, preterm birth, and low birthweight. RESULTS The most prevalent maternal mental condition was MDP (3.9%), followed by PMAD (2.7%) and severe mental illness (0.13%). PMAD was associated with a higher risk of severe maternal morbidity, hypertensive disorders of pregnancy, and cesarean section, as well as a higher risk of preterm birth and low birthweight infants. Severe mental illness was associated with low birthweight, hypertensive disorders of pregnancy, and cesarean section. Pregnant populations with MDP were more at risk for severe maternal morbidity, preterm birth, hypertensive disorders of pregnancy, low birthweight, and cesarean section. Each maternal mental health outcome was associated with an increased risk for hospital readmissions up to 45 days after childbirth. CONCLUSIONS Results demonstrate the escalating burden of PMAD and MDP for pregnant populations over time, with important consequences related to maternal and infant morbidity.
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Affiliation(s)
- Jennifer D Runkle
- North Carolina Institute for Climate Studies, North Carolina State University, Asheville, North Carolina.
| | - Kendra Risley
- North Carolina Institute for Climate Studies, North Carolina State University, Asheville, North Carolina
| | - Manan Roy
- Department of Nutrition and Health Care Management, Appalachian State University, Boone, North Carolina
| | - Margaret M Sugg
- Department of Geography and Planning, Appalachian State University, Boone, North Carolina
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16
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King BC, Eastin SM, Ho SY, Shapiro P, Sheen JJ, Fitelson EM. Inpatient obstetric consultation-liaison services: Meeting unmet needs in perinatal mental health. Gen Hosp Psychiatry 2023; 83:179-184. [PMID: 37267727 DOI: 10.1016/j.genhosppsych.2023.04.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Revised: 04/23/2023] [Accepted: 04/26/2023] [Indexed: 06/04/2023]
Abstract
Obstetric patients are at increased risk for psychological distress and the development or exacerbation of mental illness, particularly in the setting of pregnancy or delivery complications. Inpatient antepartum, labor and delivery, and postpartum hospitalization is an important opportunity for psychiatric support and intervention. The aims of this paper are to review the unmet mental health needs in obstetric inpatient care, examine the current state of obstetric consultation-liaison (OB CL) psychiatry services, present one existing model of such a service at the authors' institution, provide broad recommendations for the structure and implementation of this service, and detail areas of future research within the area of OB CL psychiatry. We argue that the inpatient obstetric setting is a critical space for mental health evaluation, education and intervention, and that dedicated OB CL psychiatry services are a potentially valuable tool in addressing the perinatal mental health crisis.
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Affiliation(s)
- Bridget C King
- Department of Psychiatry, New York-Presbyterian Hospital Columbia University Irving Medical Center, New York, NY, USA.
| | - Shiloh M Eastin
- Department of Psychiatry, New York-Presbyterian Hospital Columbia University Irving Medical Center, New York, NY, USA
| | - Sheau-Yan Ho
- Department of Psychiatry, New York-Presbyterian Hospital Columbia University Irving Medical Center, New York, NY, USA
| | - Peter Shapiro
- Department of Psychiatry, New York-Presbyterian Hospital Columbia University Irving Medical Center, New York, NY, USA
| | - Jean-Ju Sheen
- Department of Obstetrics and Gynecology, NewYork-Presbyterian Sloane Hospital for Women, New York, NY, USA
| | - Elizabeth M Fitelson
- Department of Psychiatry, New York-Presbyterian Hospital Columbia University Irving Medical Center, New York, NY, USA
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Vanderkruik R, Freeman MP, Nonacs R, Jellinek M, Gaw ML, Clifford CA, Bartels S, Cohen LS. To screen or not to screen: Are we asking the right question? In response to considering de-implementation of universal perinatal depression screening. Gen Hosp Psychiatry 2023; 83:81-85. [PMID: 37141774 DOI: 10.1016/j.genhosppsych.2023.04.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 03/10/2023] [Accepted: 04/21/2023] [Indexed: 05/06/2023]
Abstract
This Editorial is a response to the Canadian Task Force on Preventive Health Care's recent recommendation "against instrument-based depression screening using a questionnaire with cut-off score to distinguish 'screen positive' and 'screen negative' administered to all individuals during pregnancy and the postpartum period (up to 1 year after childbirth)." While we acknowledge the gaps and limitations in research on perinatal mental health screening, we have concerns regarding the potential impact of a recommendation against screening and for "de-implementation" of existing perinatal depression screening practices, particularly if there is not careful attention to the specificity as well as limitations of the recommendation, or if there are not clear alternative systems put in place to support the detection of perinatal depression. In this manuscript, we highlight some of our key concerns and suggest considerations for perinatal mental health practitioners and researchers.
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Affiliation(s)
- Rachel Vanderkruik
- Massachusetts General Hospital, Ammon Pinizzotto Center for Women's Mental Health, Boston, MA, United States of America; Harvard Medical School, Boston, MA, USA.
| | - Marlene P Freeman
- Massachusetts General Hospital, Ammon Pinizzotto Center for Women's Mental Health, Boston, MA, United States of America; Harvard Medical School, Boston, MA, USA
| | - Ruta Nonacs
- Massachusetts General Hospital, Ammon Pinizzotto Center for Women's Mental Health, Boston, MA, United States of America; Harvard Medical School, Boston, MA, USA
| | | | - Margaret L Gaw
- Massachusetts General Hospital, Ammon Pinizzotto Center for Women's Mental Health, Boston, MA, United States of America
| | - Charlotte A Clifford
- Massachusetts General Hospital, Ammon Pinizzotto Center for Women's Mental Health, Boston, MA, United States of America
| | - Stephen Bartels
- Harvard Medical School, Boston, MA, USA; The Mongan Institute, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States of America
| | - Lee S Cohen
- Massachusetts General Hospital, Ammon Pinizzotto Center for Women's Mental Health, Boston, MA, United States of America; Harvard Medical School, Boston, MA, USA
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18
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Regalado D, Connolly ME, Krutsch K, Stark A, Kendall-Tackett K, Garner CD. Psychiatric medication use among pregnant and breastfeeding mothers who used cannabis for mental health concerns: A cross-sectional survey study. WOMEN'S HEALTH (LONDON, ENGLAND) 2023; 19:17455057231199391. [PMID: 37746858 PMCID: PMC10521288 DOI: 10.1177/17455057231199391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 08/12/2023] [Accepted: 08/18/2023] [Indexed: 09/26/2023]
Abstract
BACKGROUND Use of cannabis during pregnancy and breastfeeding is increasing. Mental health concerns are reported as common reasons for maternal cannabis use, but little is known about the use of psychiatric medications in this population. OBJECTIVES This study aimed to describe psychiatric medication use among pregnant and breastfeeding mothers who used cannabis for mental health concerns. DESIGN Anonymous, online cross-sectional survey. METHODS Data were collected from May 2018 to August 2019 among pregnant and breastfeeding mothers who used cannabis. This study included mothers who reported cannabis use for mental health concerns (n = 1363). The survey assessed the timing of cannabis use (during pregnancy and/or lactation); use of cannabis to address depression, posttraumatic stress disorder, or anxiety; use of psychiatric medications; psychiatric distress (Patient Health Questionnaire-4); and demographic information. Differences between groups were examined using t-test and chi-square test in SPSS. RESULTS The mean age was 29.7 years; most were married (62%); 74% were White non-Hispanic, 9% Hispanic, and 17% Black, Indigenous or other People of Color. Mental health symptoms prompting cannabis use included anxiety (96%), depression (75%), and posttraumatic stress disorder (36%). Only 24% of respondents (n = 322) reported concomitant use of psychiatric medications, primarily selective serotonin reuptake inhibitors (72%, n = 232) and benzodiazepines (21%, n = 68). The composite Patient Health Questionnaire-4 showed most respondents had no (61%) or mild (27%) psychological distress; 14% screened positive for depression; and 17% screened positive for anxiety. Respondents who used psychiatric medications more often screened positive mental health concerns. CONCLUSION Most mothers who used cannabis for mental health concerns were not taking psychiatric medications. This may be due to a mismatch between perceived mental health and screening results, un- or under-treated mental illness, or preference for cannabis over psychiatric medications. Improved management of perinatal mental health and effective patient education about risks of cannabis versus medication use are needed.
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Affiliation(s)
- Diego Regalado
- School of Medicine, Texas Tech University Health Sciences Center, Amarillo, TX, USA
| | - Meghan E. Connolly
- School of Pharmacy, Texas Tech University Health Sciences Center, Amarillo, TX, USA
| | - Kaytlin Krutsch
- Department of Obstetrics and Gynecology, Texas Tech University Health Sciences Center, Amarillo, TX, USA
- InfantRisk Center, Texas Tech University Health Sciences Center, Amarillo, TX, USA
| | - Amy Stark
- Department of Psychiatry, Texas Tech University Health Sciences Center, Amarillo, TX, USA
| | | | - Christine D. Garner
- InfantRisk Center, Texas Tech University Health Sciences Center, Amarillo, TX, USA
- Department of Pediatrics, Texas Tech University Health Sciences Center, Amarillo, TX, USA
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19
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Altendahl MR, Xu L, Asiodu I, Boscardin J, Gaw SL, Flaherman VJ, Jacoby VL, Richards MC, Krakow D, Afshar Y. Patterns of Peripartum Depression and Anxiety During the Pre-Vaccine COVID-19 Pandemic. RESEARCH SQUARE 2022:rs.3.rs-2294673. [PMID: 36561172 PMCID: PMC9774217 DOI: 10.21203/rs.3.rs-2294673/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Background Pregnant people are vulnerable to new or worsening mental health conditions. This study aims to describe prevalence and course of symptomatic depression and anxiety in pregnancy during the pre-vaccine COVID-19 pandemic. Methods This is a prospective cohort study of pregnant individuals with known or suspected COVID-19. Participants completed Edinburgh Postnatal Depression Scale (EPDS) and Generalized-Anxiety Disorder-7 (GAD-7) questionnaires at 34weeks gestational age, 6-8weeks postpartum, and 6months postpartum. Prevalence of symptomatic depression and anxiety at each visit was described. Univariable logistic regression analysis was used to determine the association between demographic and clinical factors and symptomatic depression or anxiety. Results 317 participantswere included. The prevalence of antepartum depression was 14.6%, 10.3%, and 20.6% at 34weeks gestational age, 6-8weeks postpartum, and 6months postpartum, respectively. The rate of anxiety was 15.1%, 10.0%, and 17.3% at 34weeks gestational age, 6-8weeks postpartum, and 6months postpartum, respectively. A prior history of depression and/or anxiety (p's<0.03), as well as higher EPDS and GAD-7 scores at enrollment (p's<0.04) associated with depression and anxiety throughout pregnancy and the postpartum period. Quarantining during pregnancy was associated with symptomatic anxiety at 34weeks gestational age in univariate (P=0.027) analyses. COVID-19 diagnosis and hospitalization were not associated with depression or anxiety. Conclusions Depression and anxiety were prevalent throughout pregnancy and the postpartum period, particularly in those with prior depression and/or anxiety and who quarantined. Strategies that target social isolation may mitigate potential adverse consequences for pregnant people, and continued vigilance in recognition of depression and anxiety in pregnancy should be considered.
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Affiliation(s)
| | - Liwen Xu
- University of California, Los Angeles
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20
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Beck DC, Tabb KM, Tilea A, Hall SV, Vance A, Patrick SW, Schroeder A, Zivin K. The Association between NICU Admission and Mental Health Diagnoses among Commercially Insured Postpartum Women in the US, 2010-2018. CHILDREN (BASEL, SWITZERLAND) 2022; 9:1550. [PMID: 36291486 PMCID: PMC9600206 DOI: 10.3390/children9101550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 09/29/2022] [Accepted: 10/08/2022] [Indexed: 11/06/2022]
Abstract
Maternal mental health (MH) conditions represent a leading cause of preventable maternal death in the US. Neonatal Intensive Care Unit (NICU) hospitalization influences MH symptoms among postpartum women, but a paucity of research uses national samples to explore this relationship. Using national administrative data, we examined the rates of MH diagnoses of anxiety and/or depression among those with and without an infant admitted to a NICU between 2010 and 2018. Using generalized estimating equation models, we explored the relationship between NICU admission and MH diagnoses of anxiety and/or depression, secondarily examining the association of NICU length of stay and race/ethnicity with MH diagnoses of anxiety and/or depression post NICU admission. Women whose infants became hospitalized in the NICU for <2 weeks had 19% higher odds of maternal MH diagnoses (aOR: 1.19, 95% CI: 1.14%−1.24%) and those whose infants became hospitalized for >2 weeks had 37% higher odds of maternal MH diagnoses (aOR: 1.37 95% CI: 1.128%−1.47%) compared to those whose infants did not have a NICU hospitalization. In adjusted analyses, compared to white women, all other race/ethnicities had significantly lower odds of receiving a maternal MH condition diagnosis [Black (aOR = 0.76, 0.73−0.08), Hispanic (aOR = 0.69, 0.67−0.72), and Asian (aOR: 0.32, 0.30−0.34)], despite higher rates of NICU hospitalization. These findings suggest a need to target the NICU to improve maternal MH screening, services, and support while acknowledging the influence of social determinants, including race and ethnicity, on health outcomes.
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Affiliation(s)
- Dana C. Beck
- School of Nursing, University of California Los Angeles, Los Angeles, CA 90095, USA
| | - Karen M. Tabb
- School of Social Work, University of Illinois at Urbana-Champaign, Urbana, IL 68101, USA
| | - Anca Tilea
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI 48109, USA
| | - Stephanie V. Hall
- Department of Learning Health Sciences, University of Michigan Medical School, Ann Arbor, MI 48109, USA
- Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI 48109, USA
| | - Ashlee Vance
- Center for Health Policy and Health Services Research, Henry Ford Health, Detroit, MI 48202, USA
| | - Stephen W. Patrick
- Department of Health Policy, Vanderbilt University Medical Center, Nashville, TN 37232, USA
- Vanderbilt Center for Child Health Policy, Vanderbilt University Medical Center, Nashville, TN 37232, USA
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN 37232, USA
- Mildred Stahlman, Division of Neonatology, Vanderbilt University Medical Center, Nashville, TN 37232, USA
| | - Amy Schroeder
- Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI 48109, USA
| | - Kara Zivin
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI 48109, USA
- Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI 48109, USA
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI 48109, USA
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21
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Training and professional development needs of consultation line perinatal psychiatrists. Gen Hosp Psychiatry 2022; 78:130-132. [PMID: 35501177 DOI: 10.1016/j.genhosppsych.2022.04.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Accepted: 04/19/2022] [Indexed: 11/23/2022]
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22
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Abstract
PURPOSE OF REVIEW As maternal mortality climbs in the USA with mental health conditions driving these preventable deaths, the field of reproductive psychiatry must shift towards identification of women and other birthing individuals at risk and facilitating access. This review brings together recent studies regarding risk of perinatal depression and highlights important comorbidities that place individuals at higher vulnerability to poor perinatal outcomes. RECENT FINDINGS Recent research suggests that identifying risk for perinatal depression including historical diagnoses of depression, anxiety, trauma, and comorbid substance use and intimate partner violence may move the field to focus on preventive care in peripartum populations. Emerging data shows stark health inequities in racial and ethnic minority populations historically marginalized by the health system and in other vulnerable groups such as LGBTQ+ individuals and those with severe mental illness. Innovative models of care using systems-level approaches can provide opportunities for identification and risk analyses of vulnerable peripartum patients and facilitate access to therapeutic or preventive interventions. Utilizing intergenerational approaches and leveraging multidisciplinary teams that thoughtfully target high-risk women and other birthing individuals could promote significant changes to population-level care in maternal health.
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23
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Ponting C, Urizar GG, Dunkel Schetter C. Psychological Interventions for Prenatal Anxiety in Latinas and Black Women: A Scoping Review and Recommendations. Front Psychiatry 2022; 13:820343. [PMID: 35370831 PMCID: PMC8965279 DOI: 10.3389/fpsyt.2022.820343] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 02/03/2022] [Indexed: 12/02/2022] Open
Abstract
Anxiety symptoms are common among pregnant women worldwide. In the United States, prenatal anxiety symptoms tend to be elevated among Black and Latin American women as compared to non-Latina White women. Despite the high prevalence of anxiety and associations with adverse maternal and offspring outcomes, interventions have not been developed or tailored sufficiently to Black women or Latinas who need efficacious treatment. This article provides a scoping review of articles published since 2017 that test the effects of randomized and non-randomized psychological interventions designed to reduce prenatal anxiety in samples comprised primarily of ethnic/racial minority women. We also review published protocols of planned psychological interventions to reduce prenatal anxiety in order to highlight novel approaches. In addition to summarizing intervention efficacy and participant acceptability, we highlight gaps in the literature which, if addressed, could improve perinatal mental health equity. Finally, we discuss future directions in prenatal anxiety intervention science beginning preconception including intervention design and prevention models.
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Affiliation(s)
- Carolyn Ponting
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA, United States.,Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, CA, United States
| | - Guido G Urizar
- Department of Psychology, California State University, Long Beach, Long Beach, CA, United States
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