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    How obstetric settings can help address gaps in psychiatric care for pregnant and postpartum women with bipolar disorder

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    Authors
    Byatt, Nancy
    Cox, Lucille
    Moore Simas, Tiffany A.
    Kini, Nisha
    Biebel, Kathleen
    Sankaran, Padma
    Swartz, Holly A.
    Weinreb, Linda
    UMass Chan Affiliations
    Department of Family Medicine and Community Health
    Department of Obstetrics and Gynecology
    Systems and Psychosocial Advances Research Center
    Department of Psychiatry
    Document Type
    Journal Article
    Publication Date
    2018-03-13
    Keywords
    UMCCTS funding
    Bipolar disorder
    Obstetric
    Perinatal
    Postpartum
    Pregnancy
    Treatment
    Female Urogenital Diseases and Pregnancy Complications
    Maternal and Child Health
    Mental Disorders
    Obstetrics and Gynecology
    Psychiatric and Mental Health
    Translational Medical Research
    Women's Health
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    Link to Full Text
    https://doi.org/10.1007/s00737-018-0825-2
    Abstract
    To elucidate (1) the challenges associated with under-recognition of bipolar disorder in obstetric settings, (2) barriers pregnant and postpartum women with bipolar disorder face when trying to access psychiatric care, and (3) how obstetric settings can identify such women and connect them with mental health services. Structured, in-depth interviews were conducted with 25 pregnant and postpartum women recruited from obstetric practices who scored > /= 10 on the Edinburgh Postnatal Depression Scale and met DSM-IV criteria for bipolar disorder I, II, or not otherwise specified using the Mini International Neuropsychiatric Interview. Quantitative analyses included descriptive statistics. Interviews were transcribed, and resulting data were analyzed using a grounded theory approach. Most participants (n = 19, 79.17%) did not have a clinical diagnosis of bipolar disorder documented in their medical records nor had received referral for treatment during pregnancy (n = 15, 60%). Of participants receiving pharmacotherapy (n = 14, 58.33%), most were treated with an antidepressant alone (n = 10, 71.42%). Most medication was prescribed by an obstetric (n = 4, 28.57%) or primary care provider (n = 7, 50%). Qualitative interviews indicated that participants want their obstetric practices to proactively screen for, discuss and help them obtain mental health treatment. Women face challenges in securing mental health treatment appropriate to their bipolar illness. Obstetric providers provide the bulk of medical care for these women and need supports in place to (1) better recognize bipolar disorder, (2) avoid inappropriate prescribing practices for women with undiagnosed bipolar disorder, and (3) ensure women are referred to specialized treatment when needed.
    Source

    Arch Womens Ment Health. 2018 Mar 13. doi: 10.1007/s00737-018-0825-2. [Epub ahead of print]. Link to article on publisher's site

    DOI
    10.1007/s00737-018-0825-2
    Permanent Link to this Item
    http://hdl.handle.net/20.500.14038/50306
    PubMed ID
    29536256
    Related Resources

    Link to Article in PubMed

    ae974a485f413a2113503eed53cd6c53
    10.1007/s00737-018-0825-2
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