How obstetric settings can help address gaps in psychiatric care for pregnant and postpartum women with bipolar disorder
Moore Simas, Tiffany A.
Swartz, Holly A.
UMass Chan AffiliationsDepartment of Family Medicine and Community Health
Department of Obstetrics and Gynecology
Systems and Psychosocial Advances Research Center
Department of Psychiatry
Document TypeJournal Article
Female Urogenital Diseases and Pregnancy Complications
Maternal and Child Health
Obstetrics and Gynecology
Psychiatric and Mental Health
Translational Medical Research
MetadataShow full item record
AbstractTo 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.
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
Permanent Link to this Itemhttp://hdl.handle.net/20.500.14038/50306