How obstetric settings can help address gaps in psychiatric care for pregnant and postpartum women with bipolar disorder
Department of Psychiatry; Systems and Psychosocial Advances Research Center; Department of Obstetrics and Gynecology; Department of Family Medicine and Community Health
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
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.
UMCCTS funding, Bipolar disorder, Obstetric, Perinatal, Postpartum, Pregnancy, Treatment
DOI of Published Version
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
Archives of women's mental health
Byatt, Nancy; Cox, Lucille; Moore Simas, Tiffany A.; Kini, Nisha; Biebel, Kathleen; Sankaran, Padma; Swartz, Holly A.; and Weinreb, Linda, "How obstetric settings can help address gaps in psychiatric care for pregnant and postpartum women with bipolar disorder" (2018). UMass Center for Clinical and Translational Science Supported Publications. 134.