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Purpose: Research about academic medicine women faculty has focused on comparisons of men and women or specific groups who achieved leadership. To better understand the low percentages of women in academic medicine leadership, attention should be paid to the career continuum within genders. Study findings will inform policies and programs to support women in building careers and acquiring leadership positions. Materials and Methods: Association of American Medical Colleges (AAMC) StandPoint Faculty Engagement Survey data are used to describe and compare women assistant, associate and full professors' perceptions of (1) career development and advancement opportunities, and (2) a culture and climate that fosters diversity, equity, and inclusion. Specific similarities and differences with men are highlighted. Results: Fifty-nine percent of women respondents were assistant, 25% associate, and 16% full professors. Associate professors of both genders were the least satisfied on the main measures. Women were less satisfied than men at each career stage across the majority of variables. Among women, fewer than half of full and associate professors, and 52% of assistant professors believe they can express their opinions without fear of retribution. While the majority at all ranks (69%-75%) report feeling respected in the workplace, among those who did not, the highest percentage of disrespect based on gender was among associate professors. Conclusions: The perceptions of >7,500 academic medicine women faculty, representing different generations and ranks, underscore the need to broadly address gender inequity and sexism throughout the career continuum. It identifies the mid-career stage as a challenging experience for both men and women. Women, especially at the associate professor rank, remain a critically dissatisfied and underresourced group that is at risk for underutilization and potentially exit from academic medicine. All ranks of women need career development and equitable policies to support their sense of belonging and career advancement.
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Medicina , Médicos Mujeres , Humanos , Masculino , Femenino , Estados Unidos , Movilidad Laboral , Docentes Médicos , Sexismo , Liderazgo , Satisfacción PersonalRESUMEN
Introduction: Medical mis- and disinformation are on the rise and impact patient health outcomes. The complexity of modern medicine and health care delivery necessitates that care be delivered by an interprofessional team of providers well versed in addressing this increased prevalence of medical misinformation. Health professions educational curricula often lack opportunities for students to learn how to address medical misinformation, employ advanced communication techniques, and work collaboratively. Methods: Based on literature and our previous qualitative research, we created a module offering prework learning on COVID-19 and addressing misinformation through advanced communication techniques and interprofessional collaboration. After completing prework, students participated in a standardized patient encounter addressing COVID misinformation. Health professions student dyads completed a preencounter planning huddle and together interviewed a standardized patient. Students received global and checklist-based feedback from standardized patients and completed pre- and postsession self-assessments. Results: Twenty students participated (10 third-year medical, nine third-year pharmacy, one fourth-year pharmacy). Key findings included the following: Nine of 15 survey questions demonstrated statistically significant improvement, including all three questions assessing readiness to have difficult conversations and six of 10 questions assessing interprofessional collaboration and team function. Discussion: Students participating in this novel curriculum advanced their readiness to address medical misinformation, including COVID-19 vaccine disinformation, with patients and coworkers to improve health decision-making and patient care. These curricular methods can be customized for use with a range of health professions learners.
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COVID-19 , Comunicación , Curriculum , SARS-CoV-2 , Humanos , COVID-19/prevención & control , Educación Interprofesional/métodos , Relaciones Interprofesionales , Conducta Cooperativa , Simulación de PacienteRESUMEN
Academic medicine is evolving from the traditional model of a medical school and teaching hospital owned by the same entity to one with complex academic medical centers and health systems. This increased complexity is evident not only in the funding streams and organizational priorities of these growing health systems but also in the evolution of leadership roles toward more matrixed positions and more individuals who hold both medical school and health system roles. Given this changing landscape, the authors of this commentary raise the following questions: Will the levers of power remain in the hands of those in traditional academic roles? Or are they moving toward those in roles that are more aligned with the clinical enterprise and health system? Then, if this shift is occurring, what is needed to prepare women to be competitive candidates for these new roles? Because of the long history of and current gender imbalance in academic leadership roles, professional development programs have traditionally focused on preparing women to advance through the faculty ranks and for department chair and decanal roles. With the shift to more complicated health systems, the definitions, responsibilities, and types of leadership roles in academic medicine are also evolving to include nontraditional academic positions in the health system, such as c-suite and other senior executive roles. In parallel to the gender inequities in traditional roles, women are also underrepresented in health system leadership roles. Therefore, it is critical to explicitly identify emerging roles in health care leadership, address systemic barriers, and actively train and prepare women with the knowledge, skills, and experience required for these positions. Only with consistent attention to outcomes and the implementation of intentional systems to engage, prepare, and advance women will the gender gap be closed.
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Liderazgo , Médicos Mujeres , Humanos , Femenino , Masculino , Docentes , Centros Médicos Académicos , Facultades de Medicina , Atención a la Salud , Docentes MédicosRESUMEN
BACKGROUND: A notable portion (21%) of female patients receiving treatment for depression in community mental health centers (CMHC) has childhood sexual abuse (CSA) histories. Treatment outcomes in this population are heterogeneous; identifying factors associated with differential outcomes could inform treatment development. This exploratory study begins to address the gap in what is known about predictors of treatment outcomes among depressed women with sexual abuse histories. METHOD: Seventy women with major depressive disorder and CSA histories in a CMHC were randomly assigned to interpersonal psychotherapy (n = 37) or usual care (n = 33). Using generalized estimating equations, we examined four pretreatment predictor domains (i.e. sociodemographic characteristics, clinical features, social and physical functioning, and trauma features) potentially related to depression treatment outcomes. RESULTS: Among sociodemographic characteristics, Black race/ethnicity, public assistance income, and unemployment were associated with less depressive symptom reduction over the course of treatment. Two clinical features, chronic depression and borderline personality disorder, were also related to less reduction in depressive symptoms across the treatment period. CONCLUSION: Our results demonstrate the clinical relevance of attending to predictors of depressed women with CSA histories being treated in public sector mental health centers. Particular sociodemographic characteristics and clinical features among these women may be significant indicators of risk for relatively poorer treatment outcomes.
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Abuso Sexual Infantil/psicología , Trastorno Depresivo Mayor/psicología , Trastorno Depresivo Mayor/terapia , Psicoterapia/métodos , Adulto , Trastorno de Personalidad Limítrofe/complicaciones , Trastorno de Personalidad Limítrofe/psicología , Niño , Enfermedad Crónica , Trastorno Depresivo Mayor/complicaciones , Empleo/psicología , Empleo/estadística & datos numéricos , Etnicidad/psicología , Etnicidad/estadística & datos numéricos , Femenino , Estado de Salud , Humanos , Relaciones Interpersonales , Matrimonio/psicología , Pobreza/psicología , Pobreza/estadística & datos numéricos , Escalas de Valoración Psiquiátrica/estadística & datos numéricos , Grupos Raciales/psicología , Grupos Raciales/estadística & datos numéricos , Conducta Social , Factores Socioeconómicos , Trastornos por Estrés Postraumático/complicaciones , Trastornos por Estrés Postraumático/psicología , Resultado del TratamientoRESUMEN
Background: A gender gap in leadership exists in academic medicine. Medical school faculty rosters indicate an overrepresentation of women in entry-level positions. As positions increase in seniority and leadership responsibilities, there is an underrepresentation of women. The reasons for this discrepancy are not fully understood, but the mid-career transition is one career point that some scholars hypothesize is part of the leaky pipeline. The University of Rochester Medical Center developed a career development program (CDP) to focus on this pivotal career developmental time period. We assessed the impact of the CDP on self-assessed knowledge, competence, self-identified goals, and promotions. Materials and Methods: Four cohorts of mid-career women completed preself-assessment and postself-assessment and ranked their current knowledge and competence on 11 topics grouped into 3 career development domains. They identified three personal goals and ranked their success in achieving them at the end of the program. Facilitators followed participants annually for promotions and accomplishments. Results: Fifty-one participants reported statistically significant improvements in knowledge and competency in all domains-promotional, organizational infrastructure, and communication. They identified 148 individual goals that we grouped into 4 categories: career development (32%), leadership (26%), networking (22%), and negotiation (20%), and the majority achieved their individual goals. Upon the last review, 23.5% of women were promoted or received tenure. Conclusions: A CDP targeting the needs of mid-career women faculty in academic medicine improved knowledge and competency in multiple domains. Longitudinal data and comparison to nonparticipants are needed to fully understand its impact.
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Movilidad Laboral , Desarrollo de Personal , Centros Médicos Académicos , Docentes Médicos , Femenino , Humanos , Liderazgo , Desarrollo de ProgramaRESUMEN
OBJECTIVES: Estimates of depression prevalence in pregnancy and postpartum are based on the Edinburgh Postnatal Depression Scale (EPDS) more than on any other method. We aimed to determine if any EPDS cutoff can accurately and consistently estimate depression prevalence in individual studies. METHODS: We analyzed datasets that compared EPDS scores to Structured Clinical Interview for DSM (SCID) major depression status. Random-effects meta-analysis was used to compare prevalence with EPDS cutoffs versus the SCID. RESULTS: Seven thousand three hundred and fifteen participants (1017 SCID major depression) from 29 primary studies were included. For EPDS cutoffs used to estimate prevalence in recent studies (≥9 to ≥14), pooled prevalence estimates ranged from 27.8% (95% CI: 22.0%-34.5%) for EPDS ≥ 9 to 9.0% (95% CI: 6.8%-11.9%) for EPDS ≥ 14; pooled SCID major depression prevalence was 9.0% (95% CI: 6.5%-12.3%). EPDS ≥14 provided pooled prevalence closest to SCID-based prevalence but differed from SCID prevalence in individual studies by a mean absolute difference of 5.1% (95% prediction interval: -13.7%, 12.3%). CONCLUSION: EPDS ≥14 approximated SCID-based prevalence overall, but considerable heterogeneity in individual studies is a barrier to using it for prevalence estimation.
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Depresión Posparto , Trastorno Depresivo Mayor , Depresión , Trastorno Depresivo Mayor/diagnóstico , Trastorno Depresivo Mayor/epidemiología , Femenino , Humanos , Embarazo , Prevalencia , Escalas de Valoración PsiquiátricaRESUMEN
This study aims to describe the phenomenology of obsessive-compulsive symptoms (OCS) and disorders (OCD) in perinatal women and to explore the relationship of OCS/OCD to postpartum depression. A prospective longitudinal study of 44 women screened with the Obsessive-Compulsive Inventory-Revised (OCI-R) and Edinburgh Postnatal Depression Scale (EPDS) between 30 and 37 weeks of pregnancy. Twenty-four women completed a diagnostic interview and the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) before delivery and were contacted postpartum to repeat the EPDS and Y-BOCS. In the third trimester, 32% reported high levels of anxiety and/or depressive symptoms (EPDS ≥ 10 and/or OCI-R ≥ 15) and 29% of those who completed the diagnostic interview met criteria for OCD. At 1 month postpartum, 12.5% had new OCS (Y-BOCS ≥ 8) and 25% had new high levels of depressive symptoms (EPDS ≥ 10). OCS increased in intensity postpartum but did not change in character. OCD and OCS may be of greater prevalence during the perinatal period than previously recognized. The high rates provide new information and require replication in larger, more diverse populations. Research in the perinatal period must expand beyond the exploration of depression to include anxiety disorders and specifically OCD.
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Depresión Posparto , Trastorno Obsesivo Compulsivo , Periodo Posparto/psicología , Complicaciones del Embarazo , Tercer Trimestre del Embarazo/psicología , Adolescente , Adulto , Comorbilidad , Depresión Posparto/epidemiología , Depresión Posparto/psicología , Manual Diagnóstico y Estadístico de los Trastornos Mentales , Escolaridad , Etnicidad , Femenino , Humanos , Estado Civil , Tamizaje Masivo/instrumentación , Trastorno Obsesivo Compulsivo/epidemiología , Trastorno Obsesivo Compulsivo/psicología , Proyectos Piloto , Embarazo , Complicaciones del Embarazo/psicología , Prevalencia , Estudios Prospectivos , Escalas de Valoración Psiquiátrica , Factores Socioeconómicos , Encuestas y CuestionariosRESUMEN
OBJECTIVE: Resident physicians have an important role in medical student teaching. There has been limited curriculum development in this area for general psychiatric residents. A 4-hour workshop for PGY-2 psychiatric residents was designed and implemented to improve residents' self-assessment of their knowledge of the medical student curriculum and core teaching skills. METHODS: Residents completed pre- and postcourse self-assessments of their knowledge, skills, attitudes, and values about teaching. Descriptive statistics were obtained on pre- and postcourse data and were analyzed using t tests assuming unequal variance. RESULTS: Following course participation, there was statistically significant improvement in residents' self-assessment of their knowledge of the medical student curriculum (p ≤ 0.001), their self-assessment regarding perception of peers' view of their teaching ability (p ≤ 0.02), and their perceived knowledge of various teaching methods (p ≤ 0.02). CONCLUSION: Our findings suggest that a brief workshop may enhance psychiatric residents' self-assessment of teaching knowledge and skills.
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Internado y Residencia , Competencia Profesional/normas , Psiquiatría/educación , Educación de Postgrado en Medicina/organización & administración , Humanos , Internado y Residencia/normas , Proyectos Piloto , Psiquiatría/métodos , Autoeficacia , Desarrollo de Personal/métodos , Encuestas y Cuestionarios , Enseñanza/normas , Recursos HumanosRESUMEN
OBJECTIVES: A previous individual participant data meta-analysis (IPDMA) identified differences in major depression classification rates between different diagnostic interviews, controlling for depressive symptoms on the basis of the Patient Health Questionnaire-9. We aimed to determine whether similar results would be seen in a different population, using studies that administered the Edinburgh Postnatal Depression Scale (EPDS) in pregnancy or postpartum. METHODS: Data accrued for an EPDS diagnostic accuracy IPDMA were analysed. Binomial generalised linear mixed models were fit to compare depression classification odds for the Mini International Neuropsychiatric Interview (MINI), Composite International Diagnostic Interview (CIDI), and Structured Clinical Interview for DSM (SCID), controlling for EPDS scores and participant characteristics. RESULTS: Among fully structured interviews, the MINI (15 studies, 2,532 participants, 342 major depression cases) classified depression more often than the CIDI (3 studies, 2,948 participants, 194 major depression cases; adjusted odds ratio [aOR] = 3.72, 95% confidence interval [CI] [1.21, 11.43]). Compared with the semistructured SCID (28 studies, 7,403 participants, 1,027 major depression cases), odds with the CIDI (interaction aOR = 0.88, 95% CI [0.85, 0.92]) and MINI (interaction aOR = 0.95, 95% CI [0.92, 0.99]) increased less as EPDS scores increased. CONCLUSION: Different interviews may not classify major depression equivalently.
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Trastorno Depresivo Mayor/diagnóstico , Entrevista Psicológica/normas , Complicaciones del Embarazo/diagnóstico , Escalas de Valoración Psiquiátrica/normas , Adulto , Depresión Posparto/diagnóstico , Femenino , Humanos , EmbarazoRESUMEN
Pediatric residency reforms have increased emphasis on psychosocial issues, but we do not know whether this has changed pediatricians' perceptions of barriers to addressing maternal depression. A survey of 1600 members of the American Academy of Pediatrics investigated whether training in adult mental health issues and perceived barriers to addressing maternal depression differed for current pediatric residents, pediatricians in practice <5 years, and those in practice >or=5 years. Training did not differ for respondents who were currently in training, in practice <5 years, or in practice >or=5 years. Those in practice >or=5 years reported more barriers to addressing maternal depression compared with current residents. Current residents with training in adult mental techniques reported fewer barriers to the care of maternal depression. However, in spite of residency reforms, 81% of current residents reported no training in adult mental health issues.
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Depresión/diagnóstico , Internado y Residencia , Madres/psicología , Pediatría/educación , Adulto , Competencia Clínica , Becas/estadística & datos numéricos , Femenino , Encuestas de Atención de la Salud , Humanos , Internado y Residencia/estadística & datos numéricos , Modelos Lineales , Masculino , Salud Mental , Estados UnidosRESUMEN
BACKGROUND: Women with depression and childhood sexual abuse histories constitute more than 20% of the female patient population in publicly funded community mental health centers (CMHCs). Interventions are needed that address depression and posttraumatic stress disorder (PTSD) symptoms and social health. METHOD: We compared Interpersonal Psychotherapy-Trauma (IPT-T), an IPT adaptation for this population and setting, to Clinic Psychotherapy (CP). CP clinicians were free to implement the psychotherapy of choice. Women (n = 162; 54% White, 10.5% Hispanic; 52.2% Medicaid-insured) with a major depressive episode (MDE) and history of sexual abuse before 18 were randomly assigned to IPT-T or CP. Participants were offered 16 free sessions of IPT-T or CP. Outcomes were MDE remission, improved depression (Beck Depression Inventory, Hamilton Depression Rating Scale) and PTSD symptoms (Modified PTSD Symptom Scale), and improved social health (e.g., UCLA Loneliness Scale). Weighted generalized estimating equations were used to examine outcomes at 8 (primary) and 20 (secondary) months postrandomization. RESULTS: IPT-T led to greater improvements in PTSD symptoms and many social health indicators, including loneliness and social support, at both 8- and 20-month follow-up. Effect sizes ranged from .18 to .39 at the primary endpoint (8 months). IPT-T and CP yielded comparable improvements in depression symptoms and MDE remission. CONCLUSION: Evidence-based psychotherapies like IPT-T are needed in CMHCs, where some of the most vulnerable patients receive treatment. With comparable findings for depression, IPT's superior improvements in social health and PTSD symptoms are cause for optimism. IPT-T should be evaluated in dissemination trials. (PsycINFO Database Record (c) 2018 APA, all rights reserved).
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Adultos Sobrevivientes del Maltrato a los Niños/psicología , Trastorno Depresivo Mayor/terapia , Relaciones Interpersonales , Psicoterapia/métodos , Delitos Sexuales/psicología , Trastornos por Estrés Postraumático/terapia , Adulto , Femenino , Humanos , Persona de Mediana Edad , Resultado del TratamientoRESUMEN
OBJECTIVE: Resident mental health (MH) problems can be associated with reduced empathy and increased medical errors. The Accreditation Council for Graduate Medical Education mandates resident MH support services, but it is unknown if these services are accessible and meet resident needs. We sought to describe the prevalence of anxiety and depression in current pediatric residents in New York State (NYS), and their self-reported use of and barriers to support services. METHODS: We developed an online survey and distributed it to all categorical pediatric residents in 9 NYS programs. Items addressing self-concern for clinical anxiety and depression and use of MH services were pilot tested for content and construct validity. The validated Patient Health Questionnaire-2 (PHQ-2) measured depressive symptoms. Analyses used descriptive and chi-square tests. RESULTS: Respondents included 227 residents (54% response rate) distributed across training levels and programs. Many reported "often" or "almost always" feeling stress (52%), physical exhaustion (41%), and mental exhaustion (35%); 11% had PHQ-2-defined depressive symptoms. Some thought that their stress levels raised concern for clinical depression (25%) or anxiety (28%); among these, only 44% and 39%, respectively, had sought care. More women reported physical exhaustion (P < .05). Only 45% of residents reported educational offerings on resident MH; 66% wanted to know more about available resources. Barriers to receipt of services included inflexible schedules (82%), guilt about burdening colleagues (65%), fear of confidentiality breach (46%), and difficulty identifying services (44%). CONCLUSIONS: Pediatric residents frequently experience MH symptoms, but many do not know about or use support services. Programs should enhance MH support by overcoming barriers and increasing resident awareness of services.
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Trastornos de Ansiedad/psicología , Trastorno Depresivo/psicología , Accesibilidad a los Servicios de Salud , Internado y Residencia , Fatiga Mental/psicología , Servicios de Salud Mental , Pediatría/educación , Estrés Psicológico/psicología , Adulto , Confidencialidad , Depresión/psicología , Emociones , Fatiga , Femenino , Humanos , Masculino , Salud Mental , New York , Apoyo SocialRESUMEN
OBJECTIVE: To describe the incidence, continuation, and resolution of symptoms during the postpartum year in urban women experiencing high depressive symptom levels at one or more well child care visits. METHODS: As part of a prior study of postpartum depressive symptoms, demographic data and the Edinburgh Postnatal Depression Scale (EPDS) were systematically collected from pediatric records of a clinic that routinely screens mothers with the EPDS at each first-year well child care visit. To explore the course of depressive symptoms throughout the postpartum year in this pilot study, we included only data from the records that had at least one EPDS > or = 10 (N = 100), a score indicating a high likelihood for clinically significant depressive symptoms. RESULTS: Among 49 women who completed the EPDS at least once before 3 months and between 3 and 11 months postpartum, 33% had high symptom levels throughout the year, 41% improved after the first 3 months, and 26% developed high symptom levels after the first 3 months. CONCLUSIONS: Postpartum depressive symptoms persist in many women throughout the postpartum year. Routine screening throughout the year might better identify both a subgroup of women who develop new symptoms during the year, as well as the women whose symptoms persist.
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Servicios de Salud del Niño , Depresión Posparto/diagnóstico , Madres/psicología , Adulto , Depresión Posparto/epidemiología , Pruebas Diagnósticas de Rutina , Femenino , Humanos , Incidencia , Lactante , Proyectos Piloto , Estudios RetrospectivosRESUMEN
BACKGROUND: Maternal depression can have significant repercussions for the health and well-being of mothers and children. In primarily white middle-income populations, approximately 15% of mothers experience depression. Among ethnically and socioeconomically diverse populations, the prevalence of maternal depression has not been as well established. However, the highest rates have been observed among low-income women. Because information about minority, underserved women is particularly sparse, we utilize data from the San Mateo County, California, Prenatal to Three project to describe the prevalence and self-recognition of depressive symptoms among low-income Hispanic mothers of infants and toddlers. METHOD: Telephone interviews of a random sample of women who received Medicaid and gave birth in San Mateo County provided our sample of 218 nonpregnant Hispanic mothers. High levels of depressive symptoms were defined as a score of > or =10 on the Edinburgh Postnatal Depression Scale (EPDS). We performed descriptive analyses and analyses of variance. RESULTS: Twenty-three percent of mothers reported high levels of depressive symptoms. Half of them recognized a need for help with depression. CONCLUSIONS: High levels of maternal depressive symptoms were prevalent among the Hispanic women on Medicaid, but only half of the women experiencing these symptoms identified themselves as needing help with depression.
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Trastorno Depresivo/epidemiología , Hispánicos o Latinos/psicología , Madres/psicología , Pobreza/estadística & datos numéricos , Adolescente , Adulto , California/epidemiología , Trastorno Depresivo/diagnóstico , Trastorno Depresivo/psicología , Escolaridad , Femenino , Estado de Salud , Encuestas Epidemiológicas , Hispánicos o Latinos/estadística & datos numéricos , Humanos , Entrevistas como Asunto , Estado Civil , Madres/estadística & datos numéricos , Paridad , Inventario de Personalidad , Pobreza/psicología , Prevalencia , Factores de Riesgo , Encuestas y CuestionariosRESUMEN
BACKGROUND: One quarter of mothers of young children experience high levels of depressive symptoms, and only half are identified by themselves or their providers. Little is known about what factors influence maternal and provider recognition of depression. We use data from the San Mateo County, California, Prenatal to Three project to explore self-recognition, provider response, and referral among low-income Hispanic mothers of infants and toddlers. The goals are (1) to describe the patterns of self-recognition of maternal depression, maternal reporting of health professional response, and referrals for mental health services as related to depression severity and (2) to identify determinants of self-recognition, provider response, and mental health referrals. METHODS: Our sample consists of 218 nonpregnant Hispanic mothers in San Mateo County. Self-recognition was defined as an affirmative answer to the question, "Have you thought that you needed help with sadness or depression since your child was born?" High depressive symptoms were defined as a score of > or =10 on the Edinburgh Postnatal Depression Scale (EPDS). We performed chi-square and logistic regression analyses. RESULTS: Twenty-eight percent responded that they needed help with depression since the birth of their baby. Less than half discussed depressive feelings with their provider. Depression recognition factors differed between mothers and health professionals. CONCLUSIONS: Maternal depression is prevalent among Hispanic women on Medicaid but is not readily detected by women or providers. Women and providers use different cues to identify depression, possibly leading to communication discrepancies. Further research on the factors that influence self-recognition and provider recognition of maternal depression is needed.
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Actitud Frente a la Salud , Depresión Posparto/diagnóstico , Hispánicos o Latinos/psicología , Madres/psicología , Pobreza , Adolescente , Adulto , California/epidemiología , Distribución de Chi-Cuadrado , Depresión/diagnóstico , Depresión Posparto/epidemiología , Depresión Posparto/psicología , Femenino , Hispánicos o Latinos/estadística & datos numéricos , Humanos , Modelos Logísticos , Centros de Salud Materno-Infantil/normas , Madres/estadística & datos numéricos , Responsabilidad Parental/psicología , Encuestas y CuestionariosRESUMEN
BACKGROUND: The evidence for a spectrum of bipolar disorders is mounting. Of particular interest and importance is the evolution and recurrence of bipolar disorder in the postpartum period and its relationship to postpartum psychosis. Understanding whether such a phenomenological link exists has diagnostic, prognostic, and treatment implications. OBJECTIVES: A comprehensive review of (1) the literature regarding the relationships between postpartum psychosis and bipolar affective disorder, (2) the data regarding prophylactic treatment and acute management of postpartum psychosis and bipolar disorder in the puerperium, and (3) critical areas for future research. STUDY DESIGN: MEDLINE and PubMed (1966-2002) databases were searched for English-language articles using the keywords postpartum/puerperal depression, puerperal/postpartum psychosis, bipolar disorder, lithium, anticonvulsants, antipsychotics, and breastfeeding. RESULTS: Evidence from studies of women with a history of bipolar disorder, longitudinal studies of women with puerperal episodes of psychosis, and family studies support a link between postpartum psychosis and bipolar disorder. CONCLUSIONS: Understanding the relationship between postpartum psychosis and bipolar disorder has implications for perinatal and long-term treatment. Prophylactic treatment of women with bipolar disorder and/or a history of postpartum psychosis may be indicated. Epidemiological, genetic, and pharmacologic research must be completed to understand, prevent, and adequately treat postpartum psychosis.
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Antipsicóticos/uso terapéutico , Trastorno Bipolar/fisiopatología , Trastorno Bipolar/psicología , Periodo Posparto/psicología , Trastornos Psicóticos/fisiopatología , Trastornos Psicóticos/psicología , Adulto , Trastorno Bipolar/tratamiento farmacológico , Diagnóstico Diferencial , Femenino , Humanos , Estudios Longitudinales , Linaje , Embarazo , Pronóstico , Trastornos Psicóticos/tratamiento farmacológicoRESUMEN
The treatment of depression during pregnancy can be challenging for patients and providers alike. An increasing attention to perinatal mood disorders has led to an expanding literature that is often difficult for providers to navigate. It can be a challenge for providers to feel comfortable reviewing the broad scope of the risks and benefits of treatments in the context of the limitations of the literature. Women who are depressed during pregnancy have been found to have an elevated risk of poor obstetrical outcomes, although studies of the relationship between depression and outcomes are limited. Women who are treated with antidepressants during pregnancy are also at risk for a host of poor obstetrical and fetal outcomes. The risks for these outcomes are often confused by confounding factors and study design limitations. Understanding the current data and their limitations will allow providers to guide their patients in choosing treatment options. Consistent and simple strategies should be used when discussing the risk-benefit analysis with the patient.
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Anomalías Inducidas por Medicamentos/etiología , Anomalías Inducidas por Medicamentos/prevención & control , Antidepresivos/efectos adversos , Antidepresivos/uso terapéutico , Trastorno Depresivo Mayor/tratamiento farmacológico , Trastorno Depresivo/tratamiento farmacológico , Complicaciones del Embarazo/tratamiento farmacológico , Resultado del Embarazo , Adulto , Terapia Combinada , Trastorno Depresivo/diagnóstico , Trastorno Depresivo/psicología , Trastorno Depresivo Mayor/diagnóstico , Trastorno Depresivo Mayor/psicología , Relación Dosis-Respuesta a Droga , Femenino , Humanos , Recién Nacido , Embarazo , Complicaciones del Embarazo/diagnóstico , Complicaciones del Embarazo/psicología , Psicoterapia , Recurrencia , Medición de Riesgo , Sertralina/efectos adversos , Sertralina/uso terapéuticoRESUMEN
BACKGROUND: Scant literature exists on whether prior pregnancy loss (miscarriage, stillbirth, and/or induced abortion) increases the risk of postpartum psychiatric disorders-specifically depression and anxiety-after subsequent births. This study compares: (1) risk factors for depression and/or anxiety disorders in the postpartum year among women with and without prior pregnancy loss; and (2) rates of these disorders in women with one versus multiple pregnancy losses. METHODS: One-hundred-ninety-two women recruited at first-year pediatric well-child care visits from an urban pediatric clinic provided demographic information, reproductive and health histories. They also completed depression screening tools and a standard semi-structured psychiatric diagnostic interview. RESULTS: Almost half of the participants (49%) reported a previous pregnancy loss (miscarriage, stillbirth, or induced abortion). More than half of those with a history of pregnancy loss reported more than one loss (52%). Women with prior pregnancy loss were more likely to be diagnosed with major depression (p=0.002) than women without a history of loss. Women with multiple losses were more likely to be diagnosed with major depression (p=0.047) and/or post-traumatic stress disorder (Fisher's exact [FET]=0.028) than women with a history of one pregnancy loss. Loss type was not related to depression, although number of losses was related to the presence of depression and anxiety. CONCLUSIONS: Low-income urban mothers have high rates of pregnancy loss and often have experienced more than one loss and/or more than one type of loss. Women with a history of pregnancy loss are at increased risk for depression and anxiety, including post-traumatic stress disorder (PTSD), after the birth of a child. Future research is needed to understand the reasons that previous pregnancy loss is associated with subsequent postpartum depression and anxiety among this population of women.