ABSTRACT
Women living with serious mental illness (SMI) are at increased risk for adverse pregnancy and parenting outcomes. However, little is known about the experiences and preferences of women with SMI related to addressing pregnancy and parenting with their mental health providers. We conducted semistructured interviews with twenty-two reproductive-age cisgender women patients living with SMI. Participants characterized discussions about pregnancy and medication teratogenicity with their mental health providers as limited or unsatisfactory. Participants' openness to discussing pregnancy varied by topic and its perceived relevance to their individual circumstances, and it hinged on participants' trust in their providers. Participants characterized discussions about parenting with their mental health providers as helpful and identified additional opportunities for parenting support. Our findings highlight critical gaps in the delivery of information, support, and resources that can inform efforts to increase providers' capacity to address pregnancy and parenting with women living with SMI.
Subject(s)
Mental Disorders , Pregnancy , Humans , Female , Mental Disorders/therapy , Mental Disorders/psychology , Mental Health , Parenting/psychology , TrustABSTRACT
To characterize co-occurring social determinants of health for clients experiencing perinatal anxiety and depression (perinatal mood and anxiety disorders) or serious mental illness (SMI) in a diverse population receiving prenatal care in a safety-net health system, we conducted a latent class analysis, using data from a social determinants screener in pregnancy for the health system's clients during 2017-20. The sample included clients with positive screens for depression or anxiety or SMI diagnoses. Prenatal clients with a positive screen for perinatal mood and anxiety disorders or SMI comprised 13-30 percent of classes, characterized by more than two co-occurring social determinants (for example, co-occurring socioeconomic and interpersonal factors). The study findings highlight the salience of social determinants among prenatal patients experiencing perinatal mood and anxiety disorder and SMI and suggest the necessity of consistent screening for both social determinants and perinatal mental health. Policies to address social determinants within and beyond health care settings are critical.
Subject(s)
Depressive Disorder , Pregnancy Complications , Pregnancy , Female , Humans , Depression/diagnosis , Depression/epidemiology , Depression/psychology , Social Determinants of Health , Pregnancy Complications/epidemiology , Anxiety/epidemiology , Anxiety/psychology , Anxiety DisordersABSTRACT
Perinatal mental health is gaining recognition as a key antecedent of adverse maternal and child outcomes as the United States experiences a maternal mortality and morbidity crisis. Recent policy efforts have attempted to mitigate adverse outcomes through legislation such as the Taskforce Recommending Improvements for Unaddressed Mental Perinatal and Postpartum Health (TRIUMPH) for New Moms Act of 2021 and postpartum coverage through Medicaid expansion. Even with progress, perinatal mental health policy continues to grapple with a basic truth: The United States lacks an overarching health care system capable of meeting the mental health care needs of perinatal people and their families.⯠Moreover, the burden of undiagnosed and untreated perinatal mental health challenges remains greatest among racially minoritized populations, such as Black, Asian, and multiracial people. A broader understanding of perinatal mental health is needed, grounded in the tenets of reproductive justice. From this perspective, we articulate specific policies to meet perinatal mental health challenges and promote thriving for birthing people and their families.
Subject(s)
Delivery of Health Care , Mental Health , Female , Humans , Pregnancy , Policy , Postpartum Period , United StatesABSTRACT
Perinatal mental health conditions are the most common complications of childbirth and have well-established enduring negative effects. Obstetric (Ob) clinicians care for patients with perinatal mental health conditions across a spectrum of acuity, severity, and complexity. Ob and psychiatric clinicians can collaborate to create a cohesive continuum of psychopharmacologic care for perinatal patients. This chapter provides an overall framework for Ob-psychiatric clinician collaboration with examples of innovation in care delivery.