Satisfaction of Women Faculty in Academic Medicine.

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.

Power Reimagined: Advancing Women Into Emerging Leadership Positions.

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.

Meeting the Needs of Mid-Career Women in Academic Medicine: One Model Career Development Program.

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.

Depression prevalence based on the Edinburgh Postnatal Depression Scale compared to Structured Clinical Interview for DSM DIsorders classification: Systematic review and individual participant data meta-analysis.

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.

Comparison of major depression diagnostic classification probability using the SCID, CIDI, and MINI diagnostic interviews among women in pregnancy or postpartum: An individual participant data meta-analysis.

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.

Effectiveness of interpersonal psychotherapy-trauma for depressed women with childhood abuse histories.

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).

Availability of Emotional Support and Mental Health Care for Pediatric Residents.

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.

Increased risk for postpartum psychiatric disorders among women with past pregnancy loss.

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.

Complex challenges in treating depression during pregnancy.

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.

Predictors of treatment outcomes among depressed women with childhood sexual abuse histories.

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.

Co-occurring intimate partner violence and mental health diagnoses in perinatal women.

OBJECTIVES: To describe the co-occurrence of intimate partner violence (IPV) and mental health burden among perinatal mothers attending well-baby visits with their infants in the first year of life. We compare rates of depression, anxiety disorder, and substance abuse diagnoses between mothers who reported IPV within the past year to those who did not. METHODS: This cross-sectional study of 188 mothers of infants (under 14 months) was conducted in an urban hospital pediatric clinic. Participants reported demographics and IPV and completed a semistructured psychiatric diagnostic interview. RESULTS: Mothers reporting IPV were more likely to be diagnosed with mood and/or anxiety diagnoses (p<0.05, Fisher's exact test), specifically current depressive diagnoses (p<0.01, Fisher's exact test) and panic disorder (p<0.05, Fisher's exact test). There was a trend for more posttraumatic stress disorder (PTSD) (p<0.06) among abused mothers. Substance abuse and dependence, age, race, insurance status, employment, education, and family arrangements did not differ between groups. Prior major or minor depression increases the odds for perinatal depression threefold (OD 3.18). CONCLUSION: These findings have implications for practitioners who encounter perinatal women. Findings suggest providers should explore signs and symptoms of depression and anxiety disorders among women reporting IPV. Similarly, when perinatal mothers report symptoms of depression, PTSD, or panic disorder, practitioners should be alert to the possible contributory role of IPV.

A randomized effectiveness trial of interpersonal psychotherapy for depressed women with sexual abuse histories.

OBJECTIVES: Many depressed women seen in community mental health centers (CMHCs) have histories of childhood sexual abuse and are economically disadvantaged. Randomized trials are needed to test the effectiveness of evidence-based interventions in this population and setting. This study compared interpersonal psychotherapy with usual care psychotherapy among women in a CMHC. METHODS: Among 1,100 women seeking treatment in a CMHC, 230 (21%) had major depression and histories of childhood sexual abuse. Seventy women with major depression and sexual abuse before age 18 were randomly assigned to interpersonal psychotherapy (N=37) or usual care psychotherapy (N=33). Staff clinicians provided all treatments. Participants were assessed at study entry and at ten, 24, and 36 weeks after random assignment. Generalized estimating equations were used to examine change over time. RESULTS: Compared with women assigned to usual care, women who received interpersonal psychotherapy had greater reductions in depressive symptoms (Hamilton Rating Scale, p=.05, d=.34; Beck Depression Inventory-II, p=.01, d=.29), posttraumatic stress disorder symptoms (p=.04, d=.76), and shame (p=.002, d=.38). Interpersonal psychotherapy and usual care yielded comparable improvements in social and mental health-related functioning. CONCLUSIONS: Interpersonal psychotherapy compared favorably to usual care psychotherapy in a CMHC in improving psychiatric symptoms and reducing shame among sexually abused women. However, there is a critical need for continued research to develop more effective treatments for the social and psychiatric sequelae of interpersonal trauma and socioeconomic disadvantage.

Psychiatric residents' self-assessment of teaching knowledge and skills following a brief "psychiatric residents-as-teachers" course: a pilot study.

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.

The obsessive-compulsive spectrum in the perinatal period: a prospective pilot study.

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.

Accuracy of depression screening tools for identifying postpartum depression among urban mothers.

OBJECTIVE: The goal was to describe the accuracy of the Edinburgh Postnatal Depression Scale (EPDS), Beck Depression Inventory II (BDI-II), and Postpartum Depression Screening Scale (PDSS) in identifying major depressive disorder (MDD) or minor depressive disorder (MnDD) among low-income, urban mothers attending well-child care (WCC) visits during the postpartum year. METHODS: Mothers (N = 198) attending WCC visits with their infants 0 to 14 months of age completed a psychiatric diagnostic interview (standard method) and 3 screening tools. The sensitivities and specificities of each screening tool were calculated in comparison with diagnoses of MDD or MDD/MnDD. Receiver operating characteristic curves were calculated and the areas under the curves for each tool were compared to assess accuracy for the entire sample (representing the postpartum year) and subsamples (representing early, middle, and late postpartum time frames). Optimal cutoff scores were calculated. RESULTS: At some point between 2 weeks and 14 months after delivery, 56% of mothers met criteria for either MDD (37%) or MnDD (19%). When used as continuous measures, all scales performed equally well (areas under the curves of > or =0.8). With traditional cutoff scores, the measures did not perform at the expected levels of sensitivity and specificity. Optimal cutoff scores for the BDI-II (> or =14 for MDD and > or =11 for MDD/MnDD) and EPDS (> or =9 for MDD and > or =7 for MDD/MnDD) were lower than currently recommended. For the PDSS, the optimal cutoff score was consistent with current guidelines for MDD (> or =80) but higher than recommended for MDD/MnDD (> or =77). CONCLUSIONS: Large proportions of low-income, urban mothers attending WCC visits experience MDD or MnDD during the postpartum year. The EPDS, BDI-II, and PDSS have high accuracy in identifying depression, but cutoff scores may need to be altered to identify depression more accurately among urban, low-income mothers.

Does education influence pediatricians' perceptions of physician-specific barriers for maternal depression?

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.