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How obstetric settings can help address gaps in psychiatric care for pregnant and postpartum women with bipolar disorder

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Abstract

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.

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Funding

This work was supported by the National Center for Research Resources and the National Center for Advancing Translational Sciences, National Institutes of Health (NIH), [grant numbers KL2TR000160, UL1TR000161]. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH.

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Authors and Affiliations

  1. University of Massachusetts Medical School and UMass Memorial Health Care, 55 Lake Ave North, Worcester, MA, 01655, USA

    Nancy Byatt, Lucille Cox, Tiffany A. Moore Simas, Kathleen Biebel, Padma Sankaran & Linda Weinreb

  2. European Medical and Clinical Division, Terumo Europe N.V., Researchpark Hassrode 1520, Interleuvenlaan 40, 3001, Leuven, Belgium

    Nisha Kini

  3. University of Pittsburgh School of Medicine, 3811 O’Hara Street, Pittsburgh, PA, 15213, USA

    Holly A. Swartz

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  1. Nancy Byatt
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  2. Lucille Cox
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  5. Kathleen Biebel
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Correspondence to Nancy Byatt.

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Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of The University of Massachusetts Institutional Review Board (who approved the study) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all study participants before they participated in the study.

Conflict of interest

The first, third, fourth, and eighth authors have received salary and/or funding support from the Massachusetts Department of Mental Health via the Massachusetts Child Psychiatry Access Program for Moms (MCPAP for Moms). The first author is also the statewide Medical Director of MCPAP for Moms. The first author has served on the Perinatal Depression Advisory Board for the Janssen Disease Interception Accelerator Program and Advisory Boards for Sage Therapeutics. She has also received speaking honoria from Sage Therapeutics and in a council member of the Gerson Lerhman Group. The third author is the Lead Obstetric Liaison for MCPAP for Moms and has served on a Physician Advisory Board for Sage Therapeutics and is a consultant for two research projects. The fifth author has been the Program Director of MCPAP for Moms, and the eight author has served as a Consultant for MCPAP for Moms. The seventh author serves as a consultant for Myriad Genetic, Inc. The second, fourth, and sixth authors declare that they do not have conflicts of interest.

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Byatt, N., Cox, L., Moore Simas, T.A. et al. How obstetric settings can help address gaps in psychiatric care for pregnant and postpartum women with bipolar disorder. Arch Womens Ment Health 21, 543–551 (2018). https://doi.org/10.1007/s00737-018-0825-2

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