Reproductive Psychiatry Research Articles

Reproductive psychiatry training: A critical component of access to perinatal mental health treatment

Perinatal Mental Health Disorders (PMHDs) pose significant challenges to the well-being of perinatal individuals, infants, and families. Despite their prevalence and impact, PMHDs often go undetected and untreated due to gaps in clinician education and training. This manuscript reviews the current state of perinatal mental health training, identifies emerging initiatives, and discusses innovative models of care aimed at enhancing the clinical preparedness of healthcare providers. Key findings highlight disparities in PMHD detection and treatment, the need for standardized education across disciplines, and the role of interdisciplinary collaboration in improving care outcomes. The manuscript emphasizes the urgency of prioritizing reproductive psychiatry education to mitigate the adverse effects of PMHDs on maternal and infant health. By standardizing education and fostering interdisciplinary collaboration, we can ensure that all perinatal individuals receive the care they need to thrive.

Prioritizing Maternal Mental Health in Addressing Morbidity and Mortality.

The rate of maternal mortality in the United States is 2-fold to 3-fold greater than that in other high-income countries. While many national initiatives have been developed to combat maternal mortality, these efforts often fail to include mental illness. To highlight the underrecognized contribution of mental illness to maternal mortality, which is nearly double that of postpartum hemorrhage. A topic outline was developed to include challenges in measuring perinatal mental conditions and mortality rates; contributions of social determinants of health to mental conditions and mortality; perinatal psychiatric disorder characterization; mechanisms by which maternal mental illness increases mortality, specifically, suicide and addictive disorders; access limitations and care "deserts"; prenatal stress and its impact on reproductive outcomes; increasing clinician expertise through cross-disciplinary education; intervention sites and models; and asserting that mental health is fundamental to maternal health. Publications in the last 3 years were prioritized, particularly those relating to policy. References were selected through consensus. Sources were PubMed, Ovid, direct data published on government websites, and health policy sources such as the Policy Center for Maternal Mental Health. Priority was given to recent sources. Citations from 2022-2023 numbered 26; within the last 5 years, 14; and historical references, 15. Recommendations to address each topic area serve as concluding statements for each section. To mitigate the contributions of mental illness to the maternal mortality risk, a coordinated effort is required across professional and governmental organizations. Concrete programmatic and policy changes are needed to reduce perinatal stress and address trauma, standardize the collection of social determinant of health data among perinatal patients, increase access to reproductive psychiatry curricula among prescribers, reduce perinatal mental health and obstetrical deserts, institute paid parental leave, and support seamless integration of perinatal and behavioral health care. Moreover, instead of focusing on a relatively minor portion of the contributors to health that current medical practice targets, fortifying the social foundation strengthens the prospects for the health of families for our current and future generations.

Reproductive Psychiatry: Postpartum Depression is Only the Tip of the Iceberg.

Reproductive Psychiatry: Postpartum Depression is Only the Tip of the Iceberg.

Reproductive Psychiatry: Postpartum Depression is Only the Tip of the Iceberg

Reproductive Psychiatry: Postpartum Depression is Only the Tip of the Iceberg

(195) Reproductive Psychiatry Training within C-L Psychiatry Fellowship Programs

(195) Reproductive Psychiatry Training within C-L Psychiatry Fellowship Programs

(190) Lasting Impact of a Peer-to-Peer, Longitudinal Reproductive Psychiatry Curriculum for Obstetrics and Gynecology Residents: An Update on Resident Knowledge, Attitudes, and Comfort

(190) Lasting Impact of a Peer-to-Peer, Longitudinal Reproductive Psychiatry Curriculum for Obstetrics and Gynecology Residents: An Update on Resident Knowledge, Attitudes, and Comfort

Improving rigor through gender inclusivity in reproductive psychiatric science

Accurately defining the individuals that research involves and generalizes to is critical for rigorous and reproducible science. In reproductive psychiatry, which historically focuses on the impact of the menstrual cycle, pregnancy, and menopause on mental health, this means moving beyond characterizing samples and relevant populations as “women” in favor of language that precisely identifies the physiological characteristics pertinent to the research being conducted and accurately reflects the varied genders represented in those populations. Concrete recommendations are provided for precise use of sex and gender terminology and gender inclusivity throughout the scientific process, including study conceptualization, etiquette in research environments, recruitment, methods, and dissemination. Recommendations are discussed in depth and presented in a checklist format for ease of use by research teams. Suggested items for assessing gender and relevant sex-related physiology in the context of reproductive psychiatry are also provided.

A Grading System to Assess Female Sexual and Reproductive Psychiatry and Identification of a New Syndrome

Female reproductive and sexual psychiatry is an unexplored arena and little has been done to qualify and quantify the female sexuality and reproductive psychiatry. This work puts forward a systemic quantitative and qualitative study of it. A questionnaire based system termed “Designed Unorganized Random Gynae-psychiatric Assessment” or DURGA was made and used for the purpose. A scale termed as DURGA scale was designed to quantify reproductive behaviour as well. Survey was conducted in Russian population to validate the system and a new syndrome was identified as well. The aim and objective of this research is to understand gynaecological and female sexual psychiatry in depth in correlation with associated psychiatric spectrums. The introduced system as mentioned can be hence used in clinical setup for assessment and by governments to conduct population study and decide national health policy.

Postpartum Depression-Identifying Risk and Access to Intervention.

As maternal mortality climbs in the USA with mental health conditions driving these preventable deaths, the field of reproductive psychiatry must shift towards identification of women and other birthing individuals at risk and facilitating access. This review brings together recent studies regarding risk of perinatal depression and highlights important comorbidities that place individuals at higher vulnerability to poor perinatal outcomes. Recent research suggests that identifying risk for perinatal depression including historical diagnoses of depression, anxiety, trauma, and comorbid substance use and intimate partner violence may move the field to focus on preventive care in peripartum populations. Emerging data shows stark health inequities in racial and ethnic minority populations historically marginalized by the health system and in other vulnerable groups such as LGBTQ+ individuals and those with severe mental illness. Innovative models of care using systems-level approaches can provide opportunities for identification and risk analyses of vulnerable peripartum patients and facilitate access to therapeutic or preventive interventions. Utilizing intergenerational approaches and leveraging multidisciplinary teams that thoughtfully target high-risk women and other birthing individuals could promote significant changes to population-level care in maternal health.

Special Report: Women’s Reproductive Mental Health—A Clinical Framework

Special Report: Women’s Reproductive Mental Health—A Clinical Framework

A Peer-to-Peer, Longitudinal Reproductive Psychiatry Educational Curriculum for Obstetrics/Gynecology Residents.

Pregnant patients with psychiatric diagnoses are commonly advised to stop their psychiatric medications. Few studies assess the knowledge of, attitude toward, or comfort levels of obstetrics and gynecology (OB/GYN) residents in managing psychiatric conditions, which carry adverse and potentially life-threatening risks to mother and fetus. A gap remains between evidence advocating for active psychopharmacological treatment during pregnancy and implementation of curricula targeting OB/GYN physicians in mental health. The authors' goals are to assess the knowledge, attitude, and comfort that OB/GYN residents have toward assessing and managing active psychiatric conditions in pregnant/postpartum women and to develop an educational, case-based intervention targeting these conditions in the perinatal/postpartum period. Eight perinatal/postpartum psychiatric topics were developed into interactive cases designed for OB/GYN residents. Two weeks before the curriculum administration, OB/GYN residents were surveyed on prior knowledge in, attitudes toward, and comfort levels in assessing and discussing psychiatric conditions in pregnant patients. The assessment was administered again after the intervention to assess its effectiveness. Pre- (N = 19) and post-intervention (N = 15) surveys of residents were analyzed. Most residents (94%) felt it was both important and their responsibility to discuss mental health conditions with pregnant patients. Comfort levels with counseling psychiatric patients increased for all eight topics after the educational intervention was implemented, with statistically significant increases (p < 0.05) for five of the topics. OB/GYN residents feel responsible for caring for pregnant patients with psychiatric illness, and case-based interventions offer an interactive, helpful tool for increasing residents' knowledge and comfort level in treating this patient population.

Abortion Is Only the Beginning

Abortion Is Only the Beginning

Longer wait time after identification of peripartum depression symptoms is associated with increased symptom burden at psychiatric assessment

Untreated peripartum depression (PD) affects one in seven women and is associated with negative maternal outcomes. This retrospective observational study used health record data from an integrated health system in Texas to assess the extent to which time to access reproductive psychiatry influences the mental health of peripartum women. Women with at least one screening for depression symptoms conducted in obstetric or pediatric settings between May 2014 and October 2019 and subsequently seen by the reproductive psychiatry clinic (n=490) were included. Descriptive and inferential statistics were used to assess timing and factors related to psychiatry follow-up. Findings from this study demonstrated that the average time between a positive screen and a psychiatry assessment was 5 weeks. At psychiatry referral appointments, 85% of women continued to screen positive for PD symptoms. Depression symptom scores at the psychiatry appointment were significantly higher than scores precipitating the referral (p = 0.002). Wait time between initial positive screen and referral appointment was positively correlated with clinically meaningful increases in depression symptom scores (p < 0.001). Each week spent waiting for an appointment produced a 13% increase in odds of clinically meaningful worsening of PD scores and 9% increase in odds of developing new self-harm ideation. Given the findings that a longer period between primary care referral and subspecialty appointment has a negative impact on the mental health of women, this study supports the need for earlier psychiatric assessment to minimize decompensation. Expansion of reproductive psychiatry services are needed to support peripartum women and improve maternal outcomes.

A Pregnant Pause: System-Level Barriers to Perinatal Mental Health Care.

Perinatal mood and anxiety disorders, defined as mood and anxiety disorders during pregnancy and the year following birth, affect one in five pregnant and postpartum individuals in the United States and are associated with substantial morbidity and mortality for both pregnant individuals and their infants. Despite this tremendous prevalence and associated disease burden, the overwhelming majority of those affected do not receive treatment. Although prior research has identified several patient-level barriers to effective treatment, the contributions of system-level factors have been underappreciated. We present a pilot study using a simulated patient approach to describe the accessibility and affordability of mental health care through the 18 clinics affiliated with U.S. reproductive psychiatry fellowship programs. Based on our experience, a prospective patient seeking care from these 18 clinics without a prior referral would only have been successful half of the time-and even then may have to wait as long as 2 months for an initial appointment. These data underscore the need for clinicians, public health professionals, and institutions to address system-level barriers that undermine effective referrals for care, including implementing "warm-handoffs" to mental health providers and ending practices that restrict appointments to existing patients within a health care system. They also reinforce the importance of contemporary federal policy efforts to address maternal health, particularly among low-income and racially minoritized communities. Key policies include expanding postpartum insurance coverage, which plays a critical role in reducing insurance disruptions that can undermine the accessibility of mental health care and other vital health services.

Setting Common Standards for Reproductive Psychiatry Education: Effectiveness of the National Curriculum in Reproductive Psychiatry.

The National Curriculum in Reproductive Psychiatry (NCRP) provides standardized education for psychiatry residency training programs. The authors hypothesized that residents' preparedness to treat reproductive psychiatric concerns and their medical knowledge would improve following teaching with the NCRP. Pre- and post-assessments were administered to residents enrolled in two waves of pilot NCRP training (Early-Modules and All-Modules). Data were collected by individual survey, and pre- and post-responses matched via anonymous ID. Statistical analyses were conducted using R version 3.5.3 and included paired Student's t-tests and a chi-square test. Thirty-eight residents completed the Early-Modules survey and 16 the All-Modules survey. In both groups, there was significant improvement in preparedness to treat pregnant and postpartum women with mental illness (p<0.05). Scores on the 29-point knowledge test rose by 2.5 points in the Early-Modules group and 4.3 points in the All-Modules group (p<0.001 for both). In both cohorts, a majority of residents felt reproductive psychiatry was among the top three specialties needed to become competent independent adult psychiatrists. Classroom training with local faculty using a standardized curriculum is feasible and results in substantial and significant improvements in both feelings of preparedness and medical knowledge. Psychiatry trainees view training in reproductive psychiatry as an important and missing aspect of their education. Dissemination of a standardized curriculum may help to forge a path toward subspecialty certification for reproductive psychiatry, and can be used as a model for other specialties.

The frequency of pregnancy recognition across the gestational spectrum and its consequences in the United States

The frequency of pregnancy recognition across the gestational spectrum and its consequences in the United States

Trainees Form New Reproductive Psychiatry Group to Learn, Network, Collaborate

Trainees Form New Reproductive Psychiatry Group to Learn, Network, Collaborate

Is Valproate Reasonable? Response to Leistikow et al.

Back to table of contents Previous article Next article Letters to the EditorFull AccessIs Valproate Reasonable? Response to Leistikow et al.Rita Suri, M.D., Donna Kanar Socol, J.D., Michael Gitlin, M.D.Rita SuriSearch for more papers by this author, M.D., Donna Kanar SocolSearch for more papers by this author, J.D., Michael GitlinSearch for more papers by this author, M.D.Published Online:1 Jan 2021https://doi.org/10.1176/appi.ajp.2020.20030350rAboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail To the Editor: We appreciate the comments by Drs. Leistikow, Smith, Payne, and Osborne and agree that, in this day and age, the field of reproductive psychiatry views valproate as a last resort for treatment in women of childbearing age, potentially justifiable when it is the only option for treating severe mental illness. We also agree that in utero valproate exposure has been associated with an increased risk of lower IQ, attention deficit hyperactivity disorder, and behavioral issues in exposed children and an increased risk of polycystic ovary syndrome, hyperandrogenism, and menstrual irregularities in women.The case presented in our Clinical Case Conference, “Standard of Care: Reasonable But Not Perfect,” occurred more than 13 years ago, well before the risks of valproate use during pregnancy were understood to the extent that they are today. At the time, valproate was commonly used as a treatment modality, with more than 900,000 prescriptions written annually for women of reproductive age (1). The patient in the case presented was using a reliable form of birth control, placing her risk of having an infant with a neural tube defect at less than one in a thousand. She had severe mental illness, with symptoms of suicidality and thoughts of harming her children and her husband, necessitating a rapid treatment response. Her symptoms had failed to respond to other pharmacologic treatments, and the atypical features of her case suggested a more favorable response to valproate than to lithium (2, 3).At the time this case occurred, the treating clinicians met the standard of care; nevertheless, at trial, they lost the malpractice case. The purpose of our Clinical Case Conference was to clarify that standard of care requires that the threshold of reasonable care, not optimal care, is provided, and to understand the decisions that the treating clinicians made at the time of the case, as well as to highlight areas where alternative decisions, precautions, and actions could have been considered.Drs. Leistikow, Smith, Payne, and Osborne accurately point out “a changing standard of care” regarding the use of valproate in reproductive-age women and suggest that the doctors’ decision, in this case, to “treat with valproate instead of other options, such as lithium, may look less reasonable in years to come.” However, clinicians can be responsible only for making treatment decisions and be held to a standard of care based on the information and the body of knowledge available at the time. Therefore, it may be time for current practice guidelines in the treatment of bipolar disorder to address the issue of whether valproate should be used at all, and if so, the specific circumstances and criteria for use, in the treatment of reproductive-age women.Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at University of California Los Angeles, Los Angeles (Suri, Gitlin); Hughes Socol Piers Resnick & Dym, Ltd., Chicago (Socol).Send correspondence to Dr. Suri ([email protected]).The authors’ disclosures accompany the original article.References1 Meador KJ, Loring DW: Risks of in utero exposure to valproate. JAMA 2013; 309:1730–1731Crossref, Medline, Google Scholar2 Pfennig A, Schlattmann P, Alda M, et al.: Influence of atypical features on the quality of prophylactic effectiveness of long-term lithium treatment in bipolar disorders. Bipolar Disord 2010; 12:390–396Crossref, Medline, Google Scholar3 Bowden CL: Clinical correlates of therapeutic response in bipolar disorder. J Affect Disord 2001; 67:257–265Crossref, Medline, Google Scholar FiguresReferencesCited byDetailsCited byNone Volume 178Issue 1 January 01, 2021Pages 100-100 Metrics KeywordsWomenPre/Peri/Postnatal IssuesEducation-PsychiatricForensic PsychiatryPDF download History Accepted 27 July 2020 Published online 1 January 2021 Published in print 1 January 2021

The impact of the COVID-19 pandemic on women's mental health.

The current worldwide outbreak of COVID-19 has changed the modus operandi of all segments of society. While some pandemic-related stressors affect nearly everyone, many especially affect women. Purpose: To review what is known about the pandemic’s effect on women’s mental health, what makes them more predisposed to vulnerabilities and adverse impacts, and strategies for preventing and treating these mental health consequences in the female population during specific stages across the lifespan. Methods: The authors performed a narrative review in combination with their observations from clinical experience in the field of women’s mental health and reproductive psychiatry. Articles on women’s mental health and COVID-19 up to May 30, 2020, were searched using the electronic PubMed and PsychInfo databases, as well as publications by major health entities (e.g., World Health Organization, Centers for Disease Control and Prevention, the United Nations) and press releases from prime communication outlets (e.g., National Public Radio). Results and conclusions: Women who are pregnant, postpartum, miscarrying, or experiencing intimate partner violence are at especially high risk for developing mental health problems during the pandemic. Proactive outreach to these groups of women and enhancement of social supports could lead to prevention, early detection, and prompt treatment. Social support is a key protective factor. Similarly, parenting may be substantially more stressful during a pandemic. Gender disparities may be accentuated, particularly for employed women or single parents, as women are disproportionately responsible for the bulk of domestic tasks, including childcare and eldercare.

Courts Strike Down Trump’s ‘Refusal of Care’ Conscience Rule

Courts Strike Down Trump’s ‘Refusal of Care’ Conscience Rule