Screening for Mental Health and Substance Use Disorders in Obstetric Settings

Byatt, Nancy; Masters, Grace A.; Bergman, Aaron L.; Simas, Tiffany A. Moore

doi:10.1007/s11920-020-01182-z

Cited by 17 publications

(18 citation statements)

References 133 publications

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“…Eighty-nine percent of clinicians in our study reported consistently screening for depression. These screening rates are at the higher end of the estimated national average of 50 À 98% [24,25]. It is known that self-reported and actual screening rates are not always concordant, but this rate is still markedly higher than the percentage of clinicians who report treating depression regularly, illuminating the gap in care.…”

Section: Discussionmentioning

confidence: 99%

The role of clinician assistants in addressing perinatal depression

Cooper

Masters

Simas

et al. 2021

Journal of Psychosomatic Obstetrics & Gynecology

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Background: Upwards of one in seven individuals experience perinatal depression and many individuals cannot access treatment. In response, perinatal depression is increasingly being managed in the obstetric setting. This study aimed to characterize the experiences of clinicians and clinician assistants to inform the extent to which clinician assistants can help address depression in obstetric settings. Methods: This cross-sectional analysis used data from an ongoing cluster randomized control trial: The PRogram In Support of Moms (PRISM). Participants included clinicians (physicians, certified nurse midwives, nurse practitioners) and clinician assistants (medical assistants, nursing assistants). Baseline data regarding practices and attitudes of clinicians and clinician assistants toward addressing depression in the obstetric setting were described. Logistic regressions were used to examine the association of clinician time to complete work and depression management. Results: Clinician assistants experienced significantly fewer time constraints than did clinicians. However, having adequate time to complete work was not significantly associated with increased depression management in clinicians. Clinician assistants reported feeling that addressing depression is an important part of their job, despite variation in doing so. Conclusion: Clinician assistants are interacting with perinatal women extensively and are a vital part of obstetric care workflows. Clinician assistants report that they want to address depression and have time to do so. Thus, clinician assistants may be poised to help address the mental health needs of perinatal individuals.

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Section: Discussionmentioning

confidence: 99%

The role of clinician assistants in addressing perinatal depression

Cooper

Masters

Simas

et al. 2021

Journal of Psychosomatic Obstetrics & Gynecology

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“…Suicide and drug overdose combine to constitute the leading cause of maternal mortality during pregnancy and the postnatal period ( 4 , 5 ), with PMADs, PSUDs and IPV increasing this risk. Additionally, each of these disorders contribute to significant maternal and child morbidity ( 6 , 7 ). Despite strong recommendations from virtually all professional societies to implement effective screening and referral processes, the uptake of these recommendations has been limited and many screening and referral practices are largely ineffective.…”

Section: Discussionmentioning

confidence: 99%

“…Perinatal Mood and Anxiety Disorders (PMADs), Perinatal Substance Use Disorders (PSUDs) and Intimate Partner Violence (IPV) are common during pregnancy and the postpartum year ( 1 , 2 , 3 ), and have been strongly associated with significant morbidity and mortality for both women and their children ( 4 , 5 ). Multiple professional organizations have endorsed screening for PMADs, PSUDs and IPV during pregnancy and the postpartum period using standardized, validated screening tools, followed by assessment and referral to treatment ( 6 ). For those screening positive for substance use, a brief intervention using in‐person motivational interviewing to support behavioral change and referral to treatment (e.g., Screening, Brief Intervention and Referral to Treatment [SBIRT]) is recommended ( 7 , 8 ).…”

mentioning

confidence: 99%

A Non‐Randomized Trial of In‐Person Versus Text/Telephone Screening, Brief Intervention and Referral to Treatment for Pregnant and Postpartum Women

Guille

Maldonado

Simpson

et al. 2021

PRCP

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Background Systems of care that improve mental health and substance use disorder Screening, Brief Intervention and Referral to Treatment (SBIRT) for pregnant and postpartum women are needed. Aims The aim of this study is to determine if women receiving prenatal care from January 2020 to April 2021 are more likely to be screened, screen positive, be referred for treatment and attend treatment with technology facilitated SBIRT, compared to women receiving prenatal care and in‐person SBIRT January 2017 to December 2019. Materials & Methods Technology facilitated SBIRT, designated Listening to Women (LTW), includes text message‐based screening, phone‐based brief intervention, and referral to treatment by a remote care coordinator. A total of 3535 pregnant and postpartum women were included in the quasi‐experimental study and data were collected via text message and Electronic Health Record. Results In‐person SBIRT was completed by 65.2% (1947/2988) of women while 98.9% (547/553) of women approached agreed to take part in LTW and 71.9% (393/547) completed SBIRT via LTW. After controlling for potentially confounding variables, women enrolled in LTW were significantly more likely to be screened (relative risk [RR]: 1.10, 95% CI 1.03–1.16), screen positive (RR 1.91, 95% CI 1.72–2.10), referred to treatment (RR 1.55, 95% CI 1.43–1.69) and receive treatment (RR 4.95, 95% CI 3.93–6.23), compared to women receiving in‐person SBIRT. Black women enrolled in LTW were significantly more likely to screen positive (RR 1.65, 95% CI 1.35–2.01), be referred to treatment (RR 1.54, 95% CI 1.35–1.76) and attend treatment (RR 5.49, 95% CI 3.69–8.17), compared to Black women receiving in‐person SBIRT. Discussion LTW appears to increase the proportion of pregnant and postpartum women receiving key elements of SBIRT.

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“…Mood and anxiety disorders affect pregnant people and their families at increased rates throughout the perinatal period. Perinatal depression affects between 11-15% of obstetric populations [1][2][3][4]. According to a 2013 study by Wisner et al, individuals experienced onset of depressive episodes at the highest rate during postpartum (40.1%), pregnancy (33.4%), and before pregnancy (26.5%) [5].…”

Section: Introductionmentioning

confidence: 99%

“…Further, 19.3% of individuals across the peripartum period experience suicidal ideations [5], and suicidality in pregnancy and postpartum is on the rise in the US [6]. Of those who screen positive for unipolar depression, approximately 20% of individuals meet criteria for bipolar depression [1]. Anxiety affects up to 20% of individuals during pregnancy, and as many as 50% of individuals immediately postpartum [7].…”

Section: Introductionmentioning

confidence: 99%

The Michigan Clinical Consultation and Care model (MC3 Perinatal): A Novel Approach to Perinatal Mental Health Care

Muzik¹,

Menke²,

Issa³

et al. 2023

Preprint

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Mood and anxiety disorders affect pregnant people and their families at increased rates throughout the perinatal period. Geographic, financial, and social barriers persist in identification and access to care that preclude adequate diagnosis and treatment of anxiety and mood disorders. These challenges have been exacerbated by the COVID-19 pandemic, particularly for Black and Indigenous People and People of Color (BIPOC) who already experience increased risk for adverse mental health outcomes and faced structural barriers to accessing perinatal mental health care at baseline. The literature shows that integrated care can improve mental health outcomes and save billions of dollars in annual healthcare costs. This study evaluated a novel statewide integrated care effort designed to facilitate access to perinatal mental health care for OB/GYN patients. In addition to enrollment data, variables studied were maternal program satisfaction, retention rates, and preliminary maternal mental health outcomes. 285 patients were ever referred for care. Of this, we contacted 259 patients (91%) and enrolled 209 (72%). Of the 209, 48 were lost to follow up, while 107 remained enrolled at the time of data analysis. 54 patients met their treatment goals. 97% of individuals asserted they were satisfied with the services they received. Black race and public insurance predicted faster attrition from treatment; risk for interpersonal violence exposure and substance use were not related to attrition. Preliminary mental health outcomes showed significant decreases in anxiety and depression, with the most dramatic decreases in the first month of treatment. The MC3 Perinatal care program is a viable, patient-endorsed collaborative care model that increases access to perinatal mental health and facilitate access to outside resources.

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Screening for Mental Health and Substance Use Disorders in Obstetric Settings

Cited by 17 publications

References 133 publications

The role of clinician assistants in addressing perinatal depression

The role of clinician assistants in addressing perinatal depression

A Non‐Randomized Trial of In‐Person Versus Text/Telephone Screening, Brief Intervention and Referral to Treatment for Pregnant and Postpartum Women

The Michigan Clinical Consultation and Care model (MC3 Perinatal): A Novel Approach to Perinatal Mental Health Care

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