Success of mental health referral among pregnant and postpartum women with psychiatric distress

Abstract

Objective-This study measured rates of and determined factors associated with mental health service use among a cohort of 465 pregnant and postpartum women receiving care at publicly funded obstetrical clinics.Methods-Women underwent a diagnostic evaluation, were provided with at least one mental health referral, and were encouraged to seek treatment; follow-up with provision of additional referrals occurred at 1, 3, and 6 months after the initial assessment. Logistic regression was used to estimate the relationship between clinical and psychosocial factors and self-reported mental health service use.Results-38.1% of referred women attended at least one mental health visit while only 6% of women remained in treatment during the entire 6-month follow-up interval. Postpartum women were more likely than pregnant women to attend a mental health treatment visit (O.R. = 4.17). Being born in the United States (O.R = 2.06), exposed to interpersonal violence (O.R. = 2.52), and unemployed (O.R. = 2.69) were associated with attending at least one mental health care visit. Women who received a behavioral health referral to the same site as their prenatal or postpartum care were more likely than those women referred offsite to attend a mental health treatment visit (O.R. = 3.23).Conclusions-Despite active follow-up, rates of accessing and particularly continuing in mental health treatment were low. More work is needed to support the integration of specialty behavioral health services in primary care settings accessed by perinatal women.

Screening for Psychiatric Morbidity in the Postpartum Period: Clinical Presentation and Outcome at One-Year Follow-Up

“…One study found that only 38.5% of women referred for psychiatric assessment attended at least one session, and only 6% continued treatment [34]. The drop-out rate in this study was also high: 50% at the six-month follow-up and 54% at the 12-month follow-up.…”

Computerized Behavioral Activation Treatment for Maternal Depression Delivered in an Obstetric Clinic: A Case Study

“…Within the traditional model, physicians provide patients with referrals to outpatient mental health providers. However, there are many barriers and limitations to the traditional referral model, including stigma, delayed access to services, and the lack of follow-up by many patients [3,5,19,23,27]. Additionally, many women experiencing depression during and after pregnancy prefer to receive treatment in their obstetric clinic rather than in an outpatient therapy setting [5].…”

“…Despite the fact that several efficacious psychosocial treatments for depression exist [17], research has shown that the majority of pregnant and postpartum women, especially low income women, do not receive services because they do not follow up on referrals to outpatient mental health care [3, 23,24].…”

Psychologists partnering with obstetricians and gynecologists: Meeting the need for patient-centered models of women’s health care delivery.

“…This is particularly the case when the women's health psychologist is integrated directly into the ob/gyn practice. Women's health patients are nearly four times more likely to follow up with behavioral health treatment when services are offered at the same site (Smith et al, 2009). …”