Screening for Mental Health and Substance Use Disorders in Obstetric Settings
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REPRODUCTIVE PSYCHIATRY AND WOMEN'S HEALTH (CN EPPERSON AND L HANTSOO, SECTION EDITORS)
Screening for Mental Health and Substance Use Disorders in Obstetric Settings Nancy Byatt 1 & Grace A. Masters 1 & Aaron L. Bergman 1 & Tiffany A. Moore Simas 1
# Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Purpose of Review The objective of this review is to describe the extent to which (1) obstetric settings are currently screening for mental health and substance use disorders and social determinants of health (SDoH), and (2) screening is followed by systematic approaches for ensuring an adequate response to positive screens. Additionally, clinical and policy implications of current screening practices and recommendations are discussed. Recent Findings Screening for perinatal depression in obstetric settings has increased. Despite their prevalence and negative impact, screening for other mental health and substance use disorders and SDoH is much less common and professional society recommendations are either nonexistent, less consistent, or less prescriptive. Summary To truly address maternal mental health, we need to move beyond focusing solely on depression and address other mental health and substance use disorders and the contextual social determinants in which they occur. Keywords Perinatal . Pregnancy . Screening . Anxiety . Depression . Mood disorder
Introduction Mental health and substance use disorders are the most common complication of pregnancy and have deleterious effects on women and other perinatal individuals, and their children [1]. They are associated with negative consequences for the mother, child, and family, such as decreased healthcare utilization during pregnancy and negative birth and infant outcomes, including preeclampsia, low birth weight, and mother-infant bonding challenges [2–4]. Children of mothers with mood or anxiety disorders are at increased risk of having their own mood, anxiety, or behavioral disorders. Mental health and substance use disorders are on par with infection as a leading cause of preventable maternal mortality in the USA.
This article is part of the Topical Collection on Reproductive Psychiatry and Women’s Health * Nancy Byatt [email protected] 1
University of Massachusetts Medical School and UMass Memorial Health Care, 55 Lake Ave North, Worcester, MA 01655, USA
Much of the attention and focus of maternal mental health has been specific to postpartum depression - depression that occurs in the first year postpartum. While addressing postpartum depression is critical, it is also important to recognize that (1) other mental health and substance use disorders are common during pregnancy and the first year postpartum [5–8], and (2) for up to 60% of women who screen positive for postpartum depression, the onset will have occurred preconception or during pregnancy [9]. During the perinatal time period, anxiety disorders, post-traumatic stress disorder (PTSD), bipolar disorder, and substance use disorders are also common [5–8, 10, 11]
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