University of Massachusetts Medical School and UMass Memorial Health Care, 55 Lake Ave North, Worcester, MA, 01655, USA.
European Medical and Clinical Division, Terumo Europe N.V., Researchpark Hassrode 1520, Interleuvenlaan 40, 3001, Leuven, Belgium.
Arch Womens Ment Health. 2018 Oct;21(5):543-551. doi: 10.1007/s00737-018-0825-2. Epub 2018 Mar 13.
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.
为了阐明（1）在产科环境中识别双相情感障碍方面存在的挑战，（2）患有双相情感障碍的孕妇和产后妇女在寻求精神保健服务时所面临的障碍，以及（3）产科环境如何识别这些妇女并将其与精神保健服务联系起来。采用结构式深入访谈法，对 25 名来自产科实践的孕妇和产后妇女进行了访谈，这些妇女在爱丁堡产后抑郁量表上的得分≥10 分，且使用 Mini 国际神经精神访谈，符合 DSM-IV 诊断标准的 I 型、II 型或非特定双相情感障碍。定量分析包括描述性统计。转录访谈记录，使用扎根理论方法分析所得数据。大多数参与者（n=19，79.17%）的医疗记录中没有记录到双相情感障碍的临床诊断，也没有在怀孕期间获得治疗转诊（n=15，60%）。接受药物治疗的参与者中（n=14，58.33%），大多数单独接受抗抑郁药治疗（n=10，71.42%）。大多数药物由产科医生（n=4，28.57%）或初级保健提供者（n=7，50%）开具处方。定性访谈表明，参与者希望他们的产科实践主动筛查、讨论并帮助他们获得精神保健治疗。妇女在获得适合其双相情感障碍的精神保健治疗方面面临挑战。产科提供者为这些妇女提供大部分医疗服务，需要提供支持，以（1）更好地识别双相情感障碍，（2）避免对未确诊的双相情感障碍妇女进行不当处方治疗，以及（3）确保在需要时将妇女转介至专门治疗。
