Menninger Department of Psychiatry and Behavioral Health Sciences, Baylor College of Medicine, Houston, TX, USA.
Department of Health and Human Performance, University of Houston, Houston, TX, USA.
Arch Womens Ment Health. 2024 Feb;27(1):89-97. doi: 10.1007/s00737-023-01372-7. Epub 2023 Sep 23.
US female veterans have higher rates of mental health (MH) disorders compared to US civilian females and, consequently, are at risk for poor MH outcomes during pregnancy. This study evaluated the MH burden and identified the prevalence of antidepressant prescription and discontinuation among pregnant veterans (PGVets). The electronic health records (EHR) of PGVets using the US Veterans Administration's (VA) maternity care benefits over a two-year period were retrospectively reviewed. Inclusion criteria for this study were a current MH diagnosis of depression, anxiety, or posttraumatic stress disorder (PTSD) at the onset of pregnancy (n=351). Outcomes examined included antidepressant use prior to pregnancy, the use and discontinuation of antidepressants during pregnancy, and risk factors for discontinuation. PGVets had a high MH burden, as indicated by multiple comorbid diagnoses of unipolar depression, anxiety, and PTSD in 67% of the sample. At the onset of pregnancy, 163 (46%) were treated with an antidepressant. Only 56 (34%) continued using antidepressants through the pregnancy. Self-discontinuation (34%) and VA provider discontinuation (31%) of antidepressants were found. Among PGVets with documented past suicidal behaviors, 90% discontinued their active antidepressants. PGVets with indicators for more severe MH diagnoses were most likely to discontinue. The MH burden of PGVets and high rates of antidepressant discontinuation have implications for engaging this population in a higher level of perinatal monitoring and intervention. The findings suggest that VA providers and veterans would benefit from risks and benefits education regarding antidepressant use during pregnancy as well as the provision of alternative therapies.
美国女性退伍军人的心理健康（MH）障碍发病率高于美国平民女性，因此在怀孕期间她们面临着 MH 不良预后的风险。本研究评估了 MH 负担，并确定了在怀孕退伍军人（PGVets）中抗抑郁药处方和停药的流行率。通过美国退伍军人事务部（VA）的产妇保健福利，对两年期间的 PGVets 的电子健康记录（EHR）进行了回顾性审查。本研究的纳入标准为在怀孕初期（n=351）有当前 MH 诊断为抑郁症、焦虑症或创伤后应激障碍（PTSD）。检查的结果包括怀孕前使用抗抑郁药、怀孕期间使用和停止使用抗抑郁药以及停药的风险因素。PGVets 的 MH 负担很高，67%的样本中存在单相抑郁、焦虑和 PTSD 的多种合并诊断。在怀孕初期，有 163 名（46%）患者接受了抗抑郁药治疗。只有 56 名（34%）患者在整个孕期继续使用抗抑郁药。发现有 34%的患者自行停药，31%的 VA 提供者停药。在有记录的过去自杀行为的 PGVets 中，90%停止了他们的活性抗抑郁药。有更严重 MH 诊断指标的 PGVets 最有可能停药。PGVets 的 MH 负担沉重，抗抑郁药停药率高，这对该人群进行更高水平的围产期监测和干预具有影响。研究结果表明，VA 提供者和退伍军人将受益于有关怀孕期间使用抗抑郁药的风险和益处的教育，以及替代疗法的提供。
