Valentine Sarah E, Godfrey Laura B, Gellatly Resham, Paul Emilie, Clark Caitlin, Giovannini Karissa, Saia Kelley A, Nillni Yael I
Department of Psychiatry, Boston University School of Medicine, Boston, MA, USA.
Department of Psychiatry, Boston Medical Center, Boston, MA, USA.
SSM Ment Health. 2023 Dec 15;4. doi: 10.1016/j.ssmmh.2023.100256. Epub 2023 Aug 22.
Pregnant people with comorbid posttraumatic stress disorder (PTSD) and substance use disorder (SUD) constitute a highly vulnerable population. PTSD and SUD confer risks to both the pregnant person and the fetus, including a host of physical and mental health consequences. When PTSD and SUD co-occur, potential negative impacts are amplified, and the symptoms of each may exacerbate and maintain the other. Pregnancy often increases engagement in the healthcare system, presenting a unique and critical opportunity to provide PTSD and SUD treatment to birthing people motivated to mitigate risks of losing custody of their children. This paper presents implementation process outcomes of Written Exposure Therapy (WET), a brief, scalable, and sustainable evidence-based PTSD treatment delivered to pregnant persons receiving care in an integrated obstetrical-addiction recovery program at Boston Medical Center. Trial participants (N = 18) were mostly White, non-Hispanic (61.1%), not currently working (77.8%), had a high school or lower level of education (55.5%), had an annual household income less than $35,000 (94.4%), and were living in a substance use residential program (55.6%). We examined intervention feasibility, acceptability, appropriateness, adoption; barriers and facilitators to implementation; and feedback on supporting uptake and sustainability of the intervention using coded qualitative sources (consultation field notes [N = 47] and semi-structured interviews [N = 5]) from providers involved in trial planning and treatment delivery. Results reflected high acceptability, appropriateness, and adoption of WET. Participants described system-, provider-, and patient-level barriers to implementation, offered suggestions to enhance uptake, but did not raise concerns about core components of the intervention. Findings suggest that WET is an appropriate and acceptable PTSD treatment for this difficult-to-reach, complex population, and has the potential to positively impact pregnant persons and their children.
患有创伤后应激障碍（PTSD）和物质使用障碍（SUD）的孕妇是一个高度脆弱的群体。PTSD和SUD会给孕妇和胎儿带来风险，包括一系列身心健康后果。当PTSD和SUD同时出现时，潜在的负面影响会被放大，而且每种症状可能会加剧并维持另一种症状。怀孕通常会增加孕妇与医疗系统的接触，这为向有动力降低失去孩子监护权风险的分娩者提供PTSD和SUD治疗提供了一个独特且关键的机会。本文介绍了书面暴露疗法（WET）的实施过程结果，这是一种简短、可扩展且可持续的循证PTSD治疗方法，应用于在波士顿医疗中心综合产科-成瘾康复项目中接受护理的孕妇。试验参与者（N = 18）大多为非西班牙裔白人（61.1%），目前没有工作（77.8%），高中及以下学历（55.5%），家庭年收入低于35,000美元（94.4%），并且居住在物质使用康复项目中（55.6%）。我们使用参与试验规划和治疗实施的提供者提供的编码定性资料（咨询现场记录 [N = 47] 和半结构化访谈 [N = 5]），研究了干预的可行性、可接受性、适宜性、采用情况；实施的障碍和促进因素；以及关于支持干预采用和可持续性的反馈。结果显示WET具有较高的可接受性、适宜性和采用率。参与者描述了实施过程中系统、提供者和患者层面的障碍，提出了提高采用率的建议，但没有对干预的核心组成部分提出担忧。研究结果表明，WET对于这个难以接触到的复杂群体是一种合适且可接受的PTSD治疗方法，并且有可能对孕妇及其子女产生积极影响。
