the study by Nelson and associates (2013) more than three fourths of the 1106 women with abnormally elevated EPDS scores did not keep their later appointment, which ofered more formal psychiatric evaluation. Barriers include diiculties with access to care, personal perception of depression, and societal stigmata (Flynn, 2010; Smith, 2008). Women referred to a behavioral health provider located at the same site as their obstetrical care are four times more likely to access treatment than those referred elsewhere (Smith, 2009). To take advantage of this, at Parkland Hospital, mental health counselors also practice at postpartum clinic sites. Other promising interventions for puerperal depression include home visits, telephonebased peer support, and interpersonal psychotherapy (Dennis, 2013; Lavender, 2013; Yonemoto, 2017). A report from Kaiser Permanente, which describes the benefits and hurdles to system-based perinatal mental health care, provides a glimpse into the possible future of universal perinatal screening and treatment (Avalos, 2016; Flanagan, 2016).
Many psychiatric disorders can be improved with counseling and psychotherapies. In some instances, psychotropic medications are needed. Treatment decisions are ideally shared between patients and their health-care providers. In particular, women taking psychotropic medication are informed of likely side efects. Many of these drugs are discussed in Chapter 12 and by the American College of Obstetricians and Gynecologists (2016b) in their Practice Bulletin No. 92. Some of these drugs are discussed subsequently.
Emerging information on psychiatric disorders and pregnancy outcomes suggest a link between maternal psychiatric illness and untoward outcomes such as preterm birth, low birthweight, and perinatal mortality (Grigoriadis, 2013; Steinberg, 2014; Straub, 2012; Yonkers, 2009). In a study of 16,334 deliveries, Shaw and coworkers (2014) identiied a signiicant association between posttraumatic stress disorder and spontaneous pre term delivery. Domestic abuse-another aforementioned risk factor for perinatal mood disorder-is also linked with adverse perinatal outcomes (Yost, 2005). Finally, Littleton and associates (2007) reviewed 50 studies and concluded that anxiety symptoms, which are commonly comorbid with depression, had no adverse efect on perinatal outcomes.
is the most recent version by the American Psychiatric Associa tion (2013). It assists in classiying mental disorders and speci fies criteria for each diagnosis.
Of categories, depressive disorders are common. According to the National Institute of Mental Health (2010), the life time prevalence of depressive disorders in the United States is 21 percent. Historically, depressive disorders include major bipolar disorder with both manic and depressive episodes. It also includes dysthymia, which is chronic, mild depression.
This is the most common depressive disorder, and the 12-month prevalence of major depressive episodes among U.S. women is 8.2 percent (Center for Behavioral Health Statistics and Quality, 2015). In 2011 to 2014, 16 percent of U.S. women had used an antidepressant in the prior month (Pratt, 2017). The diagnosis is made by identiying symptoms listed in Table 61-2, but very few patients manifest all of these.