The detection and treatment of psychiatric disorders and substance use among pregnant women cared for in obstetrics
Abstract
OBJECTIVE: This investigation assessed the detection and treatment of psychiatric disorders and at-risk substance use among pregnant women in the obstetric sector. METHOD: The Primary Care Evaluation of Mental Disorders Patient Health Questionnaire and modified CAGE questionnaires were used to assess current psychiatric disorders and at-risk substance use among 186 women receiving prenatal care. Medical records were reviewed for evidence of obstetrical providers' recognition of psychiatric and substance use symptoms and diagnoses and initiation of evaluations and treatments. The associations between patient characteristics and chart-documented evaluations and treatments were ascertained. RESULTS: Seventy (38%) of the women met screening criteria for psychiatric disorders or substance use. Among women who screened positive, symptoms were recorded in 43% of the charts, diagnoses in 18%, evaluations in 35%, and treatments in only 23% Patients who screened positive for psychiatric disorders and/or substance use were significantly more likely to have a documented mental health evaluation if they were less well educated, had inadequate prenatal care, or had longer hospital stays at delivery. CONCLUSIONS: A substantial number of women treated in obstetrics have unrecognized and untreated psychiatric disorders and substance use. Given the potential impact of antenatal mental disturbances on maternal and infant outcomes, further investigations into the psychiatric evaluation and treatment of pregnant women in the obstetrical sector are required.
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In the absence of systematic screening in routine prenatal care, affected women are often not identified.
“In the absence of systematic screening in routine prenatal care, affected women are often not identified (35–38).”
From Acceptance, experiences, and needs of hospitalized pregnant women toward an electronic mindfulness-based intervention: A pilot mixed-methods study (2022) · cites this paper as [38]
In another study, pregnant women who received prenatal care at a university hospital were screened for psychiatric disorders; however, a corresponding diagnosis was only recorded in the medical charts of 18% of women who screened positive.
“In another study, pregnant women who received prenatal care at a university hospital were screened for psychiatric disorders; however, a corresponding diagnosis was only recorded in the medical charts of 18% of women who screened positive (38).”
From Acceptance, experiences, and needs of hospitalized pregnant women toward an electronic mindfulness-based intervention: A pilot mixed-methods study (2022) · cites this paper as [38]
The high underreporting of pregnant women with prenatal depression and anxiety disorders is consistent with findings from other studies.
“The high underreporting of pregnant women with prenatal depression and anxiety disorders is consistent with findings from other studies.”
From Acceptance, experiences, and needs of hospitalized pregnant women toward an electronic mindfulness-based intervention: A pilot mixed-methods study (2022) · cites this paper as [38]
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- Authors
- Kelly, R. H., Zatzick, D. F., & Anders, T. F.
- Affiliations
- University of California, Davis (US)
- Venue
- American Journal of Psychiatry
- Published
- 2001-02-01
- Volume
- 158
- Issue
- 2
- Pages
- 213-219
- ISSN
- 0002-953X (ISSN-L)
- 1535-7228
- OpenAlex
- W2110100764
- Cited by
- 250
- References
- 29
- Citations by year
- 2026: 3 · 2025: 4 · 2024: 6 · 2023: 6 · 2022: 8 · 2021: 10 · 2020: 5 · 2019: 4 · 2018: 9 · 2017: 15 · 2016: 10 · 2015: 16 · 2014: 12 · 2013: 12 · 2012: 13
- FWCI
- 10.12
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- American Journal of Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institutes of Health (1f32mh011892-01, 5r01mh050741-03)
- National Institute of Mental Health (MH-11892, MH01610, MH50741, K08MH001610)
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Maternal Mental Health During Pregnancy and Postpartum
- Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
- Health Sciences › Health Professions › General Health Professions › Maternal and Neonatal Healthcare
- Keywords
- psychiatric disorders in pregnancy, prenatal substance use, prenatal care, obstetric care, mental health screening, CAGE questionnaire, Patient Health Questionnaire, treatment initiation, underdiagnosis, maternal mental health, educational attainment, prenatal care adequacy, length of hospital stay
- MeSH terms
- Adult, Mental Disorders, California, Female, Hospital Records, Humans, Mass Screening, Obstetrics and Gynecology Department, Hospital, Pregnancy, Pregnancy Complications, Prenatal Care, Psychiatric Status Rating Scales, Quality of Health Care, Prevalence, Substance-Related Disorders
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