Postpartum Mood and Anxiety Disorder (PMAD) has been associated with a multitude of adverse antepartum and post-partum consequences. The overarching concern is that up to 15% of women will die in the first year postpartum due to suicide or overdose1. Moreover, women with PMAD have additional pregnancy complications, including increased risk for fetal growth restriction, pre-term delivery as well as adverse developmental, behavioral, and cognitive issues for their children2. Women who are undiagnosed or untreated for PMAD experience significant difficulties engaging with their infants1–5.
Despite the estimated prevalence of depression and anxiety in the perinatal period, ranging from 10–20% and 2.6–39%, respectively, studies have demonstrated low and inconsistent screening rates among healthcare professionals in the United States6–11. Both the American College of Obstetricians and Gynecologists and American Academy of Pediatricians recommend the utilization of a validating screening tool more than once during and after pregnancy12–13. A review of seven studies indicated that only 55% of healthcare professionals assess for depression. Eighty percent of pediatricians and 60% of Ob/Gyn clinicians have been observed to utilize clinical assessment, as opposed to validated screening tools. This further limits the accuracy in evaluating mental health concerns and also contributes to an underlying low screening rate14. Even when perinatal mood and anxiety disorder (PMAD) symptoms are recognized, clinicians report feeling ill-prepared to prescribe treatment and medications. They also report being challenged to find the necessary behavioral health providers for long-term care and follow up15. One survey of 118 clinicians from an academic center reported that 34.7% had never received any PMAD management training, and 21.2% attended a single workshop about PMAD interventions16.
There are three main intervention types that have been studied to address the gaps in screening, treatment, and referral to behavioral health. These intervention types include provider education, electronic medical record (EMR) changes, and standardized patient exercises9. The educational strategies used varies from seminars, lectures, and educational websites. These educational media contain information about the symptoms of PMAD, treatment options, crisis interventions, and the general impact of PMAD on mothers and childern9. A literature review examining these interventions revealed a lack of pre- and post-natal assessments. It is therefore difficult to determine the effectiveness of these interventions9.
With the large negative impact PMADs can have on the development of an infant, and the general increased risk of mental illness to their caregiver, it is imperative that all women are screened and treated for PMAD. We report the findings of an observational study designed to implement a training program to educate resident physicians about best practices for screening for and treating PMAD. Using an observational, single group (descriptive) pretest- posttest study design, we examine whether education can lead to increased knowledge and confidence of OB/GYN residents in assessing and treating prenatal mood and anxiety disorders.