Front Line Interventions for Perinatal Psychiatry: The Utility of Informational Guides to Improve Psychiatric Education for Obstetric Providers

Friday, November 11, 2022

2:15 PM – 3:45 PM

Location: Room 217

Presenting Author(s)

Marissa Beal, DO

Assistant Professor
Johns Hopkins University School of Medicine
Baltimore, Maryland

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Co-Author(s)

Lindsay Standeven, MD

Assistant Professor of Psychiatry at Johns Hopkins and the Clinical and Education Director of the Ce
Johns Hopkins
Baltimore, Maryland
SM

Samantha Meilman

Not applicable
Not applicable
Westfield, Indiana
Lauren Osborne, MD

Associate Professor
Johns Hopkins University School of Medicine
Baltimore, Maryland

Abstract: Background/Significance: Perinatal mood disorders are common and often go undetected and undertreated due to patient, provider, and systemic barriers (Byatt et al., 2012). Improving education for obstetric providers is one way to improve screening, diagnosing, and treating perinatal mental health disorders.

Methods: We created a clinical guide to perinatal mental health diagnosis and treatment, “Front Line Interventions for Perinatal Psychiatry (FLIPP).” The guide was adapted with permission from the Massachusetts Child Psychiatry Access Program (MCPAP) for Moms toolkit with changes particular to our hospital setting. Prior to introduction of the FLIPP guide, we created and administered a survey to Johns Hopkins Gynecology and Obstetrics clinicians to assess comfort in recognizing psychiatric symptoms and prescribing psychotropic medications during the perinatal period. After completion of the survey, respondents were provided with a copy of the FLIPP guide. A post-guide survey was sent two months later to assess changes in clinical knowledge and practices.

Results: Thirty-nine participants across different training levels completed the pre-guide survey: residents (n = 22), attendings (n = 8), and nurse-midwives (n=5). While most respondents (53%, n = 20) felt at least moderately comfortable identifying perinatal mood and anxiety disorders, a minority (30%, n = 11) felt at least moderately comfortable identifying other psychiatric disorders (e.g bipolar disorder, PTSD). The majority of respondents do not use psychiatric scales regularly (with 73%, n = 27 reporting using scales half of the time or less). The primary barriers to prescribing psychotropics to perinatal patients were insufficient training to have risk/benefit discussions about medications (36%, n = 12), lack of knowledge about medications (27%, n = 9), and concern about follow-up (24%, n = 8). This study is ongoing, but preliminary post-survey results (n = 9), showed that most respondents read all or some of the guide (89%, n = 8) and felt at least moderately more comfortable prescribing during pregnancy (83%, n = 5) and breastfeeding (67%, n = 4) after utilizing the guide.

Discussion: Preliminary results in our small sample show that, without specific training, obstetric providers are unlikely to use screening scales to identify perinatal mood and anxiety disorders and overall feel uncomfortable prescribing during pregnancy and postpartum, citing lack of training, knowledge, and concern about follow-up.

Conclusion: The FLIPP guide and similar modified toolkits may be useful in improving dissemination of psychiatric knowledge to obstetric colleagues, expanding care, and improving patient outcomes.

Acknowledgements: MCPAP for Moms https://www.mcpapformoms.org/Toolkits/Toolkit.aspx

References:

Byatt, N., Simas, T. A. M., Lundquist, R. S., Johnson, J. V., & Ziedonis, D. M. (2012). Strategies for improving perinatal depression treatment in North American outpatient obstetric settings. Journal of Psychosomatic Obstetrics & Gynecology, 33(4), 143-161.