(101) Barriers and Enablers of Decision-Making Considering Use of Antidepressants – A Mixed-Method Study Among Pregnant and Postpartum Women with a Mental Illness

Publication Number: 1146

Background: No study has fully shown how perinatal women with a mental illness contemplate decisions about the use of antidepressants (AD) in pregnancy or while breastfeeding.

Objectives: To address our current knowledge gaps on women’s barriers and preferences to treatment with AD in the perinatal period, as well as expectations about treatment and individual priorities.

Methods: This is a cross-sectional, web-based study conducted all over Norway in June 2019-June 2020. Women who were currently pregnant and had been offered antidepressants in the last 5 years could participate. This study applies a mix-method approach to examine decision-making perspectives among women considering antidepressant medication use in pregnancy and the postpartum period. In a sample of women, we characterized pregnant and postpartum women in relation to key variables such as sociodemographic and clinical features. Further, we conducted four focus groups with pregnant and postpartum women with moderate to high decision-making difficulty to explore the considerations and support needs of these women. Thematic networks as an analytical tool for qualitative analysis was used.

Results: 276 women participated. Pregnant women with high decisional conflict (DC) (n=125) were older, had higher education and were more often employed, more often nulliparous, more often had a psychiatric illness and fewer users of antidepressants than women with low DC (n=47). Similar characteristics were seen in postpartum women with high DC (n=75) with the exception of age and history of psychiatric illness; low DC women (n=29) were older with a higher prevalence of psychiatric illness. Findings from the focus groups showed enablers in decision-making regarding AD use such as regular discussions and proper communication with healthcare providers and follow-ups; fear of postpartum depression and disease severity and unfamiliarity with the potential risks of the medication. Barriers in decision-making regarding AD use included concerns regarding mother and foetal health, difficulty in access to urgent help & referrals, diverging recommendations by the healthcare providers and a plethora of online resources and inadequately informed decision-making.

Conclusions: The difficulty in the decision-making seems to be driven by gaps in knowledge about antidepressant use during and after pregnancy, concerns about the health of the mother and child, and disease severity and unfamiliarity with the potential risks of the medication. Due to a plethora of online resources, it is difficult to get the right help and information. Individual perception of the antidepressant benefit-risk differential and specialized support are key factors to consider when managing perinatal psychiatric illness.