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Decisional conflict among women considering antidepressant medication use in pregnancy

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Abstract

The purpose of this study was to examine decision-making among women considering antidepressant medication use in pregnancy. Decisional conflict was assessed using the Decisional Conflict Scale (DCS) among pregnant women considering antidepressant medication treatment (N = 40). Overall DCS and subscale scores were compared between women who were antidepressant users and non-users. Semi-structured interviews (N = 10) explored barriers and facilitators of decision-making. Twenty-one women (52 %) had moderate or high decisional conflict (DCS ≥ 25). Overall DCS scores did not differ between groups, but antidepressant use was associated with feeling more adequately informed (subscale mean 17.5, SD 17.9 vs. 42.1, SD 23.8, p = 0.001) and clear about values (subscale mean 16.7, SD 15.1 vs. 29.8, SD 24.0, p = 0.043). Barriers to decision-making were (1) difficulty weighing maternal versus infant health, (2) lack of high quality information, (3) negative external influences, and (4) emotional reactions to decision-making. Facilitators were (1) interpersonal supports, (2) accessible subspecialty care, and (3) severe depressive symptoms. Many pregnant women facing decisions regarding antidepressant medication use experience decisional conflict. Interventions that provide accurate information, assistance with weighing risks and benefits of treatment, management of problematic external influences, and emotional support may reduce decisional conflict and facilitate the decision-making process.

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Acknowledgments

The study was conducted at the Women’s College Research Institute, Women’s College Hospital, fully affiliated with the University of Toronto, in Toronto, Ontario, Canada. We would like to acknowledge Ms. Talia Leszcz and Ms. Sarah Somerton for their important work in the preparation of research ethics boards submissions, data collection, and overall study management for this research project. Ms. Leszcz and Ms. Somerton were employed as research assistants through the Women’s College Research Institute at Women’s College Hospital in Toronto, Ontario. Funding for the research was provided by an operating grant from the Alternate Funding Program Physician Innovation Fund of the Ontario Ministry of Health and Long Term Care (MOHLTC). The opinions, results, and conclusions reported in this paper are those of the authors and are independent from the funding sources. No endorsement by the Ontario MOHLTC is intended or should be inferred.

Integrity of research and reporting

This study was approved by the Research Ethics Board at Women’s College Hospital in Toronto, Ontario (REB# 2011-0011-B, approved May 16, 2011) and has been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments. All persons gave their informed consent prior to inclusion in the study.

Conflict of interest

The authors of this study report no conflict of interest. Within the past 3 years, Dr. Vigod and Dr. Grigoriadis received a one-time consulting fee from Multi-Dimensional Health Care (MDH) consulting for the development of continuing health-care activities related to perinatal mental health, Dr. Vigod and Dr. Stewart received compensation as UpTodate co-authors of Infants and Antenatal Exposure to SSRIs and SNRIs During Pregnancy, Dr. Stewart is on the Scientific Advisory Board of Cymbalta Pregnancy Registry, Eli Lilly, and Drs. Walton, Ross, and Dennis have no relevant financial disclosures.

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Authors and Affiliations

  1. Department of Psychiatry, University of Toronto, Toronto, ON, Canada

    Georgia D. Walton, Lori E. Ross, Donna E. Stewart, Sophie Grigoriadis, Cindy-Lee Dennis & Simone Vigod

  2. Women’s College Research Institute, Centre for Addiction and Mental Health, University of Toronto, Toronto, ON, Canada

    Lori E. Ross

  3. University Health Network, University of Toronto, Toronto, ON, Canada

    Donna E. Stewart

  4. Sunnybrook Research Institute, University of Toronto, Toronto, ON, Canada

    Sophie Grigoriadis

  5. Faculty of Nursing, Women’s College Hospital, Women’s College Research Institute, University of Toronto, Toronto, ON, Canada

    Cindy-Lee Dennis

  6. Women’s College Hospital, Women’s College Research Institute, University of Toronto, 76 Grenville St., Toronto, ON, M5S 1B2, Canada

    Simone Vigod

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  1. Georgia D. Walton
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  2. Lori E. Ross
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  3. Donna E. Stewart
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  4. Sophie Grigoriadis
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  5. Cindy-Lee Dennis
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  6. Simone Vigod
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Correspondence to Simone Vigod.

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Walton, G.D., Ross, L.E., Stewart, D.E. et al. Decisional conflict among women considering antidepressant medication use in pregnancy. Arch Womens Ment Health 17, 493–501 (2014). https://doi.org/10.1007/s00737-014-0448-1

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  • DOI: https://doi.org/10.1007/s00737-014-0448-1

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