Abstract
Purpose
Postpartum psychosis (PP) is a severe psychiatric disorder affecting 1–2 per 1,000 deliveries. Prompt access to healthcare and timely initiation of treatment are crucial to minimizing harm and improving outcomes. This analysis seeks to fill gaps in knowledge surrounding barriers to care and treatment experiences among this population.
Methods
Participants were individuals with histories of PP who enrolled in the Massachusetts General Hospital Postpartum Psychosis Project (MGHP3). The MGHP3 Healthcare Access Survey, a cross-sectional questionnaire, assesses barriers to care, treatment-seeking behaviors, and experiences with treatment. Descriptive statistics were utilized to describe sample characteristics.
Results
139 participants provided 146 episode-specific survey responses. Lack of available services was cited as the greatest barrier to care for PP. Among those who sought treatment, obstetric providers (34.5%) and emergency medical professionals (29.4%) were the most common initial points of contact. 82.2% of the respondents went to an emergency room or crisis center during their episode(s). Most (61.8%) reported being given insufficient information to manage their PP. Approximately half of participants were hospitalized (55.5%), the majority of whom had no access to their infant during hospitalization (70.4%). Of those breastfeeding or pumping at admission, 31.3% were not given access to a breast pump. 44.4% dealt with delivery-related medical issues during their hospitalization.
Conclusion
This report is the first of its kind to assess key public health domains among individuals with PP. Findings point to several directions for future research and clinical practice to improve treatment timeliness and quality, potentially improving long-term outcomes related to this serious illness.
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Funding
This study was supported by the Jeanne and Gerhard Andlinger Research Fund for Innovative Science at Massachusetts General Hospital and The Rosalie Katz Family Foundation.
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Lauren A. Kobylski, MPH, Miranda H. Arakelian, BA, Margaret L. Gaw, BA, and Rachel Vanderkruik, PhD, MSc have no conflicts of interest to disclose.
Marlene P. Freeman, MD (as of 7/10/2023): Research Support: Dr. Freeman is an employee of Massachusetts General Hospital, and works with the MGH National Pregnancy Registry. MGH National Pregnancy Registry: Current Sponsors: Alkermes, Inc. (2016-Present); Eisai, Inc. (2022-Present); Johnson & Johnson/Janssen Pharmaceuticals, Inc (2019-Present); Otsuka America Pharmaceutical, Inc. (2008-Present); Sage Therapeutics (2019-Present); Supernus Pharmaceuticals (2021-Present); Teva Pharmaceutical Industries Ltd. (2018-Present). As an employee of MGH, Dr. Freeman works with the MGH CTNI, which has had research funding from multiple pharmaceutical companies and NIMH. Other Research Support: SAGE Therapeutics, JayMac. Advisory/Consulting, Data Safety Committees: Independent Data Safety and Monitoring Committees: Janssen (Johnson& Johnson), Novartis, Neurocrine; Advisory Boards: Eliem, Sage; Brainify; Everly Health; Tibi Health; Relmada; Beckley Psytech.
Speaking/Honoraria: WebMD, Medscape, Pri-Med, Postpartum Support International. Royalty/patent, other income: Scale Royalties- through MGH Scale, The Massachusetts Female Reproductive Lifecycle and Hormones Questionnaire.
Lee S. Cohen, MD (as of 1/20/2023): Research Support: Dr. Cohen is an employee of Massachusetts General Hospital, and works with the MGH National Pregnancy Registry. MGH National Pregnancy Registry: Current Sponsors: Alkermes, Inc. (2016-Present); Eisai, Inc. (2022-Present); Johnson & Johnson/Janssen Pharmaceuticals, Inc (2019-Present); Otsuka America Pharmaceutical, Inc. (2008-Present); Sage Therapeutics (2019-Present); Supernus Pharmaceuticals (2021-Present); Teva Pharmaceutical Industries Ltd. (2018-Present). As an employee of MGH, Dr. Cohen works with the MGH CTNI, which has had research funding from multiple pharmaceutical companies and NIMH. Other research support: National Institutes of Health; SAGE Therapeutics. Advisory/Consulting: None. Speaking/Honoraria: None. Royalty/patent, other income: None.
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Lauren A. Kobylski and Miranda H. Arakelian share co-first authorship
Lee S. Cohen and Rachel Vanderkruik share co-senior authorship
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Kobylski, L.A., Arakelian, M.H., Freeman, M.P. et al. Barriers to care and treatment experiences among individuals with postpartum psychosis. Arch Womens Ment Health (2024). https://doi.org/10.1007/s00737-024-01447-z
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DOI: https://doi.org/10.1007/s00737-024-01447-z