番茄社区

COLORADO SPRINGS, Colo. -- Women's group sessions conducted at a single psychiatric unit improved participants' understanding and comfort discussing topics related to reproductive health, according to survey data from a small trial program.

After 13 sessions, all of the 32 participants said they better understood the contraceptive options available to them and reported feeling better prepared to seek the contraceptive methods that were most appropriate for them, noted Avanti Puri, MD, of Arnot Ogden Medical Center in Elmira, New York, during the 2022 Neuroscience Education Institute Congress.

The survey showed that just 26.4% of participants self-identified as using contraception, and 50% reported having had an unplanned pregnancy. About 24% had an abortion, and 26.4% had child protective services involved in their family life.

Puri pointed out that women with mental illness are five times more likely to have an unplanned pregnancy due to lower rates of effective contraception use.

"Most often [for] these women, their primary point of contact with the healthcare system is psychiatry," Puri told 番茄社区.

"This is one of the things that got me into psychiatry, seeing how high risk an inpatient psychiatric population is and how generational it can become -- if they're having kids that potentially are being removed from their custody, being raised in the foster care system, suffering more abuse, and it just becomes so generational," she said.

Most of the women in this patient population are often homeless, have substance use disorders, and have several other major risk factors for poor reproductive health outcomes, she added, explaining that it is less common for these women to receive education about reproductive health and family planning, in part because they are not made available in inpatient mental health settings.

"We don't think about contraception and women's healthcare being part of psychiatry, but with how high risk our population is, it needs to be," Puri said. "I've seen and heard of multiple patients who are pregnant on an inpatient unit. They're psychotic. They are going back and forth [on] whether they need to keep the pregnancy."

She highlighted the difficulties in managing these patients' care while also trying to support their health outside of their psychiatric disorders, adding that it is an aspect of healthcare that has led many of her colleagues to ask, "how do we go about this?" and "what's the ethical way to do this?"

For this trial program, Puri and colleagues developed weekly groups in their psychiatric inpatient unit. The sessions were led by psychiatry residents who were trained and provided a script for the groups. Each session began with scripted contraception education followed by a question-and-answer period with the participants.

The researchers collected data on the women's experiences with reproductive health and family planning, including their history of contraception use, unplanned pregnancies, and the percentage of women who found the group helpful. Attendance for the sessions by the women in the inpatient unit was 42%.

The sessions were conducted in an open-discussion format to allow participants to share their experiences, which also had the effect of being therapeutic, according to Puri. They also received positive feedback from both the participants and the staff, and many patients requested future group sessions to discuss other issues important to them, such as motherhood or domestic violence.

These groups will hopefully lead to appropriate referral and follow-up with primary care or women's clinic providers, Puri said, noting that the goal is to increase group attendance and staff participation to help build the program.

"This is a pretty low-effort intervention, honestly," she added. "If this could become a standard of care in inpatient units, I think that would be amazing."

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