VA Mental Health Use During Pregnancy/Postpartum Periods Remained Strong among Women with Prepregnancy Depression, PTSD, and Anxiety Diagnoses
Psychiatric disorders during pregnancy and postpartum are prevalent in the general population, and, if left unrecognized, may negatively affect the health of the mother and baby. Compared to the general population, female Veterans have unique needs for perinatal mental healthcare, and there has been a significant increase in the number of women receiving VA maternity benefits in the last decade that is expected to continue to grow as VA offers maternity care for women Veterans through referral to community providers. This study examined how prepregnancy psychiatric diagnoses could impact treatment use during pregnancy and postpartum, given there is increased risk of symptom recurrence and/or medication discontinuation during pregnancy. Data for this analysis were obtained from the Center for Maternal & Infant Outcomes & Research in Translation (COMFORT) study. The study cohort included 594 pregnant Veterans recruited from 15 VA healthcare facilities across the U.S., most (99%) having served in OEF/OIF/OND. Two telephone surveys were conducted: one during the second or third trimester (20-24 weeks of gestation) and a second within three months after delivery. The telephone surveys collected information on sociodemographic characteristics, military service, health status, healthcare use, social support, and pregnancy- and delivery-related factors. Depression symptoms also were assessed.
- There was a strong correlation between a prepregnancy diagnosis of major depressive disorder (MDD), PTSD, or anxiety and use of mental healthcare during pregnancy and postpartum period. For women with these pre-pregnancy diagnoses, there was an increase in the use of psychotherapy during pregnancy and postpartum, while the percentage of women using antidepressants only or antidepressants plus therapy decreased during the same time periods; 42% of women reported stopping their antidepressants at the onset of the pregnancy.
- Over the study period (pre-conception through postpartum), 32%, 27%, and 22% of Veterans were diagnosed with MDD, PTSD, or anxiety, respectively. Military sexual trauma was highly prevalent, with 53% of Veterans reporting experiences of sexual harassment and 30% reporting being victims of rape during military service.
- VA clinicians should be educated on pregnancy and postpartum mental health needs of female Veterans within VA, and patients should be counseled on various treatment strategies during pregnancy and postpartum periods.
- The new onset of depression during pregnancy and the postpartum period was not examined.
This study was funded by HSR&D (IIR 13-081). Drs. Kroll-Desrosiers, Copeland, and Mattocks are part of the VA Central Western Massachusetts Healthcare System.
Shivakumar G, Kroll-Desrosiers A, Copeland L, Anderson E, Maydon A, and Mattocks K. Patterns of Treatment Utilization across the Perinatal Period in the COMFORT Veterans Study. Journal of Women’s Health. November 18, 2020; Online ahead of print.