The importance of correct assessment and treatment of psychiatric disease in pregnancy has been highlighted in the recent Confidential Enquiry into Maternal and Child Health. The authors evaluated our psychiatric outpatient service, run within our obstetric medicine clinic by a consultant psychiatrist, by auditing 40 referrals over 3 months in 2009, to see if appropriate women are being referred.
7(19%) women had a history of postnatal depression, 23 had a history of depression, 2 had eating disorders, 1 had an anxiety disorder, 1 ADHD, 1 a history of self-harm; 5 had no psychiatric history. 14 had previously been on medication and under psychiatric services but were now out of contact or discharged. A further 3 had received psychotherapy in the past. 62.5% were white, 30% Asian and 2.5% from black ethnic groups, compared with 50, 35 and 10% of the general obstetric population.
33 were diagnosed with depressive or anxiety disorders (including 22 with moderate or severe depression); 4 did not attend, 3 were well. 75% of those seen were assessed as needing medication (3 had already commenced it, 16 accepted, 6 declined). 24 (67%) required referral to the community health teams for monitoring.
This highlights the importance of access to a psychiatrist within the outpatient antenatal setting. Depressive disorder can lead to suicide, and early institution of care can be life saving.
Our audit also highlighted than women of black ethnicity were underrepresented, perhaps reflecting the need to develop a different assessment tool to better identify those needing referral.
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