Perinatal Mood, Anxiety, and Substance Use Disorders: Are Future U.S. Obstetric Physicians Being Trained to Address the Most Common Complications of Pregnancy?

Background/Objective: Perinatal mental health conditions and substance use disorders are the most common complications of pregnancy and the leading cause of overall and preventable maternal mortality. These conditions remain under-detected and under-treated. Both the Council on Resident Education in Ob/Gyn and the American Academy of Family Physicians expect graduating residents to be competent at diagnosing and treating perinatal mental health and substance use disorders. This study surveyed contemporary obstetric trainees to understand training modalities being utilized and confidence addressing steps in the perinatal mental health care pathway to understand current state, unmet needs, and educational opportunities. Methods: Web-based cross-sectional anonymous survey developed and distributed via Qualtrix in October 2019 to Ob/Gyn and Family Medicine (FM) residents in U.S. programs accredited by the Accreditation Committee of Graduate Medical Education (ACGME; 282 Ob/Gyn, 455 FM, and 93 MFM programs). Respondents self-reported exposure to 8 modes of training and separately, their confidence addressing perinatal mental health and substance use disorders on 6-point Likert scales. Results: Total respondents (n=125) included 69.6% Ob/Gyn and 30.4% FM trainees representing all U.S. regions. For both perinatal mental health and substance use disorders the majority (75% and 68% respectively) trained via didactic sessions. Most respondents felt at least moderate confidence detecting, assessing, and treating both depression and anxiety (82% and 72% respectively). A majority reported at least moderate confidence in determining when to refer for therapy (81%), when and how to start medications for depression and anxiety (67%). In general, smaller proportions were calculated across the pathway for substance use disorders. The majority responded they should have ‘more’ or ‘a lot more’ training in depression and anxiety disorders (78% Ob/Gyn, 61% FM) and substance use disorder (91% Ob/Gyn, 79% FM). Conclusions: To make significant progress in increasing detection, assessment, and treatment access for perinatal mental health and substance use disorders, the next generation of clinicians need more training and greater confidence in their abilities. Graduate medical education for obstetric clinicians has a critical opportunity to address perinatal mental health and substance use disorders and thus improve intergenerational outcomes and decrease maternal morbidity and mortality.