Psychiatric Disorders in Economically Disadvantaged Pregnant Women:
Treatment and Policy Implications
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Cynthia A. Loveland Cook
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School of Social Service
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St. Louis University
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3550 Lindell Boulevard
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St. Louis MO 63103
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CookGreer@aol.com
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Louise H. Flick
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School of Nursing
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St. Louis University
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3525 Caroline Mall
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St. Louis MO 63104
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Sharon M. Homan
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School of Public Health
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St. Louis University
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3663 Lindell Boulevard
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St. Louis MO 63103
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Claudia Campbell
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School of Public Health
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St. Louis University
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3663 Lindell Boulevard
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St. Louis MO 63103
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Maryellen McSweeney
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School of Nursing
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St. Louis University
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3525 Caroline Mall
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St. Louis MO 63104
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MaryBeth Gallagher
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School of Social Service
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St. Louis University
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3550 Lindell Boulevard
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St. Louis MO 63103
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Lisa A. Parnell
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School of Social Service
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St. Louis University
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3550 Lindell Boulevard
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St. Louis MO 63103
Purpose: Research demonstrates that psychiatric symptoms and
psychological distress are associated with poor birth outcomes, such as
low birth weight (LBW) and small-for-gestational age (SGA) infants.
LBW and SGA infants who do survive have a higher probability of suffering
from chronic, costly disabilities over their lifespan. Despite this
evidence, little is known about the prevalence of psychiatric disorders
in community-based samples of pregnant women, particularly those living
in poverty.
Methods: This prevalence study of DSM-IV psychiatric diagnoses
in economically disadvantaged women is part of a larger NIMH-funded research
project. A sample of 800 pregnant women on Medicaid who received
WIC services in the Midwest stratified by race (African American and Caucasian)
and residence (rural and urban) participated in the study. Personal
interviews were conducted in 2000 – 2001 using the Diagnostic Interview
Schedule to determine the presence or absence of current and lifetime psychiatric
diagnoses, including mood, anxiety, substance-related, psychotic, personality
and eating disorders, as well as Posttraumatic Stress Disorder.
Results: Preliminary findings suggest that nearly one
out of four women have one or more lifetime psychiatric diagnoses, excluding
nicotine use. The most common psychiatric disorders are: PTSD
(15.1%), mood disorders (12.0%), anxiety disorders (7.9%), alcohol dependence/abuse
(8.4%), behavior disorders (7.9%), and drug dependence/use (7.2%).
In the larger study, outcome data are being collected on neonatal health
status, costs of care and health service utilization.
Implications for Practice: With both prevalence and outcome
data, policy makers can better evaluate the merits of allocating resources
to detect and treat prenatal psychiatric disorders, as well as reduce unnecessary
health care costs. The preliminary findings alone suggest the need
to screen pregnant women for psychiatric disorders and appropriately refer
them for mental health treatment.