Psychiatric Comorbidities and Treatment Adherence in Women Receiving Prenatal Medication Assisted Treatment for Opioid Use
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Date
2018-11-01
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Abstract
Introduction: Approximately 25-33% of pregnant women with an opioid use disorder have a comorbid psychiatric disorder. These comorbidities may contribute to poorer treatment adherence in medication assisted treatment (MAT) programs. As little research examines the psychiatric characteristics of pregnant women seeking MAT for opioid addiction, the purpose of this research is to describe psychiatric diagnoses and explore relationships among comorbidities and program adherence.
Method: Retrospective medical chart review was conducted for patients undergoing prenatal care at a multifaceted substance abuse treatment clinic that includes MAT, high-risk obstetric care, group counseling with social workers, and newborn planning. Analysis was conducted on 369 patients. Sample: Majority non-Hispanic, white (90.2%), Single (77.2%), Medicaid insurance (90.2%); Mmaternal age = 27.75 (SD = 11.264), Mgestational age at birth = 37.96 weeks (SD = 2.216), 61.47% being treated with buprenorphine/naloxone, and 33.06% being treated with methadone at the time of delivery.
Results: Half of the patients (50.25%) had at least one psychiatric diagnosis noted during pregnancy in their medical documentation. Of those patients with a diagnosis in pregnancy, a high percentage (91.90%) had a historical psychiatric diagnosis and 20.54% had a history of suicide attempt. Nearly two-thirds (60.54%) had documented illicit substance use during pregnancy other than opiates. Analyses exploring relationships between substance use, program adherence, and psychiatric diagnoses found that women with comorbid psychiatric diagnoses were more likely to test positive for an illicit substance during pregnancy and more likely to be discharged from care.
Conclusions: The rate of comorbid psychiatric diagnoses during pregnancy reported here is much higher than expected based on the literature. This clinic is unique in its multi-faceted approach, which likely contributes to greater attention to psychiatric care among providers. The analysis suggests women with comorbid psychiatric diagnoses are more likely to leave care and have more illicit drug use initially. However the data also shows that the differences in illicit drug use dissipate by delivery, theoretically due to STEPP’s involvement in care. These results highlight the importance of including psychiatry in prenatal MAT.
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Meyer, A., Sharp, M., Prasad, M., Whitlow, W. T., Lynch, C., & Carpenter, K. (April, 2018). Psychiatric Comorbidities and Treatment Adherence in Women Receiving Prenatal Medication Assisted Treatment for Opioid Use. Poster presented at the 39th Annual Meeting & Scientific Sessions of the Society of Behavioral Medicine, New Orleans, LA.