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Open Access 22-07-2023 | Antidepressant Drugs | Original Article

Assessing decisional conflict and challenges in decision-making among perinatal women using or considering using antidepressants during pregnancy—a mixed-methods study

Authors: Fatima Tauqeer, Anne Moen, Kirsten Myhr, Claire A. Wilson, Angela Lupattelli

Published in: Archives of Women's Mental Health | Issue 5/2023

Abstract

This study aims to investigate decisional conflict and elucidate challenges in decision-making among perinatal women using or considering using antidepressant (AD) during pregnancy. A sequential, mixed-methods study was employed among pregnant and postnatal women in Norway who had been offered ADs in the last 5 years. Quantitative data were obtained through an electronic questionnaire. Decisional conflict in pregnancy was assessed using the Decisional Conflict Scale (DCS) defined as either low (< 25) or moderate-high ( ≥ 25) (evaluated retrospectively for postnatal women). Logistic regression was used to identify factors associated with moderate–high decisional conflict. Qualitative data were collected through focus groups with pregnant and postnatal women, and an inductive approach was used for data analysis. Among 174 pregnant and 102 postnatal women, 67.8% and 69.6%, respectively, reported moderate–high decisional conflict during pregnancy. Unsatisfactory doctor-patient relationship was associated with greater likelihood of having moderate–high decisional conflict in pregnancy, both in pregnant (aOR = 1.20, 95% CI: 1.00–1.44) and postnatal women (aOR = 1.40, 95% CI: 1.08–1.82). Reported barriers to decision-making regarding AD use in pregnancy encompassed five DCS subscales: uninformed knowledge following contradictory research and unfamiliarity with authorised resources, unclear values due to emotional blunting and fear associated with AD use, inadequate support, uncertainty in decisions and ineffective decisions due to difficulty in finding personalised treatment, and diverging recommendations by the healthcare providers (HCPs). The quality of the interaction with the HCP plays a crucial role in managing decisional conflict and supporting informed decisions in the management of perinatal mental illness. This study highlights the need for increased provision of clear, evidence-based information by HCPs to facilitate shared decision-making and create personalised treatments for perinatal women considering AD use during pregnancy.

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Barker LC, Dennis C-L, Hussain-Shamsy N, Stewart DE, Grigoriadis S, Metcalfe K., . . . Vigod SN (2020a). Decision-making about antidepressant medication use in pregnancy: a comparison between women making the decision in the preconception period versus in pregnancy. BMC psychiatry, 20(1), 54–54. https://doi.org/10.1186/s12888-020-2478-8

Barker LC, Dennis CL, Hussain-Shamsy N, Stewart DE, Grigoriadis S, Metcalfe K., . . . Vigod SN. (2020b). Decision-making about antidepressant medication use in pregnancy: a comparison between women making the decision in the preconception period versus in pregnancy. BMC psychiatry, 20(1). https://doi.org/10.1186/s12888-020-2478-8

Bayrampour H, Kapoor A, Bunka M, Ryan D (2020) The risk of relapse of depression during pregnancy after discontinuation of antidepressants: a systematic review and meta-analysis. J Clin Psychiatry. 81(4):19r13134CrossRefPubMed

Becker M, Weinberger T, Chandy A, Schmukler S (2016) Depression during pregnancy and postpartum. Curr Psychiatry Rep 18(3):32. https://doi.org/10.1007/s11920-016-0664-7CrossRefPubMed

Biaggi A, Conroy S, Pawlby S, Pariante CM (2016) Identifying the women at risk of antenatal anxiety and depression: a systematic review. J Affect Disord 191:62–77. https://doi.org/10.1016/j.jad.2015.11.014CrossRefPubMedPubMedCentral

Bilszta JL, Tsuchiya S, Han K, Buist AE, Einarson A (2011) Primary care physician’s attitudes and practices regarding antidepressant use during pregnancy: a survey of two countries. Arch Womens Ment Health 14(1):71–75. https://doi.org/10.1007/s00737-010-0197-8CrossRefPubMed

Bjørndal LD, Tauqeer F, Heiervang KS, Clausen HK, Heitmann K, Lupattelli A (2022) Perceived risk of neurodevelopmental outcomes in offspring related to psychotropic and mental illness exposures in pregnancy and breastfeeding: a cross-sectional survey of women with past or current mental illness. BMJ open 12(9):e061159. https://doi.org/10.1136/bmjopen-2022-061159CrossRefPubMedPubMedCentral

Cox JL, Holden J, & Henshaw C (2014). Perinatal mental health: the Edinburgh postnatal depression scale (EPDS) manual: RCPsych publications London

Dennis CL, Falah-Hassani K, Shiri R (2017) Prevalence of antenatal and postnatal anxiety: systematic review and meta-analysis. Br J Psychiatry 210(5):315–323. https://doi.org/10.1192/bjp.bp.116.187179CrossRefPubMed

European Network of Teratology Information Services (ENTIS). (2022). Retrieved from https://www.entis-org.eu/about

Farr SL, Dietz PM, O’Hara MW, Burley K, Ko JY (2014) Postpartum anxiety and comorbid depression in a population-based sample of women. J Womens Health 23(2):120–128CrossRef

Gavin NI, Gaynes BN, Lohr KN, Meltzer-Brody S, Gartlehner G, Swinson T (2005) Perinatal depression: a systematic review of prevalence and incidence. Obstet Gynecol 106(5 Pt 1):1071–1083. https://doi.org/10.1097/01.AOG.0000183597.31630.dbCrossRefPubMed

Hippman C, Balneaves LG (2018) Women’s decision making about antidepressant use during pregnancy: A narrative review. Depress Anxiety 35(12):1158–1167. https://doi.org/10.1002/da.22821CrossRefPubMed

Kittel-Schneider S, Felice E, Buhagiar R, Lambregtse-van den Berg M, Wilson CA, Banjac Baljak V, . . . Lupattelli A (2022). Treatment of peripartum depression with antidepressants and other psychotropic medications: a synthesis of clinical practice guidelines in Europe. International Journal of Environmental Research and Public Health, 19(4), 1973. Retrieved from https://www.mdpi.com/1660-4601/19/4/1973

Kroenke K, Spitzer RL, Williams JB (2003). The Patient Health Questionnaire-2: validity of a two-item depression screener. Medical care, 1284–1292

Malterud K (2012) Systematic text condensation: a strategy for qualitative analysis. Scand J Public Health 40(8):795–805. https://doi.org/10.1177/1403494812465030CrossRefPubMed

McDonagh M, Matthews A, Phillipi C, Romm J, Peterson K, Thakurta S, & Guise JM (2014). Antidepressant treatment of depression during pregnancy and the postpartum period. Evid Rep Technol Assess (Full Rep)(216), 1–308. https://doi.org/10.23970/ahrqepcerta216

Metz MJ, Veerbeek MA, van der Feltz-Cornelis CM, de Beurs E, Beekman ATF (2018) Decisional conflict in mental health care: a cross-sectional study. Soc Psychiatry Psychiatr Epidemiol 53(2):161–169. https://doi.org/10.1007/s00127-017-1467-9CrossRefPubMed

Molenaar NM, Kamperman AM, Boyce P, Bergink V (2018) Guidelines on treatment of perinatal depression with antidepressants: an international review. Aust N Z J Psychiatry 52(4):320–327. https://doi.org/10.1177/0004867418762057CrossRefPubMedPubMedCentral

Molenaar NM, Bais B, Lambregtse-van den Berg MP, Mulder CL, Howell EA, Fox NS, . . . Kamperman AM (2020). The international prevalence of antidepressant use before, during, and after pregnancy: a systematic review and meta-analysis of timing, type of prescriptions and geographical variability. J Affect Disord, 264, 82–89. https://doi.org/10.1016/j.jad.2019.12.014

MotherToBaby. (2022). Retrieved from https://mothertobaby.org/

O’Connor A, Jacobsen M (2007) Decisional conflict: Supporting people experiencing uncertainty about options affecting their health. Ottawa Health Decision Centre, Ottawa

Oliver DG, Serovich JM, Mason TL (2005) Constraints and opportunities with interview transcription: towards reflection in qualitative research. Soc Forces 84(2):1273–1289CrossRefPubMedPubMedCentral

Patel SR, Wisner KL (2011) Decision making for depression treatment during pregnancy and the postpartum period. Depress Anxiety 28(7):589–595. https://doi.org/10.1002/da.20844CrossRefPubMedPubMedCentral

Petersen I, McCrea RL, Lupattelli A, Nordeng H (2015) Women’s perception of risks of adverse fetal pregnancy outcomes: a large-scale multinational survey. BMJ Open 5(6):e007390CrossRefPubMedPubMedCentral

Pluye P, Hong QN (2014) Combining the Power of stories and the power of numbers: mixed methods research and mixed studies reviews. Annu Rev Public Health 35(1):29–45. https://doi.org/10.1146/annurev-publhealth-032013-182440CrossRefPubMed

RELIS - Produsentuavhengig legemiddelinformasjon for helsepersonell (2022). Retrieved from https://relis.no/

Sandelowski M (2000) Focus on research methods combining qualitative and quantitative sampling, data collection, and analysis techniques. Res Nurs Health 23(3):246–255CrossRefPubMed

Spigset O, & Nordeng H (2016). Safety of psychotropic drugs in pregnancy and breastfeeding. Pharmacovigilance Psychiatry, 299–319

Statistics Norway n.d. ICT usage in households. Retrieved from https://www.ssb.no/en/teknologi-og-innovasjon/informasjons-og-kommunikasjonsteknologi-ikt/statistikk/bruk-av-ikt-i-husholdningene

Stevenson FA, Barry CA, Britten N, Barber N, Bradley CP (2000) Doctor–patient communication about drugs: the evidence for shared decision making. Soc Sci Med 50(6):829–840. https://doi.org/10.1016/S0277-9536(99)00376-7CrossRefPubMed

Stevenson F, Hamilton S, Pinfold V, Walker C, Dare CRJ, Kaur H, . . . Petersen I (2016). Decisions about the use of psychotropic medication during pregnancy: a qualitative study. BMJ open, 6(1), e010130. https://doi.org/10.1136/bmjopen-2015-010130

Trinh NTH, Nordeng HME, Bandoli G, Eberhard-Gran M, Lupattelli A (2022) Antidepressant and mental health care utilization in pregnant women with depression and/or anxiety: an interrupted time-series analysis. J Affect Disord 308:458–465. https://doi.org/10.1016/j.jad.2022.04.101CrossRefPubMed

Tryggmammamedisin. (2022). Retrieved from https://tryggmammamedisin.no/

UK Teratology Information Service (UKTIS). (2022). Retrieved from http://www.uktis.org/

van Gelder MM, Bretveld RW, Roeleveld N (2010) Web-based questionnaires: the future in epidemiology? Am J Epidemiol 172(11):1292–1298. https://doi.org/10.1093/aje/kwq291CrossRefPubMed

Ververs T, van Dijk L, Yousofi S, Schobben F, Visser GHA (2009) Depression during pregnancy: views on antidepressant use and information sources of general practitioners and pharmacists. BMC Health Serv Res 9(1):119. https://doi.org/10.1186/1472-6963-9-119CrossRefPubMedPubMedCentral

Vigod SN, Wilson CA, & Howard LM (2016). Depression in pregnancy. BMJ (Clinical research ed.), 352, i1547. https://doi.org/10.1136/bmj.i1547

Walton GD, Ross LE, Stewart DE, Grigoriadis S, Dennis C-L, Vigod S (2014a) Decisional conflict among women considering antidepressant medication use in pregnancy. Arch Womens Ment Health 17(6):493–501. https://doi.org/10.1007/s00737-014-0448-1CrossRefPubMed

Walton GD, Ross LE, Stewart DE, Grigoriadis S, Dennis CL, Vigod S (2014b) Decisional conflict among women considering antidepressant medication use in pregnancy. Arch Womens Mental Health 17(6):493–501. https://doi.org/10.1007/s00737-014-0448-1CrossRef

Title: Assessing decisional conflict and challenges in decision-making among perinatal women using or considering using antidepressants during pregnancy—a mixed-methods study
Authors: Fatima Tauqeer
Anne Moen
Kirsten Myhr
Claire A. Wilson
Angela Lupattelli
Publication date: 22-07-2023
Publisher: Springer Vienna
Keywords: Antidepressant Drugs
Antidepressant Drugs
Mood Disorders
Affective Disorder
Published in: Archives of Women's Mental Health / Issue 5/2023
Print ISSN: 1434-1816
Electronic ISSN: 1435-1102
DOI: https://doi.org/10.1007/s00737-023-01341-0

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Assessing decisional conflict and challenges in decision-making among perinatal women using or considering using antidepressants during pregnancy—a mixed-methods study

Abstract

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

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