Considerations for the provision of PTSD treatment among pregnant women with substance use histories: A clinical conceptual model based on case consultation field notes.

Autor: Valentine SE; Department of Psychiatry, Boston University Chobanian & Avedisian School of Medicine Boston MA, USA; Department of Psychiatry, Boston Medical Center, Boston, MA, USA. Electronic address: sarah.valentine@bmc.org., Alshabani N; Department of Psychiatry, Boston Medical Center, Boston, MA, USA; Immigrant and Refugee Health Center, Boston Medical Center, Boston, MA, USA., Godfrey LB; Department of Psychiatry, Boston Medical Center, Boston, MA, USA., Paul E; Department of Psychiatry, Boston Medical Center, Boston, MA, USA., Clark C; Department of Obstetrics & Gynecology, Boston Medical Center, Boston, MA, USA; Department of Obstetrics & Gynecology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA., Giovannini K; Department of Obstetrics & Gynecology, Boston Medical Center, Boston, MA, USA; Department of Obstetrics & Gynecology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA., Nillni YI; Department of Psychiatry, Boston University Chobanian & Avedisian School of Medicine Boston MA, USA; National Center for PTSD, Women's Health Sciences Division at VA Boston Healthcare System, Boston, MA, USA.
Jazyk: angličtina
Zdroj: General hospital psychiatry [Gen Hosp Psychiatry] 2023 Sep-Oct; Vol. 84, pp. 3-11. Date of Electronic Publication: 2023 May 29.
DOI: 10.1016/j.genhosppsych.2023.05.013
Abstrakt: Objective: Increasing prevalence of substance use in pregnancy presents a public health crisis that is compounded by posttraumatic stress disorder (PTSD) comorbidity. We aimed to detail the clinical complexities of PTSD treatment provision among pregnant women with substance use histories.
Methods: We conducted a qualitative study using clinical case consultation field notes (N = 47 meetings) which were gathered during a hybrid effectiveness-implementation pilot study of Written Exposure Therapy (WET) for PTSD among pregnant women seen in an obstetrics-SUD clinic [2019-2021]. Patient baseline survey data (N = 25) were used to characterize the sample and contextualize engagement.
Results: Participants were exposed to a high number of trauma/adversity event types. There was no association between number of trauma/adversity event types and treatment response or dropout. Qualitative findings revealed clinical features relevant to PTSD treatment, including multi-system involvement; parental trauma and substance use; relevance of substance use to trauma context and posttraumatic cognitions, emotions, and behaviors; impact of trauma on experiences of pregnancy, attachment, and child rearing; limited social networks placing women at risk of ongoing violence; and experiences of substance use discrimination.
Conclusion: PTSD treatment among pregnant women with substance use histories is highly important to maternal-child health.
(Copyright © 2023 Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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