A Qualitative Study of Treatment Needs Among Pregnant and Postpartum Women with Substance Use and Depression

Abstract

Little is known about treatment for pregnant and postpartum women with cooccurring substance use and depression. Funded by the National Institute of Drug Abuse, we conducted three focus groups with 18 pregnant and postpartum women in 2011 at an urban substance use treatment clinic. A semi-structured discussion guide probed for factors impacting treatment outcomes and needs. Data were analyzed using grounded theory. Women identified motivational, family, friend, romantic, and agency characteristics as facilitative or challenging to their recoveries, and desired structure (group treatment, a safe environment, and transportation) and content (attention to mental health, family, and gender-specific issues) of treatment.

RÉSUMÉ

Il y a peu de connaissances quant aux traitements pour les femmes enceintes et en période du post-partum et les effets d'usages de substance addictives et de la depression. Fondé par le National Institute of Drug Abuse, nous avons mené en 2011 trois focus groupes avec 18 femmes enceintes et en période du post-partum dans une clinique urbaine traitant l'usage de substances Un sondage, sous forme de discussion semi-structurée, visait à déterminer les facteurs qui influencent les résultats du traitements et les besoins. Les données ont été analysées en étant fondées sur des théories. Les femmes interrogées ont identifié que les motivations, la famille, les amis, les romances, et les résponsibilité personel sont soit des facilitateurs, soit des obstacles à leur rétablissement. Aussi, sont désirées des structures (groupe de traitement, un environnement sécuritaire, transport) ainsi que le contenu du traitement (attention à la santé, de la famille mental et questions sexospécifiques).

RESUMEN

Poco se sabe sobre el tratamiento del uso de sustancias y la depresión en mujeres embarazadas y en estado postparto. Patrocinado por el Instituto Nacional sobre el Abuso de Drogas, fueron conducidos tres grupos focales con 18 mujeres embarazadas y en estado postparto durante el 2011. Estas fueron conducidas en una clínica urbana de tratamiento para el uso de sustancias. Una guía de discusión semi-estructurada fue usada para investigar factores que impactan los resultados del tratamiento y las necesidades. Los datos fueron analizados usando la teoría fundamentada. Las mujeres identificaron características motivacionales, familiares, amistosas, románticas, y de agencialidad como factores de facilitación o factores que retan su recuperación, la estructura deseada (tratamiento de grupo, un ambiente seguro, transporte) y el contenido (atención a la salud mental, la familia, y asuntos específicos al género) del tratamiento.

Keywords :

• substance use
• major depressive disorders
• perinatal women
• treatment
• social support

THE AUTHORS

Caroline C. Kuo, DPhil, MPhil, is Assistant Professor in the Department of Behavioral and Social Sciences and in the Center for Alcohol and Addiction Studies at Brown University. She is a behavioral scientist focused on reducing mental health and HIV disparities among vulnerable populations in low resource settings. She is particularly interested in conducting community-engaged research and developing mental health and HIV interventions that are culturally appropriate and sustainable.

Yael Chatav Schonbrun, Ph.D., is an Assistant Professor in the Brown University Medical School, Providence, Rhode Island. Her main research fields are in qualitative research methodology, and dissemination of evidence based treatments to underserved populations.

Caron Zlotnick, Ph.D., is Professor (Research) in the Department of Psychiatry & Human Behavior, Medicine, and Obstetrics and Gynecology at Warren Alpert Brown Medical School. Her main focus is research related to the prevention and treatment of perinatal depression, trauma exposure, and posttraumatic stress disorder, especially among high-risk and financially disadvantaged women.

Nicole Bates, B.A., received her degree from Clark University and is currently working as a research assistant at Women and Infants Hospital in Rhode Island. Her main research interests involve couples therapy practices, intimacy, and sexual education. She plans to continue her education to pursue a career in couples and sex therapy.

Ralitsa Todorova, B.A., is pursuing her Ph.D. in Developmental Psychology at the Graduate Center at the City University of New York. Her main research interest is in adolescent development, particularly in regards to the health and educational outcomes of adolescents facing socioeconomic disparities. She is currently investigating approaches toward combating educational disparities among adolescents facing socioeconomic adversity.

Jennifer C. Kao, B.S., received her bachelor's degree in Neuroscience from Brown University. She works with perinatal women and incarcerated populations as part of a research team at The Warren Alpert Medical School of Brown University.

Jennifer Johnson, Ph.D., is clinical psychologist and an Associate Professor (Research) in the Department of Psychiatry and Human Behavior at Brown University. She is also affiliated with the Center for Prisoner Health and Human Rights. Her research focuses on interpersonal and gendered aspects of substance use disorder and major depression and their treatment among high-risk women, including women prisoners and perinatal substance users.