Scientific Abstract

Background: Perinatal mental health concerns are common, but many psychiatrists do not feel confident treating in the peripartum, as reproductive psychiatry exposure during training is highly variable. Substantial barriers to access in academic subspecialty centers have been reported; however, challenges accessing reproductive psychiatry services in the community have not been studied. This study identifies and quantifies care deserts at the state level.

Methods: This study analyzed publicly accessible data. The number of births and women ages 15-49 per state was obtained from the 2020 Census. Reproductive psychiatrists were defined as MD/DO psychiatrists on Psychology Today indicating ‘pregnancy/perinatal/postpartum’ as an ‘Issue’ they treat. Google Trends provided relative predominance by state of the search term ‘postpartum depression’. Abortion restrictiveness was defined by the Guttmacher Institute. Density of reproductive psychiatry care was calculated using the above data as the number of reproductive psychiatrists per 100,000 reproductive age women in the state and Spearman correlations were performed between variables.

Results: 23 states had a ratio of less than one psychiatrist comfortable treating in the peripartum per 100,000 reproductive age women. Where reproductive psychiatric care density was lower, Google searches for ‘postpartum depression’ were more prevalent (R= -0.47, p = 0.0006). More restrictive state policies on abortion were correlated both to lower reproductive psychiatric care density (R= -0.46, p =0.0007) and higher prevalence of searches for ‘postpartum depression’ (R=0.55, p<0.0001).

Conclusions: When attempting to self-refer in the community, individuals confront a scarcity of psychiatrists comfortable with care in the peripartum in most states. That reproductive psychiatric care deserts correlate strongly with higher prevalence of Google searches for ‘postpartum depression’ suggests an unmet need for services. States with restrictive abortion policies are likely to see higher levels of psychological distress the peripartum population yet are highly underserved currently with regards to reproductive psychiatric care.