title: Success of mental health referral among pregnant and postpartum women with psychiatric distress.
abstract: OBJECTIVE
  This study measured rates of and determined factors associated with mental health service use among a cohort of 465 pregnant and postpartum women receiving care from publicly funded obstetric clinics.
  
  
  METHODS
  Women underwent a diagnostic evaluation, were provided with at least one mental health referral and were encouraged to seek treatment; follow-up with provision of additional referrals occurred at 1, 3 and 6 months after the initial assessment. Logistic regression was used to estimate the relationship between clinical and psychosocial factors and self-reported mental health service use.
  
  
  RESULTS
  Of the referred women, 38.1% attended at least one mental health visit, while only 6% remained in treatment during the entire 6-month follow-up interval. Postpartum women were more likely than pregnant women to attend a mental health treatment visit [odds ratio (OR)=4.17]. Being born in the United States (OR=2.06), being exposed to interpersonal violence (OR=2.52) and being unemployed (OR=2.69) were associated with attending at least one mental health-care visit. Women who received a behavioral health referral to the same site as their prenatal or postpartum care were more likely than those referred offsite to attend a mental health treatment visit (OR=3.23).
  
  
  CONCLUSIONS
  Despite active follow-up, rates of accessing and particularly continuing in mental health treatment were low. More work is needed to support the integration of specialty behavioral health services in primary care settings accessed by perinatal women.
authors.affiliation: Department of Epidemiology and Public Health, Yale University School of Medicine, New Haven, CT 06510, USA. megan.smith@yale.edu
authors.forename: Megan V
authors.initials: MV
authors.lastname: Smith
authors.forename: Lin
authors.initials: L
authors.lastname: Shao
authors.forename: Heather
authors.initials: H
authors.lastname: Howell
authors.forename: Hong
authors.initials: H
authors.lastname: Wang
authors.forename: Karalee
authors.initials: K
authors.lastname: Poschman
authors.forename: Kimberly A
authors.initials: KA
authors.lastname: Yonkers
mesh_terms: D000328:Adult; D019052:Depression, Postpartum / Q000453:epidemiology* / Q000523:psychology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007398:Interpersonal Relations; D008605:Mental Health Services / Q000706:statistics & numerical data*; D011247:Pregnancy; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D014481:United States / Q000453:epidemiology; D014754:Violence / Q000706:statistics & numerical data