title: Decisional conflict among women considering antidepressant medication use in pregnancy.
abstract: The purpose of this study was to examine decision-making among women considering antidepressant medication use in pregnancy. Decisional conflict was assessed using the Decisional Conflict Scale (DCS) among pregnant women considering antidepressant medication treatment (N = 40). Overall DCS and subscale scores were compared between women who were antidepressant users and non-users. Semi-structured interviews (N = 10) explored barriers and facilitators of decision-making. Twenty-one women (52 %) had moderate or high decisional conflict (DCS ≥ 25). Overall DCS scores did not differ between groups, but antidepressant use was associated with feeling more adequately informed (subscale mean 17.5, SD 17.9 vs. 42.1, SD 23.8, p = 0.001) and clear about values (subscale mean 16.7, SD 15.1 vs. 29.8, SD 24.0, p = 0.043). Barriers to decision-making were (1) difficulty weighing maternal versus infant health, (2) lack of high quality information, (3) negative external influences, and (4) emotional reactions to decision-making. Facilitators were (1) interpersonal supports, (2) accessible subspecialty care, and (3) severe depressive symptoms. Many pregnant women facing decisions regarding antidepressant medication use experience decisional conflict. Interventions that provide accurate information, assistance with weighing risks and benefits of treatment, management of problematic external influences, and emotional support may reduce decisional conflict and facilitate the decision-making process.
authors.affiliation: Department of Psychiatry, University of Toronto, Toronto, ON, Canada.
authors.forename: Georgia D
authors.initials: GD
authors.lastname: Walton
authors.forename: Lori E
authors.initials: LE
authors.lastname: Ross
authors.forename: Donna E
authors.initials: DE
authors.lastname: Stewart
authors.forename: Sophie
authors.initials: S
authors.lastname: Grigoriadis
authors.forename: Cindy-Lee
authors.initials: CL
authors.lastname: Dennis
authors.forename: Simone
authors.initials: S
authors.lastname: Vigod
mesh_terms: D000328:Adult; D000928:Antidepressive Agents / Q000627:therapeutic use; D003220:Conflict, Psychological; D003376:Counseling; D003430:Cross-Sectional Studies; D003657:Decision Making; D003661:Decision Support Techniques; D003863:Depression / Q000188:drug therapy; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007407:Interviews as Topic; D010358:Patient Participation; D011247:Pregnancy; D036301:Qualitative Research; D055815:Young Adult
chemical_list: D000928:Antidepressive Agents