Supporting psychiatric mental health nurse practitioners’ preparedness to treat mental health concerns during pregnancy: Results from a grounded theory study

Background and objective: Pregnant persons are less likely to be screened and treated for depression and anxiety during pregnancy compared to the pre- and post-natal periods, despite adverse effects associated with untreated mental health concerns during pregnancy. Patients have reported that maternal and mental health providers seem unable or unwilling to discuss treatment with psychopharmacological options during pregnancy. Literature concerning this pattern has not included the perspective of psychiatric mental health nurse practitioners (PMHNP). The objective of this study was to identify the barriers and needs of PMHNPs regarding the treatment of mental health concerns during pregnancy.
Methods: In this constructivist grounded theory study, data were collected between February 2023 and February 2024 through in-depth interview. Eligible participants were PMHNPs, or PMHNP students, working with patients who might become pregnant in an outpatient setting.
Results: Seventeen PMHNPs or students participated in this study. Many believed they were unprepared to treat pregnant patients and described barriers and needs that impede their comfort and willingness to treat people who are pregnant. These included inadequate training, limited research, and concerns about legal liability. PMHNPs requested more information about perinatal mental health and its treatment to be incorporated into training programs and clinical experience.
Conclusions: Many PMHNPs were unaware or underinformed of available resources and best practices for treatment during pregnancy. In addition to best practices for the treatment of people who are pregnant, PMHNP programs should consider including preparation for the emotional consequences of practice as well as clear and accurate information about malpractice and liability risks.