Faculty Bibliography

BACKGROUND:Existing literature about the psychological side effects of hormonal contraception (HC) is limited. The goal of this study is to better characterize patients' subjective experiences with HC, its side effects, and contraception counseling. METHODS:This is a cross-sectional, survey-based study using a convenience sample of patients who had used HC at some point in their lives. Recruitment occurred from June 2021-February 2022. RESULTS:Of the 188 responses included in the analysis, 43.6% reported experiencing mood changes as a side effect of HC at some point in their lives. The most common reason participants cited for discontinuing or switching contraception methods was side effects (48.3%). Participants with a history of psychiatric illness were significantly more likely to report mood changes as a side effect of their HC (61.2%) compared to participants with no history of psychiatric illness (29.5%). Among patients with a history of psychiatric illness, 38.8% responded that their psychiatric symptoms worsened with HC while only 11.2% responded that their symptoms improved with HC. The majority (83%) of participants responded that their provider never mentioned the possibility of psychological side effects during contraception counseling. If/when they experienced side effects associated with their HC, 22.7% of participants disagreed that their provider adequately addressed their concerns. CONCLUSION/CONCLUSIONS:These findings suggest that mood changes may be among the most common perceived side effects of HC and speak to a disconnect between patients and providers when it comes to discussing the possibility of psychological side effects with HC.

We describe a case of a 25-year-old Quiche (or K'iche') speaking G2P2022 (2 pregnancies, 2 term births, 2 live births) woman who was transferred from an outside hospital on postpartum day 3, to preserve mother-baby dyad while her infant required a higher level of care after suffering an apneic episode at 22 hours of life. Although the patient was a known Quiche speaker, lack of access to Quiche interpreters in the hospital led to the use of Spanish interpreters. Her treatment team sub-sequently described her affect as "flat" and reported "poor maternal care," leading to a report to the Administration for Children's Services. As we analyze this case, we use person-centered maternity care as a framework to discuss areas for improvement in providing care to peripartum individuals, as well as cultural safety and humility as solutions to cultural gaps between patients and providers.

Black, Latinx, and Indigenous women in need of perinatal mental health services encounter the intersection of disparities in both obstetric care and mental health care. It is essential that psychiatrists gain an understanding of the historic and remaining structural elements that may affect the quality of care provided to pregnant and pe-ripartum Black, Latinx and Indigenous patients. In this article, we briefly dis-cuss the historic context of structural racism in reproductive care. We then describe the current state of racial disparities in perinatal mental health. This is followed by a description of the structural elements that reinforce the effect of racism in perinatal men-tal health care as well as brief recom-mendations to begin to address these structures. The article begins and ends with illustrative cases describing the toll exacted by racial disparities and the potential remedies.