Women’s Psychiatry Expert Discusses Importance of Addressing Patients’ Sexual Harassment

Asking patients about their history with sexual harassment and abuse should be a routine part of psychiatric care, said APA Past President Nada Stotland, M.D., during her presentation at this year’s IPS: The Mental Health Services Conference. The comments were part of a wide-ranging lecture about important social issues facing women psychiatrists today.

Stotland, who is an expert on reproductive psychiatry and women’s issues, told the audience that psychiatrists can play key roles in helping people deal with and recover from their experiences of sexual harassment and/or sexual abuse. While she noted that identifying a patient’s sexual harassment history is important, she emphasized that such questions must be asked with empathy and sensitivity. If a patient has had such an experience, the psychiatrist’s focus should be on helping the patient deal with her reactions to her experience, such as self-recrimination, shame, guilt, and/or rage. “We need to validate their reactions,” she said.

Stotland recommended that psychiatrists should primarily use psychotherapy during the early stages of therapy and prescribe medications to patients with severe, acute symptoms. Once a good rapport has been reached, medications can be given on a case-by-case basis.

Risk of sexual harassment is not limited to patients, and Stotland also provided some suggestions for women psychiatrists to help protect themselves.

“Before accepting any job, get as much information as possible about the power structure of the employer and its sexual harassment history,” she stressed. Stotland added that women should also be aware of what support services are available at the institution or in the surrounding area should any problems arise.

To read more about sexual harassment in psychiatry, see the Psychiatric News article “Sexual Harassment Still Occurs in Psychiatry, Says Women’s Caucus Leader” and the Psychiatric Services article “Gold Award: Integrated Psychiatric Treatment for Survivors of Intimate Partner Violence at the Bronx Family Justice Center.”

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Abortion Does Not Lead to Long-Term Mental Health Problems, Study Suggests

A study that tracked the long-term mental health outcomes of women who obtained or were denied abortions has concluded that abortion does not increase a woman’s risk of mental health problems five years later. In fact, as was reported this week in JAMA Psychiatry, women who had obtained an abortion demonstrated more positive outcomes initially compared with women who were denied an abortion.

“There is a considerable amount of misinformation about negative mental health consequences as a result of abortion,” said former APA President Nada Stotland, M.D., who was not involved with the study. Stotland is an expert in reproductive psychiatry. “It’s important that we, as mental health professionals, have and provide evidence-based information to patients so that they may make their own decisions … without being influenced by inaccurate information,” she told Psychiatric News. 

For the study, M. Antonia Biggs, Ph.D., of the University of California, San Francisco, and colleagues recruited women aged 15 and older from 30 abortion clinics in 21 states throughout the United States. A total of 956 women were interviewed one week after seeking an abortion, and then every six months for five years. The researchers compared the mental health trajectories of women who received and were denied an abortion (due to the pregnancy being beyond the gestational limits of the facility). The group of women turned away from abortion was further divided into those who gave birth and those who miscarried or later had an abortion elsewhere.

The researchers found that women who were denied an abortion, particularly those who later miscarried or had an abortion elsewhere, had the most elevated levels of anxiety and lowest self-esteem and life satisfaction one week after being denied an abortion. These differences quickly improved and approached levels similar to those in the other groups by 6 to 12 months. 

“Our findings add to the body of evidence rejecting the notion that abortion increases women’s risk of experiencing adverse psychological outcomes,” Biggs and colleagues wrote. “Thus, there is no evidence to justify laws that require women seeking abortion to be forewarned about negative psychological responses.”  

“It’s time for mental health professionals and for our professional organizations to be more active advocates for this important issue,” Stotland said.

For related information, read APA's Position Statement on Abortion and Women’s Reproductive Health Care Rights. 

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FDA to Change Pregnancy and Lactation Labeling Information for Prescription Drugs

On Wednesday, the Food and Drug Administration (FDA) published a final rule that will set new standards for presentation of information concerning pregnancy and breastfeeding on labels of prescription drugs and biological products. The rule goes into effect June 15, 2015.

“The [current] letter category system [A, B, D, and X] was overly simplistic and was misinterpreted as a grading system, which gave an oversimplified view of the product risk," said Sandra Kweder, M.D., deputy director of the Office of New Drugs in the FDA’s Center for Drug Evaluation and Research, in a press statement. "The new labeling rule provides for explanations, based on available information, about the potential benefits and risks for the mother, the fetus, and the breastfeeding child.” The information provided under the new labeling requirements will be divided into the following categories:

Pregnancy: Containing information such as dosing and potential risks to the developing fetus and will require information about whether there is a registry that collects and maintains data on how pregnant women are affected when they use the drug.

Lactation: Containing information about using the drug while breastfeeding, such as the amount of drug in breast milk and potential effects on the breastfed child.

Females and Males of Reproductive Potential: Containing information about pregnancy testing, contraception, and infertility as it relates to the drug.

"The new system is potentially more informative and more useful than the old grading system, ... [but] a great deal will depend on the content of the information that is provided under the new requirements, particularly for psychotropic medicines," stated Nada Stotland, M.D., a professor of psychiatry at Rush University and an expert in OB-GYN psychiatry, in an interview with Psychiatric News. "If the information provided is reasonable and clear, it should help decrease the anxiety both psychiatrists and patients may feel regarding these medication decisions." Stotland, a former APA president, emphasized that psychiatrists must continue to inform the public about multiple treatment options—including psychotherapies and social support therapies—that can safely aid in lessening symptoms of mental illnesses during pregnancy. "If left untreated—or unsuccessfully treated—mental illness can have adverse consequences for both mother and child," she emphasized.

For research on the use of psychotropic drugs during pregnancy, see the Psychiatric News articles, “Lithium Use in Pregnancy May Contribute to Birth Defects, Miscarriages” and “Certain Cardiac Abnormalities Not Linked to Prenatal Antidepressant Use, Study Finds.”

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Prenatal Exposure to Antidepressants Shows No Cardiac-associated Risk in Offspring, Study Finds

New research shows that antidepressant pharmacotherapy does not appear to pose a risk for cardiac defects in infants born to women taking the medicines during the first trimester of pregnancy—including those that are contraindicated for pregnant women.

A research team led by Krista Huybrechts, Ph.D., of Harvard Medical School conducted a large-scale study with nearly 950,000 pregnant women from 2000 to 2007 to compare the potential risk of congenital cardiac birth defects in offspring of mothers exposed to antidepressants during the first trimester of pregnancy with those who were not taking the drugs.

Study findings, published in the New England Journal of Medicine, showed no significant difference between infants in terms of congenital cardiac defect born to women who took antidepressants during the first trimester and those who did not. In addition, the study found no association between cardiac abnormalities in offspring and maternal exposure to paroxetine or sertraline, drugs classified by the Food and Drug Administration as pregnancy category C and D for potential risks for ventricular defects in the fetus. The study was funded by the Agency for Healthcare Research and Quality and the National Institutes of Health.

“This is very reassuring news,” stated Nada Stotland, M.D., a professor of psychiatry at Rush University and expert in OB-GYN psychiatry, during an interview with Psychiatric News. "Nevertheless, psychotherapy is the optimal first choice for treatment for mild to moderate depression during pregnancy; there are no negative side effects, and the patient can also benefit from the support and insight intrinsic to psychotherapy." Stotland, a former APA president, emphasized that more-serious episodes of depression warrant a trial of antidepressant medication, because "untreated depression poses risk for mother, fetus, and newborn."

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