Psychiatrists' Perceptions of the Barriers and Facilitators to Sexual and Reproductive Health Care of Adult Women with Severe Mental Illness in an Outpatient Setting Público

Abstract

Background: Women of reproductive age living with severe mental illnesses are less likely to receive critical preventive services, and are more likely to suffer from sexually transmitted infections. Mental health care settings function as the main point of access to the health care system for these women. Consequently, there is a need for psychiatrists to be better equipped to handle the sexual and reproductive health needs of their patients.

Goal: The purpose of this research project is to better understand psychiatrists' perspectives on providing sexual and reproductive healthcare to women seen in a psychiatric outpatient setting, focusing on barriers and facilitators.

Methods: This study utilized qualitative, structured in-depth interviews to understand the psychiatrists' perspective. The study included resident and attending psychiatrists who have worked at or currently work at Grady Behavioral Outpatient Center. The interview topics included the psychiatrists' perceptions of their role in providing STI testing, STI treatment, and safe sex education.

Results: Psychiatrists reported a variety of factors that affect whether, and to what extent, they provide or connect patients with sexual and reproductive health services. The Social-Ecological Model provides a useful framework to understand the interaction between the individual, interpersonal, organizational, community, and policy levels of influence.

Discussion: The most significant barrier to sexual and reproductive health care for women with severe mental illness is a fragmented health care system. Psychiatrists working in outpatient settings are uniquely positioned to either provide or connect their female patients with important STI services, and safe sex education. Additionally, healthcare models that integrate medical and mental health services may provide a solution to addressing the health disparities in this population.

Implications: This study provides an opportunity to understand the factors that inhibit and facilitate care for this population in mental health settings, thus improving sexual and reproductive health outcomes.

Table of Contents

1 INTRODUCTION 1

1.1 RESEARCH GAP 2

1.2 PURPOSE STATEMENT, RESEARCH QUESTION AND AIMS 2

1.3 SIGNIFICANCE STATEMENT 3

1.4 DEFINITION OF TERMS 3

1.5 SUMMARY 4

2 LITERATURE REVIEW 6

2.1 SEVERE/ SERIOUS MENTAL ILLNESS 6

2.2 SOCIETAL-LEVEL FACTORS 7

2.3 FRAGMENTATION OF CARE 7

2.4 ACCESS TO MEDICAL SERVICES 8

2.5 SEVERE MENTAL ILLNESS AND HEALTH SCREENINGS 9

2.6 SEVERE MENTAL ILLNESS AND HEALTH OUTCOMES 10

2.7 SEXUAL RISK FACTORS 10

2.8 SEXUALLY TRANSMITTED INFECTIONS 12

2.9 GRADY BEHAVIORAL OUTPATIENT CENTER PATIENT POPULATION 13

2.10 PROFESSIONAL STANDARDS 14

2.11 PROVIDER BARRIERS 14

2.12 2015 PSYCHIATRIST SURVEY 15

2.13 THE SOCIAL-ECOLOGICAL MODEL 16

2.14 SEXUAL AND REPRODUCTIVE HEALTH RESEARCH PROJECT 18

2.15 SUMMARY 20

3 METHODS 21

3.1 STUDY SAMPLE 21

3.2 IN-DEPTH INTERVIEW GUIDE 22

3.3 STUDY SITES 22

3.4 GRADY MEMORIAL HOSPITAL AND BEHAVIORAL HEALTH OUTPATIENT SERVICES 22

3.5 DATA COLLECTION 23

3.6 DATA MANAGEMENT AND DATA ANALYSIS 23

3.7 LIMITATIONS 24

3.8 SUMMARY 24

4 RESULTS 25

4.1 BACKGROUND INFORMATION ON PARTICIPANTS 25

4.2 PHYSICIAN RESPONSIBILITY FOR SEXUAL AND REPRODUCTIVE HEALTH CARE 26

4.3 PSYCHIATRIST'S ROLES 28

4.4 PSYCHIATRIST COMFORT LEVEL 31

4.5 PATIENT-PHYSICIAN RELATIONSHIP 32

4.6 PATIENT-RELATED FACTORS 33

4.7 PATIENT DIAGNOSIS 34

4.8 PHYSICIAN TRAINING 35

4.9 POWER DYNAMIC WITH ATTENDING PSYCHIATRISTS 37

4.10 TIME MANAGEMENT 38

4.11 REFERRAL PROCESSES 40

4.12 RESOURCES: EQUIPMENT, TREATMENTS, AND SUPPORTING STAFF 43

4.13 ELECTRONIC MEDICAL RECORD 44

4.14 LIABILITY 45

4.15 SOCIAL ECOLOGICAL MODEL 48

4.16 STRENGTH AND LIMITATIONS 51

4.17 SUMMARY 52

5 DISCUSSION 54

5.1 CONTRIBUTIONS TO THE LITERATURE 54

THE SOCIAL-ECOLOGICAL MODEL 56

5.2 FRAGMENTATION OF CARE 57

5.3 RECOMMENDATIONS AND IMPLICATIONS 58

5.4 ALTERNATIVE MODELS FOR CARE 61

5.5 FUTURE RESEARCH 62

5.6 PUBLIC HEALTH IMPLICATIONS 62

5.7 CONCLUSION 65

6 REFERENCES 66

7 APPENDIX A: RECRUITMENT E-MAIL 71

8 APPENDIX B: IDI GUIDE 72

About this Master's Thesis

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• Permission granted by the author to include this thesis or dissertation in this repository. All rights reserved by the author. Please contact the author for information regarding the reproduction and use of this thesis or dissertation.

School	Rollins School of Public Health
Department	Hubert Department of Global Health
Degree	MPH
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Public Health Health Sciences, Mental Health
Palavra-chave	Psychiatry Sexual and Reproductive Health Sexually Transmitted Infections Mental Health STIs SMI
Committee Chair / Thesis Advisor	Evans, Dabney, Emory University
Committee Members	Von Esenwein, Silke, Emory University
Partnering Agencies	Emory University schools, faculty or affiliated programs Hospital or other health care provider

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