Considerations for the provision of PTSD treatment among pregnant women with substance use histories: A clinical conceptual model based on case consultation field notes

Increasing prevalence of substance use in pregnancy presents a public health crisis that is compounded by posttraumatic stress disorder (PTSD) comorbidity. We aimed to detail the clinical complexities of PTSD treatment provision among pregnant women with substance use histories. We conducted a quali...

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Bibliographic Details
Published in:General hospital psychiatry 2023-09, Vol.84, p.3-11
Main Authors: Valentine, Sarah E., Alshabani, Nuha, Godfrey, Laura B., Paul, Emilie, Clark, Caitlin, Giovannini, Karissa, Nillni, Yael I.
Format: Article
Language:English
Subjects:
Exposure therapy
Female
Humans
Obstetrics
Pilot Projects
Posttraumatic stress disorder
Pregnancy
Pregnant Women
Referral and Consultation
Stress Disorders, Post-Traumatic - epidemiology
Substance use
Substance-Related Disorders - epidemiology
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Summary:Increasing prevalence of substance use in pregnancy presents a public health crisis that is compounded by posttraumatic stress disorder (PTSD) comorbidity. We aimed to detail the clinical complexities of PTSD treatment provision among pregnant women with substance use histories. We conducted a qualitative study using clinical case consultation field notes (N = 47 meetings) which were gathered during a hybrid effectiveness-implementation pilot study of Written Exposure Therapy (WET) for PTSD among pregnant women seen in an obstetrics-SUD clinic [2019–2021]. Patient baseline survey data (N = 25) were used to characterize the sample and contextualize engagement. Participants were exposed to a high number of trauma/adversity event types. There was no association between number of trauma/adversity event types and treatment response or dropout. Qualitative findings revealed clinical features relevant to PTSD treatment, including multi-system involvement; parental trauma and substance use; relevance of substance use to trauma context and posttraumatic cognitions, emotions, and behaviors; impact of trauma on experiences of pregnancy, attachment, and child rearing; limited social networks placing women at risk of ongoing violence; and experiences of substance use discrimination. PTSD treatment among pregnant women with substance use histories is highly important to maternal-child health.
ISSN:0163-8343
1873-7714
1873-7714
DOI:10.1016/j.genhosppsych.2023.05.013