Call to Action for Psychiatry Residency Programs: Training in Perinatal Mental Health
As part of PRMS’ ongoing commitment to behavioral health, we invited Dr. Brittany Ranieri to be featured as a guest blogger this month. Dr. Ranieri shares her research on perinatal mental health and encourages psychiatry residency training programs across the county to incorporate more training into their curriculums. Dr. Ranieri is a PGY-4 Psychiatry Resident Physician at the University of South Florida Health, Department of Psychiatry and Behavioral Neurosciences, in Tampa, FL.
The following is republished from the E-Connect, a month member newsletter of the Florida Psychiatric Society, June 2025 issue.
Understanding Reproductive Psychiatry and Its Impact on Maternal Mental Health
Reproductive psychiatry is a branch of medicine that encompasses the science and practice of treating mental, emotional, and behavioral disturbances related to female reproductive stages (1). Historically, there has been little research dedicated to women’s health, specifically mental health. Today, there is a growing amount of literature demonstrating the need for psychiatric care for this subpopulation. Perinatal depression affects 10% to 20% of women in the United States during pregnancy, the postpartum period, or both (2). The peripartum period poses a heightened risk for psychiatric deterioration for those with pre-existing mood disorders, with around one to two women in one thousand requiring psychiatric admission in the months following childbirth (3). Maternal mental health disorders contribute significantly to maternal mortality. Maternal suicide accounts for 5% to 20% of maternal deaths in high-income countries. Adverse obstetric and neonatal outcomes of women with untreated mental health disorders include increased risk of preterm birth, fetal growth impairments, and other obstetric complications such as pre-eclampsia and hemorrhage (3). The profound need for reproductive psychiatric clinical care and healthcare provider education is evident with the completed research.
Barriers to Accessing Reproductive Psychiatry and the Need for Standardized Training
There are several significant barriers to the availability of reproductive psychiatric care. These include the lack of standardized education for both psychiatrists and obstetricians and gynecologists. As reproductive psychiatry is not yet formally recognized by the American Board of Psychiatry and Neurology as a subspeciality, there are no accredited fellowships or standardized curricula. Per documentation from the Maternal Mental Health Leadership Alliance from 2022, there were fifteen women’s mental health fellowship programs in the United States at that time (4). Most of these programs accommodate only one fellow per year. There were seven identified women’s mental health tracks or concentration options within general psychiatry residencies. Among psychiatry programs who do not offer formalized training, findings suggest inconsistent training in reproductive psychiatry that is variable considerably in clinical time and content (5). In the Accreditation Council for Graduation Medical Education (ACGME) psychiatry core program requirements, there is not a dedicated requirement for education regarding reproductive psychiatry.
Expanding Perinatal Mental Health Training and Interdisciplinary Collaboration in Psychiatry
Significant improvements are needed in elevating the training in perinatal mental health. There is a need for more formalized training in reproductive psychiatry across residency programs in the United States. We are calling on psychiatry programs across the nation to create dedicated education objectives and offer specialized tracks and fellowships in reproductive psychiatry. The residency programs should integrate comprehensive reproductive psychiatry curriculum into their training. This curriculum should cover topics such as perinatal mood disorders, psychiatric medication management during pregnancy, and the impact of reproductive health issues on mental health. It would behoove the ACGME to include reproductive psychiatry education in core program requirements for all general psychiatry residencies for standardization. Collaboration should be encouraged between psychiatry and obstetrics and gynecology departments to provide comprehensive and interdisciplinary care for women. Joint didactic sessions, case discussions, and interdisciplinary clinics can facilitate a better understanding of the complex interplay between mental health and reproductive health. In addition, interdepartmental research collaboration should be promoted, highlighted, and better funded. More psychiatry residency programs need to plan, raise funds, and implement post-residency training programs in reproductive psychiatry. In the meantime, reproductive psychiatry tracks could be an excellent stopgap to provide a higher level of education in this field. By expanding perinatal mental health tracks, fellowships and fostering interdisciplinary collaboration, we can improve the quality of care for women, reduce the burden of perinatal mental health disorders, and plan to meet the ever-growing need for psychiatric care for this subpopulation.
References:
- Hutner LA, Catapano LA, Nagle-Yang SM, Williams KE, Osborne LM, editors. Textbook of Women's Reproductive Mental Health. American Psychiatric Pub; 2021 Dec 7.
- Van Niel MS, Payne JL. Perinatal depression: A review. Cleveland Clinic journal of medicine. 2020 May 1;87(5):273-7.
- Howard LM, Khalifeh H. Perinatal mental health: a review of progress and challenges. World Psychiatry. 2020 Oct;19(3):313-27.
- WMH Psychiatry. Psychiatry Fellowship Programs November 2022 [Internet]. Boston, MA: World Mental Health; 2022 [cited 2024 June 4]. Available from: https://static1.squarespace.com/static/637b72cb2e3c555fa412eaf0/t/63ecf11edec6e273397f759f/1676472606637/WMHPsychiatry-Fellowship-Programs-November-2022.pdf
- Osborne LM, MacLean JV, Barzilay EM, Meltzer-Brody S, Miller L, Yang SN. Reproductive psychiatry residency training: a survey of psychiatric residency program directors. Academic Psychiatry. 2018 Apr;42:197-201.
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