Elsevier

General Hospital Psychiatry

Volume 21, Issue 5, September–October 1999, Pages 340-347
General Hospital Psychiatry

Original Articles
Distressed women’s clinic patients:: Preferences for mental health treatments and perceived obstacles

https://doi.org/10.1016/S0163-8343(99)00038-9Get rights and content

Abstract

Women seen in public gynecology settings are at very high risk of developing psychiatric disorders. Because low-income and ethnic minority women seen in such settings underutilize mental health services, it is important to better understand treatment preferences and obstacles among this high-risk patient population. Public women’s clinic patients (N = 105) who reported psychological or emotional distress were asked about their interest in medication, psychotherapy, and psychoeducational classes, as well as perceived obstacles to using these services. The vast majority were interested in receiving some form of mental health treatment, with the most interest shown for individual therapy and general psychoeducational classes about health and stress. Less interest was expressed in group therapy and medication. Women anticipated more instrumental barriers to using services, such as lack of money, transportation, and childcare, than stigma-related barriers, such as fear of embarrassment or rejection. However, Latinas, women with less education, and those with a current mood or anxiety disorder were more likely to anticipate stigma-related barriers to treatment than other women. Implications of these findings for referral and treatment of mental health problems among public women’s clinic patients are discussed.

Introduction

Many people who seek help for mental health problems visit a primary care doctor rather than a mental health specialist [1], a pattern more pronounced among low-income and ethnic minority populations 2, 3. Among low-income young women, a group at much higher risk high of developing psychiatric disorders than the general population 4, 5, many receive medical care exclusively from gynecology or family planning services [6]. Therefore, the best setting to identify, treat, and make referrals for mental health problems in distressed low-income young women may be in women’s clinics.

Given that low-income and ethnic minority women are less likely to use mental health services than their white or higher-income counterparts 7, 8, 9, it is important to understand their preferences for treatment in order to facilitate acceptance of and adherence to mental health treatment. The most common psychiatric disorder seen among gynecology patients is depression. In gynecology settings, medication is the predominant treatment for depression, used more frequently than provider counseling or referral to specialty mental health services [10]. Therefore, it is particularly important to examine the acceptability of medication treatment for depression, and for those not interested in medication, what other treatment options would be acceptable.

Only a few studies have examined mental health treatment preferences of medical patients. In a primary care sample, Cooper-Patrick et al. [11] found that depressed patients indicated the greatest preference for individual treatment, followed by medication and waiting for the depression to remit. Group therapy was the least preferred treatment option. Black patients were less likely than whites to consider medication as an acceptable treatment. In a disadvantaged, general medical clinic sample, Areán and Miranda [12] found that although patients were most interested in psychosocial treatments focused on medical problems, most were also interested in groups dealing with stress and depression. This study did not examine acceptability of medication treatment. Although similar to this general medical sample with respect to socioeconomic status (SES), the younger and exclusively female patients seen in public care OB-GYN settings may have different treatment needs. Specifically, they may have less need for services centered around chronic medical problems and greater need for services related to other psychosocial issues, such as problems with children, domestic violence, or sexual trauma. However, it is not known what types of mental health referrals low-income women’s clinic patients would find acceptable.

In addition to treatment preferences, it is also important to understand the obstacles to mental health service use in this high-risk patient population. Compared with whites and middle-class individuals, ethnic minorities and lower SES individuals identify more barriers to entering mental health treatment and express more concerns about the reactions of others and the potential for stigmatization 13, 14, 15, 16. Most studies examining these barriers have focused on community rather than clinic samples. It is not clear whether patients already accessing medical services in settings where mental health services are available would perceive similar obstacles.

In an effort to explore ways to improve mental health services to a patient population at high risk for psychiatric disorders, this study examines preference for services, including medication as well as various psychosocial treatments, and perceived obstacles to treatment among distressed low-income patients from a public care women’s clinic. Because depression is the most common psychiatric disorder seen in gynecology settings, we also examine predictors of acceptance of different interventions for depression.

Section snippets

Participants

As part of a larger study [17], 217 women were interviewed about their attitudes towards mental illness and mental health services. During this interview, women were asked about current distress: “In the past month, have you had severe enough personal, emotional, behavior, or mental problems that you felt you needed help?” [18] Women who answered no were asked a second question: “In the past month, have you had severe enough medical or health problems that you felt they were affecting your

Psychiatric diagnosis and use of mental health services

Sixty-six percent of women met criteria for a mood disorder (43% with major depression and 23% with minor depression), 24% for an anxiety disorder (15% with generalized anxiety disorder (GAD) and 9% with panic), and 20% for a probable alcohol disorder. Twenty-one percent reported having a drug problem in the past year. Overall, 73% of the sample had at least one probable Axis I disorder. One-third (33%) reported making at least one mental health visit in the past.

Interest in services

Only one out of the 105 women

Discussion

Rates of psychiatric disorders were very high in this sample of distressed women, with nearly three-quarters having a probable Axis I disorder, suggesting that women reporting distress to their medical providers should be carefully assessed for psychiatric disorders. Similar to the findings of Areán and Miranda [12] with a general medical clinic sample, the majority of women were interested in some form of treatment or psychosocial intervention.

Although interest in services was high, actual

Conclusion

Given the high rates of psychiatric disorders, as well as the substantial interest in a variety of psychosocial services, it is clear that psychologically distressed women’s clinic patients face a number of psychosocial problems for which treatment can be provided. Results from this study highlight the need to ask women seen in public care gynecology clinics about their emotional health, to discuss available treatment options given their limited resources, to address concerns about stigma, to

Acknowledgements

This research was supported by a grant from the Latino Mental Health Research Program, Department of Psychiatry, University of California, San Francisco.

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