Assessing Factors that Influence Psychiatric Referral Time and Postpartum Follow-Up in Obstetric Patients

There is a clear shortage of psychiatric care in the population of peripartum obstetric patients in the United States(Kelly et al., 2001; Claridad, 2025). There is variability in both screening for mental illness and availability of psychiatric care which leads to a substantial gap in healthcare for such patients, particularly non-white patients. Additionally, during the postpartum period, the attendance rates to medical appointments are affected by race, ethnicity and socioeconomic status, further perpetuating the aforementioned healthcare disparity(Wilcox et al., 2016). The key purpose of this study was to understand if and how rates of seeing a reproductive psychiatrist are affected by psychiatric referral time (prenatally versus postnatally) and, if and how seeing a reproductive psychiatrist affect postpartum healthcare follow in obstetric patients. Patients referred to the reproductive psychiatrist between January to December of 2023 were chart reviewed in EPIC and data was recorded in RedCap (N=71). Data recorded included: age, ethnicity, education, employment, marital status, substance use, and medical factors such as psychotropic medication use and psychiatric diagnoses. Separate Chi Squared tests were employed to evaluate two variables including: referral time (before delivery versus after delivery versus unknown) and if patients were lost to follow up after delivery (yes versus no), respectively. There were 71 obstetric patients evaluated with a mean age of 28 and an age range of 17-39. Most were Black (N=31) or Hispanic/ Latino (N=24). The results indicate that patients referred prenatally had 3.26 times higher odds of meeting with the reproductive psychiatrist (N = 44, 62%) compared to those referred postnatally (p = 0.0002). Patients with a history of substance use, marijuana use, presence of long-term romantic partners, use of prescribed psychotropic medications, history of any bipolar disorder, and had their diagnosis made by the reproductive psychiatrist were associated with higher rates of being referred to psychiatry prenatally, while patients diagnosed with postpartum depression were associated with higher rates of being referred postnatally. The odds of patients who met with the reproductive psychiatrist (N=43, 61.4%) being lost to postpartum healthcare follow up were 3.63 times lower compared to the odds of patients who did not meet with the psychiatrist (p=0.012). Furthermore, patients who used alcohol, had a diagnosis of postpartum depression, had their mental health conditions diagnosed by the reproductive psychiatrist, were taking a prescribed psychotropic medication, particularly antidepressants including sertraline and escitalopram, were associated with lower rates of being lost to postpartum healthcare follow up. Patients who were unemployed were associated with higher rates being lost to healthcare follow up. This study explores how timing of psychiatric referral in obstetric patients affects postpartum healthcare appointment attendance, highlighting the role of early psychiatric intervention in potentially improving postpartum healthcare engagement. Knowledge of these findings may encourage providers to consider psychiatric referral more readily. Similarly, by understanding individual factors that independently influence psychiatric referral time and healthcare follow up rates, providers can bring awareness to what impacts their decision, or lack thereof, to refer patients to psychiatry.