Perinatal Mood, Anxiety, and Substance Use Disorders: Are Future U.S. Obstetric Physicians Being Trained to Address the Most Common Complications of Pregnancy?

Perinatal Mood, Anxiety, and Substance Use Disorders: Are Future U.S. Obstetric Physicians Being Trained to Address the Most Common Complications of Pregnancy? | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Perinatal Mood, Anxiety, and Substance Use Disorders: Are Future U.S. Obstetric Physicians Being Trained to Address the Most Common Complications of Pregnancy? Anna R. Whelan, Jordan P. Trubiano, Isabella Qendro, Katherine Leung, and 5 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4432536/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background/Objective: Perinatal mental health conditions and substance use disorders are the most common complications of pregnancy and the leading cause of overall and preventable maternal mortality. These conditions remain under-detected and under-treated. Both the Council on Resident Education in Ob/Gyn and the American Academy of Family Physicians expect graduating residents to be competent at diagnosing and treating perinatal mental health and substance use disorders. This study surveyed contemporary obstetric trainees to understand training modalities being utilized and confidence addressing steps in the perinatal mental health care pathway to understand current state, unmet needs, and educational opportunities. Methods: Web-based cross-sectional anonymous survey developed and distributed via Qualtrix in October 2019 to Ob/Gyn and Family Medicine (FM) residents in U.S. programs accredited by the Accreditation Committee of Graduate Medical Education (ACGME; 282 Ob/Gyn, 455 FM, and 93 MFM programs). Respondents self-reported exposure to 8 modes of training and separately, their confidence addressing perinatal mental health and substance use disorders on 6-point Likert scales. Results: Total respondents (n=125) included 69.6% Ob/Gyn and 30.4% FM trainees representing all U.S. regions. For both perinatal mental health and substance use disorders the majority (75% and 68% respectively) trained via didactic sessions. Most respondents felt at least moderate confidence detecting, assessing, and treating both depression and anxiety (82% and 72% respectively). A majority reported at least moderate confidence in determining when to refer for therapy (81%), when and how to start medications for depression and anxiety (67%). In general, smaller proportions were calculated across the pathway for substance use disorders. The majority responded they should have ‘more’ or ‘a lot more’ training in depression and anxiety disorders (78% Ob/Gyn, 61% FM) and substance use disorder (91% Ob/Gyn, 79% FM). Conclusions: To make significant progress in increasing detection, assessment, and treatment access for perinatal mental health and substance use disorders, the next generation of clinicians need more training and greater confidence in their abilities. Graduate medical education for obstetric clinicians has a critical opportunity to address perinatal mental health and substance use disorders and thus improve intergenerational outcomes and decrease maternal morbidity and mortality. Perinatal mental health substance use disorder perinatal depression perinatal anxiety bipolar disorder screening and treatment for perinatal mental health disorders INTRODUCTION Mental health conditions are the leading general and preventable causes of pregnancy-related morbidity and mortality in the United States. 1–3 These disorders affect 1 in 5 perinatal individuals, with perinatal depression and anxiety being the most common. 1 Among those who screen positive for perinatal depression, almost a quarter have bipolar disorder. 4 In addition to mood and anxiety disorders, substance use disorders have become increasingly prevalent in pregnancy. Data from the Center for Disease Control and Prevention and National Center for Health Statistics demonstrate that 7–16% of individuals smoke cigarettes during pregnancy, 14% drink alcohol and 5% use illicit substances during pregnancy. 5–7 Perinatal mental health disorders and substance use disorders are often co-morbid. Pregnant individuals who use alcohol and/or tobacco are 1.7–2 times more likely to have experienced a major depressive episode in the 12 months prior, compared to pregnant individuals who do not use these substances. 8 When left untreated, perinatal mental health and substance use disorders can have devastating short- and long-term impacts on the perinatal individual, their child, and families. Both perinatal mental disorders and substance use disorders are associated with adverse obstetric and neonatal outcomes including preterm birth, preeclampsia, low birth weight, fetal alcohol syndrome, and neonatal abstinence syndrome. 9–13 Additionally, mental health and substance use disorders impair social function, interfere with maternal-infant bonding, and increase a child’s lifetime risk for behavioral, cognitive, and mental health disorders. 14–16 Despite the high prevalence and significant negative consequences of these conditions, many cases go unrecognized and even if recognized, untreated or undertreated. Existing literature indicates less than a quarter of perinatal individuals with recognized depression receive treatment. 17 Although most obstetric care clinicians agree that they are responsible for detecting and treating perinatal mental health and substance use disorders, historically a minority have felt prepared to do so upon completing residency. 18 A 2003 survey of Ob/Gyn residency graduates found that less than a third of respondents felt that residency prepared them to diagnose depression and less than 10% felt prepared to treat depression with medications or counseling. 18 Since 2015, significant national attention has been brought to and resources have been developed regarding increasing diagnosis and treatment of perinatal mental health and substance use disorders. The American College of Obstetricians and Gynecologists (ACOG), the Alliance on Innovation in Maternal Health (AIM), and the US Preventative Services Task Force (USPSTF) all recommend to screen for perinatal mental health and substance use disorders in the context of systems that facilitate subsequent assessment, diagnosis, treatment, follow-up, and moitoring. 10, 19–23 Both the Council on Resident Education in Obstetrics and Gynecology (CREOG) and the American Academy of Family Physicians (AAFP) Curriculum Guideline Number 261 “Maternity Care” outline that graduating residents should be competent at diagnosing and treating perinatal mood, anxiety and substance use disorders. 24, 25 To our knowledge, no evaluation of resident training in diagnosing and treating perinatal mental health and substance use disorders has occurred since 2015. This study surveyed obstetric care trainees including Obstetrics and Gynecology (Ob/Gyn) residents, Family Medicine (FM) residents, and Maternal Fetal Medicine (MFM) fellows to identify current training modalities that are being utilized to educate trainees on perinatal mental health and substance use disorders. We aimed to understand approaches and unmet needs to inform how to strengthen obstetric education such that graduates feel confident in recognizing and treating these common complications of pregnancy. METHODS Survey Design We designed a web-based cross-sectional anonymous survey about residency and fellowship training approaches for training providers to screen and treat perinatal mood, anxiety, and substance use disorders. As no previously validated surveys on this topic were identified, existing survey-based literature was reviewed to help inform survey design as well as distribution methods. 26, 27 The survey was developed and modified with input from faculty with subject matter and curriculum expertise in obstetrics, psychiatry and survey methods. The initial part of the survey asked about post-graduate year of respondents, program type (OBGYN or Family Medicine), number of residents, program affiliation (for example academic, community, military) and program geographic location. Next, respondents were asked about exposure to eight different teaching modalities regarding perinatal mood and anxiety disorders. Modalities inquired about were: didactics, bedside teaching, assigned readings, paper decision support aids/toolkits, electronic decision support aids/toolkits, online self-directed modules, mentoring from psychiatry providers, and rotation in psychiatry. Participants were then asked to rate their confidence in performing steps along the perinatal mental health care pathway to treat perinatal mood and anxiety disorders including: ( 1 ) detecting, assessing, treating depression, ( 2 ) detecting assessing, treating anxiety, ( 3 ) screening and referring for bipolar disorder, ( 4 ) assessing risk of harm to self or others, ( 5 ) determining when to refer for therapy, ( 6 ) determining when/how to start medications for depression/ anxiety, and ( 7 ) monitoring depression/ anxiety and adjusting medications. 28 Additionally, participants were asked about their confidence in screening, treating and monitoring substance use disorders in perinatal patients. Respondents were asked to rate their confidence, on a scale of 0 to 5 (0 = not at all confident, 3 = moderately confident, 5 = very confident). Answers of ≥ 3 on the Likert scale indicated moderate to high confidence. Selection of Participants The study population included Obstetrics and Gynecology (Ob/Gyn) residents, Family Medicine (FM) residents, and Maternal-Fetal Medicine (MFM) fellows enrolled in programs accredited by the Accreditation Committee of Graduate Medical Education (ACGME), at the time of survey distribution. The ACGME website provided a list of all accredited programs. The names and contact information for each program’s director and/or coordinator were obtained through the ACGME website as well as through searching the websites of individual residency and fellowship programs. This resulted in a list of 282 Ob/Gyn residency programs, 455 FM residency programs, and 93 MFM fellowship programs. Survey Administration The surveys were distributed via e-mail invitation on 10/01/2019 to program directors and/or coordinators for each potential participating program. The program directors and coordinators received e-mail invitations that included a description of the study and web link to the survey. The directors and coordinators were asked to forward the invitation e-mail to their residents and fellows. The e-mail invitations stated that participation was voluntary and informed consent would be implied by completing the survey. Reminder e-mails were sent to all participating programs 15 days and 100 days after original distribution. The survey was active from 10/1/2019 until 1/15/2020. Given this approach, the total population of trainees that this survey opportunity reached is not fully known, however the maximum based on current available residency slots would be 4,631 Ob/Gyn residents, 8,929 FM residents, and 330 MFM fellows. 29 Data Collection The data were collected through Qualtrics Software (Reference). Human Ethics and Consent to Participate Participants completed a consent to participate prior to completing the survey. As an anonymous survey of educational curriculum, the study met exemption criteria when reviewed by the institutional review board of the University of Massachusetts Chan Medical School. Data analysis Descriptive statistics were used to describe participant characteristics and survey responses overall and by specialty type (Ob/Gyn vs. FM) using frequency with percent for categorical variables and median with interquartile range (25th percentile – 75th percentile) for continuous variables. Comparisons across specialties were made using Fisher’s exact test for categorical variables or Wilcoxon rank sum test for continuous variables. Confidence performing the tasks associated with diagnosis and treatment of perinatal mental health and substance use disorders (collected as a 6-point Likert scale 0–5 with 0 = Not at all confident and 5 = very confident) were compared using Wilcoxon rank sum test. Confidence ratings were collapsed to < 3 or 3 + and compared across specialties using the Chi square test. Confidence performing the tasks associated with diagnosis and treatment of perinatal mental health and substance use disorders PMAD pathway was assessed using a 0–5 Likert scale. We calculated Spearman’s rank correlation coefficients and p-values. P-values < 0.05 were considered statistically significant and were not adjusted for multiple comparisons. All analyses were performed using Stata MP 16.1(College Station, TX, USA, 2019). RESULTS Of the 125 respondents who completed the survey, 69.6% (n = 87) were Ob/Gyn, and 30.4% (n = 38) were Family Medicine (FM) trainees. The majority (74%) of Ob/Gyn respondents were from university-based programs, while the majority (84%) of Family Medicine respondents were from university-affiliated community-based (48%) or community-based (36%) programs. All regions of the country were represented in the sample (Table 1 ). Table 1 Demographic characteristics of respondents Variable Total (N = 125) OBGYN (N = 87) FM (N = 38) P-value PGY year < 0.001 PGY-1 25 (22%) 14 (18%) 11 (33%) PGY-2 30 (27%) 15 (19%) 15 (45%) PGY-3 26 (23%) 20 (25%) 6 (18%) PGY-4 13 (12%) 12 (15%) N/A Fellow (PGY 5–7) 18 (16%) 18 (23%) 1 ( 3%) Program type < 0.001 Community-based 20 (18.0%) 8 (10%) 12 (36%) University-based 62 (56%) 58 (74%) 4 (12%) Military-based 1 ( 1%) 0 ( 0%) 1 ( 3%) Community-based University-affiliated 28 (25%) 12 (15%) 16 (48%) Program location 0.726 New England 16 (14%) 12 (15%) 4 (12%) Mid & South Atlantic 42 (37%) 30 (38%) 12 (36%) North Central 28 (25%) 19 (24%) 9 (27%) South Central 10 ( 9%) 5 ( 6%) 5 (15%) Mountain 5 ( 4%) 4 ( 5%) 1 ( 3%) Pacific 11 (10%) 9 (11%) 2 ( 6%) Number of residents/fellows per class < 0.001 1–5 34 (31%) 31 (39%) 3 ( 9%) 6–10 61 (55%) 40 (51%) 21 (66%) 11–15 11 (10%) 6 ( 8%) 5 (16%) More than 16 5 ( 5%) 0 ( 0%) 3 ( 9%) Table 2 A. Reported Training Modalities Utilized for Perinatal Mood, Anxiety, and Substance Use Disorders. Participants were instructed to check all that apply Training Modality Total (N = 125) OBGYN (N = 87) FM (N = 38) P-value Perinatal Mood and Anxiety Disorders Didactics (seminars, lectures, case conferences) 94 (75%) 70 (80%) 24 (63%) 0.046 Bedside teaching 58 (46%) 41 (47%) 17 (45%) 0.847 Assigned readings (textbooks, chapters, articles, reading lists) 36 (29%) 27 (31%) 9 (24%) 0.520 Paper decision support aids and toolkits 26 (21%) 18 (21%) 8 (21%) 0.999 Electronic decision support aids and toolkits 24 (19%) 13 (15%) 11 (29%) 0.085 Online self-directed modules 11 ( 9%) 8 ( 9%) 3 ( 8%) 0.999 Mentoring from psychiatry providers 11 ( 9%) 4 ( 5%) 7 (18%) 0.033 Unknown 11 ( 9%) 7 (8%) 4 (11%) 0.734 Rotation in psychiatry 10 ( 8%) 0 ( 0%) 10 (26%) < 0.001 Other 4 ( 3%) 3 ( 3%) 1 ( 3%) 0.999 Number of training modalities selected (median (IQR)) 2 ( 1 – 3 ) 2 ( 1 – 3 ) 2.5 ( 1 – 4 ) 0.534 Perinatal Substance Use Disorders Didactics (seminars, lectures, case conferences) 85 (68%) 62 (71%) 23 (61%) 0.298 Bedside teaching 49 (39%) 36 (41%) 13 (34%) 0.551 Buprenorphine waiver training 37 (30%) 24 (28%) 13 (34%) 0.524 Mentoring from providers trained in addiction medicine 33 (26%) 21 (24%) 12 (32%) 0.387 Assigned readings (textbooks, chapters, articles, reading lists) 29 (23%) 24 (28%) 5 (13%) 0.107 Online self-directed modules 25 (20%) 17 (20%) 8 (21%) 0.813 Electronic decision support aids and toolkits 14 (11%) 9 (10%) 5 (13%) 0.759 Unknown 13 (10%) 8 ( 9%) 5 (13%) 0.532 Rotation in addiction med/psychiatry 9 ( 7%) 0 ( 0%) 9 (24%) < 0.001 Paper decision support aids and toolkits 8 ( 6%) 6 ( 7%) 2 ( 5%) 0.999 Other 1 ( 1%) 1 ( 1%) 0 ( 0%) 0.999 Number of training modalities selected (median (IQR)) 2 (0–4) 2 ( 1 – 4 ) 2 (0.4) 0.855 Table 2 B. Training modalities respondents reported as having found or would find helpful in learning to address PMAD and perinatal SUD. Participants were instructed to check all that apply. Training modality Total (N = 125) OBGYN (N = 87) FM (N = 38) P-value Mentoring from experienced providers 83 (66%) 58 (67%) 25 (66%) 0.999 Didactics 82 (66%) 53 (61%) 29 (76%) 0.106 Buprenorphine waiver training 71 (57%) 51 (59%) 20 (53%) 0.561 Bedside teaching 53 (43%) 37 (43%) 16 (42%) 0.999 Rotation in addiction medicine/psychiatry 42 (34%) 26 (30%) 16 (42%) 0.219 Electronic decision support aids and toolkits 42 (34%) 28 (32%) 14 (37%) 0.682 Online self-directed modules 32 (26%) 23 (26%) 9 (24%) 0.826 Assigned readings 27 (22%) 19 (22%) 8 (21%) 0.999 Paper decision support aids and toolkits 22 (18%) 15 (17%) 7 (18%) 0.999 Rotation in psychiatry 22 (18%) 11 (13%) 11 (29%) 0.040 Most trainees (75%) reported that their programs provided didactic sessions on perinatal mood and anxiety disorders, followed by bedside teaching, assigned readings, and electronic or paper decision support aids (Table 2 A).Twenty-six percent of Family Medicine trainees reported completing a psychiatry rotation, while no Ob/Gyn trainees did. In terms of perinatal substance use disorder training, didactic sessions were most commonly reported by trainee (68%). Almost a quarter of Family Medicine trainees reported completing a rotation in addiction medicine whereas no Ob/Gyn trainees did (Table 2 A). The majority of respondents felt that they should have ‘more’ or ‘a lot more’ training in perinatal depression and anxiety disorders (78% Ob/Gyn, 61% FM) and substance use disorders (91% Ob/Gyn, 79% FM) than currently provided in their programs. The majority of participants reported at least moderate confidence detecting, assessing, and treating depression (82%) and anxiety (72%). While only 39% of participants felt at least moderately confident in screening for bipolar disorder. The majority of respondents (77%) felt at least moderately confident at assessing risk of harm to self or others and felt at least moderately confident in determining when to refer for therapy (81%). More than half (67%) of respondents felt at least moderately confident in determining when and how to start medications for depression and anxiety, whereas fewer (51%) respondents felt at least moderately confident in monitoring depression or anxiety and adjusting medications (Table 3 ). Table 3 Reported Confidence Levels in Various Aspects of Addressing Perinatal Mood, Anxiety, and Substance Use Disorders Confidence level (Likert scale 0–5 with 0 = Not at all Confident and 5 = Very Confident) Total (n = 125) OBGYN (n = 87) FM (n = 38) P-value Perinatal Mood and Anxiety Disorders Detecting, assessing, treating depression (n (%) ≥ 3) 97 (82%) 66 (78%) 31 (91%) 0.086 Median (IQR) 3 ( 3 – 4 ) 3 ( 3 – 4 ) 4 ( 3 – 5 ) 0.009 Detecting assessing, treating anxiety (n (%) ≥ 3) 83 (72%) 56 (66%) 27 (87%) 0.025 Median (IQR) 3 ( 2 – 4 ) 3 ( 2 – 3 ) 4 (3-4.5) 0.002 Screening for bipolar disorder and referring (n (%) ≥ 3) 43 (39%) 22 (28%) 21 (66%) < 0.001 Median (IQR) 2 ( 1 – 3 ) 2 ( 1 – 3 ) 3 ( 2 – 3 ) 0.002 Assessing risk of harm to self/others (n (%) ≥ 3) 92 (77%) 66 (77%) 26 (79%) 0.812 Median (IQR) 4 ( 3 – 4 ) 4 ( 3 – 4 ) 4 ( 3 – 4 ) 0.556 Determining when to refer for therapy (n (%) ≥ 3) 96 (81%) 67 (78%) 29 (88%) 0.217 Median (IQR) 4 ( 3 – 4 ) 3 ( 3 – 4 ) 4 ( 3 – 5 ) 0.019 Determining when/how to start meds for depression/anxiety (n (%) ≥ 3) 80 (67%) 53 (62%) 27 (82%) 0.036 Median (IQR) 3 ( 2 – 4 ) 3 ( 2 – 3 ) 4 ( 3 – 5 ) < 0.001 Monitoring depression/anxiety and adjusting meds (n (%) ≥ 3) 58 (51%) 31 (38%) 27 (82%) < 0.001 Median (IQR) 2 ( 1 – 4 ) 2 ( 1 – 3 ) 4 ( 3 – 4 ) < 0.001 Perinatal Substance Use Disorders Detecting, assessing, treating SUD (n (%) ≥ 3) 64 (60%) 47 (63%) 17 (53%) 0.357 Median (IQR) 3 ( 2 – 3 ) 3 (2-3.5) 3 ( 2 – 3 ) 0.362 Determining when to refer for therapy for SUD (n (%) ≥ 3) 69 (64%) 51 (68%) 18 (56%) 0.245 Median (IQR) 3 ( 2 – 4 ) 3 ( 2 – 4 ) 3 ( 2 – 4 ) 0.600 Determining when/how to start medication treatment for SUD (n (%) ≥ 3) 32 (38%) 24 (43%) 8 (29%) 0.204 Median (IQR) 2 ( 1 – 3 ) 2 ( 1 – 3 ) 1 ( 1 – 3 ) 0.646 Monitoring SUD & adjusting medications (n (%) ≥ 3) 33 (43%) 24 (47%) 9 (36%) 0.361 Median (IQR) 1 ( 1 – 3 ) 1 ( 1 – 4 ) 1 ( 1 – 3 ) 0.556 Referring patients to treatment for SUD (n (%) ≥ 3) 79 (73%) 58 (76%) 21 (66%) 0.252 Median (IQR) 4 ( 2 – 5 ) 4 ( 3 – 5 ) 3 ( 2 – 4 ) 0.192 While 64% of respondents reported screening greater than 75% of their pregnant and postpartum patients for mood and anxiety disorders at least once during their pregnancy and first year postpartum using a validated tool, only 48% of respondents reported doing the same for substance use disorders. Additionally, participants generally self-reported lower confidence in their abilities to treat perinatal substance use disorders. While 73% of respondents felt confident in knowing when to refer patients for treatment for substance use disorder, only 38% of respondents felt confident in their ability to determine when and how to start medication treatment for substance use disorder (Table 3 ). The eight training modalities were correlated with steps along the comprehensive perinatal mental health care pathway. Psychiatry mentoring had the strongest correlation (0.333) with determining when or how to start medications for depression or anxiety (Table 4 A). Buprenorphine waiver training had the strongest correlation (0.321) with monitoring and adjusting medications for substance use disorder (Table 4 B). Table 4A. Correlation Between Training Modalities Utilized and the Reported Confidence Level at Performing the Steps Along the Comprehensive Perinatal Mental Health Care Pathway to Address Perinatal Mood and Anxiety Disorders Confidence Level at Performing the Steps Along the Comprehensive Perinatal Mental Health Care Pathway Training Modalities Used for Perinatal Mood and Anxiety Disorders Didactics Online self-directed modules Paper decision support aids/ toolkits Electronic decision support aids/ toolkits Assigned readings Bedside teaching Psychiatry rotation Mentoring from psychiatry providers Other Detecting, assessing, treating depression (CC) 0.154 0.046 0.189* 0.230* 0.230* 0.243* 0.089 0.150 0.112 Median (IQR) 4 (3-4) 3 (3-5) 4 (3-5) 4 (3-4) 4 (3-4) 4 (3-4) 4 (3-5) 4 (3-5) 4 (3.5-4) Detecting assessing, treating anxiety (CC) 0.130 0.076 0.226* 0.087 0.292* 0.207* 0.113 0.262* -0.074 Median (IQR) 3 (2-4) 3 (3-4) 3 (3-4) 3 (3-4) 3 (3-4) 3 (3-4) 4 (3-4) 4 (3-5) 2.5 (2-3) Screening for BD and referring (CC) 0.203* 0.134 0.158 0.237* 0.103 0.225* 0.253* 0.173 -0.034 Median (IQR) 2 (2-3) 3 (2-3) 2.5 (2-3) 3 (2-3.5) 2 (2-3) 2 (2-3) 3 (3-4) 3 (2-4) 2 (1-3) Assessing risk of harm to self/others (CC) 0.234* 0.162 0.220* 0.203* 0.173 0.204* 0.051 0.003 -0.147 Median (IQR) 4 (3-4) 4 (3-5) 4 (3-5) 4 (3.5-4.5) 4 (3-4) 4 (3-4) 4 (3-4) 4 (2-4) 2.5 (2-3) Determining when to refer for therapy (CC) 0.191* 0.081 0.169 0.093 0.056 0.217* 0.120 0.200* 0.014 Median (IQR) 4 (3-4) 4 (3-5) 4 (3-5) 4 (3-4) 4 (3-4) 4 (3-5) 4 (3-5) 5 (3-5) 3.5 (3-4) Determining when/how to start meds for depression/ anxiety (CC) 0.153 0.099 0.099 0.193* 0.202* 0.130 0.200* 0.333* -0.007 Median (IQR) 3 (2-4) 3 (3-5) 3.5 (2-5) 3 (3-4) 3 (3-4) 3 (2-4) 4.5 (3-5) 5 (3-5) 2.5 (2-3.5) Monitoring depression/ anxiety and adjusting meds (CC) 0.093 0.083 0.116 0.231* 0.145 0.073 0.216* 0.175 -0.061 Median (IQR) 3 (1-4) 3 (2-4) 3 (1-4) 3 (2-4) 3 (2-4) 2.5 (1-4) 4 (3-5) 3 (2-4) 2 (1.5-2) The Confidence level (Likert scale 0-5 with 0=Not at all Confident and 5=Very Confident) (CC)=Correlation Coefficient *P<0.05 Table 4B. Correlation between Training Modalities Utilized and the Reported Confidence Level at Performing the Steps Along the Comprehensive Perinatal Mental Health Care Pathway to Address Perinatal Substance Use Disorders Confidence Level at Performing the Steps Along the Comprehensive Perinatal Mental Health Care Pathway Training Modalities Used for Substance Use Disorders Buprenorphine waiver Didactics Online self-directed modules Paper decision support aids/ toolkits Electronic decision support aids/ toolkits Assigned readings Bedside teaching Rotation in addiction med / psychiatry Mentoring from providers trained in addiction medicine Other Detecting, assessing, treating (CC) 0.208* 0.264* 0.215* 0.045 0.236* 0.036 0.125 0.071 0.192 0.119 Median (IQR) 3 (2-4) 3 (2-3) 3 (2-4) 2.5 (2-3.5) 3 (2-5) 3 (2-3) 3 (2-3) 3 (3-4) 3 (2-4) 4 (4-4) Determining when to refer for therapy (CC) 0.141 0.317* 0.203 0.210* 0.201 0.124 0.167 0.153 0.253* 0.153 Median (IQR) 3 (2-4.5) 3 (2-4) 3 (3-4) 4 (3-4.5) 4 (3-4) 3 (3-4) 3 (2-4) 4 (3-5) 4 (3-5) 5 (5-5) Determining when/how to start medication treatment (CC) 0.287* 0.138 0.189 0.125 0.256* 0.004 0.021 0.010 0.267* 0.088 Median (IQR) 2 (1-4) 2 (1-3) 2 (1-4) 3 (1-4) 3 (2-4) 2 (1-3) 1 (1-3) 2 (1-3) 2.5 (1-4) 3 (3-3) Monitoring & adjusting medications (CC) 0.321* 0.181 0.126 0.145 0.279* 0.114 0.039 -0.070 0.249* 0.139 Median (IQR) 3 (1-4) 2 (1-4) 2 (1-4) 3 (1-3) 3 (2-4) 2 (1-3) 1 (1-3) 1 (1-3) 3 (1-4) 4 (4-4) Referring patients to treatment (CC) 0.164 0.316* 0.088 0.199 0.096 0.093 0.042 0.103 0.172 0.132 Median (IQR) 4 (3-5) 4 (3-5) 4 (3-4) 4 (3.5-5) 4 (3-4) 4 (3-5) 4 (3-4) 4 (3-5) 4 (3-5) 5 (5-5) The Confidence level (Likert scale 0-5 with 0=Not at all Confident and 5=Very Confident) (CC)=Correlation Coefficient *P<0.05 Participants felt that the main barriers they faced when caring for patients with perinatal anxiety, mood and substance disorders are inadequate personal knowledge(80%) as well as lack of training (80%) (Table 5 ). Table 5. Barriers reported as at least somewhat affecting a respondent’s ability to effectively address perinatal mood, anxiety, and substance use disorders. Total (N = 125) OBGYN (N = 87) FM (N = 38) P-value Inadequate personal knowledge 100 (80%) 71 (81%) 29 (76%) 0.612 Lack of training 100 (80%) 74 (85%) 26 (68%) 0.010 Lack of access to support/referral services 74 (59%) 54 (62%) 20 (52%) 0.378 Concerns about negatively affecting the patient-physician relationship 35 (28%) 21 (24%) 14 (37%) 0.108 DISCUSSION This survey of OBGYN and Family Medicine trainees found that the majority of respondents felt well equipped to screen patients for perinatal mental health and substance use disorders. Participants also felt moderately comfortable with the initial treatment of depression and anxiety and when to refer for substance use disorder treatment. Almost all respondents felt they could benefit from further training in terms of treatment for mental health and substance use disorders. Mental health and substance use disorders are among the most common complications of pregnancy and the postpartum period and contribute significantly to maternal morbidity and mortality as the leading overall and preventable causes. 1, 3 Obstetric physicians are in a unique position to diagnose and treat these disorders given the frequency of prenatal care visits 1, 30 . Prior studies have examined the practices, confidence, and self-efficacy of practicing Ob/Gyns around perinatal mental health issues, but none have studied current residency or fellowship program curricula and training modalities. 17, 31, 32 In a 2003 survey, less than one half of recent Ob/Gyn graduates felt that treating depression was their responsibility. 17 Between 2003 and the present, a major paradigm shift has occurred, with significant national attention from professional societies being brought to the role of obstetric care clinicians in, and the importance of, recognizing and treating perinatal mental health disorders. As of 2020, both the Council on Resident Education in Obstetrics and Gynecology (CREOG) and the American Academy of Family Physicians (AAFP) national curricula include learning objectives that trainees should be able to diagnose and treat perinatal mental health and substance use disorders. 24, 25, 33 Consistent with these recommendations, the majority of respondents in our study reported at least some formal didactics about addressing perinatal mental health, though the amount and type of training varied widely. The perinatal mental health care pathway is composed of ( 1 ) screening, ( 2 ) assessment, ( 3 ) triage and referral, ( 4 ) treatment access, ( 5 ) treatment initiation, ( 6 ) symptom monitoring, and ( 7 ) adaptation of treatment based on measurement until symptoms remit 28 . While most respondents reported confidence with steps 1–3, they also indicated the need for significant changes in current training to address steps 4–7. Consultation from providers with experience in treatment of perinatal mental health disorders is critical in comprehensive training of obstetric care clinicians, and could be used to address the gaps in trainee knowledge and confidence in the latter steps of the perinatal mental healthcare pathway. 34 In fact, two-third of participants in this study felt that mentoring/consultation from experienced mental health providers would be, or has been, useful in learning to address perinatal mood and anxiety disorders. Unfortunately, only 9% of respondents had access to such mentorship experiences. One way to increase access to education/consultation from experienced perinatal mental health professionals to obstetrics trainees is through the use of perinatal psychiatry access programs. Perinatal psychiatry access programs aim to build providers' capacity to address perinatal mental health and substance use disorder through ( 1 ) trainings and toolkits on depression screening, assessment and treatment; ( 2 ) telephonic access to perinatal psychiatric consultation for providers serving pregnant and postpartum women; ( 3 ) One-time patient facing consultation with perinatal psychiatry expert ( 4 ) care coordination to link women with individual psychotherapy and support groups; and ( 5 ) technical assistance. 4, 35 A major tenet of these psychiatry access programs is education and sustainability; they are driven to interact and engage with obstetric training programs. Furthermore, the data support that perinatal psychiatry access programs are highly utilized. One study of the Massachusetts Child Psychiatry Access Program (MCPAP) for Moms – the first such access program – showed that 77% of obstetric programs in the state were trained and enrolled. A recent study of the effectiveness of MCPAP for Moms demonstrated a significant sustained improvement in depression symptoms from enrollment through 13 months postpartum. 36 While initially most clinician consultations were focused on treating unipolar depression, over time those utilizing the access program became more comfortable providing direct mental healthcare to patients for more complex perinatal mental health disorders including bipolar disorder. 34 Since this survey, additional resources have been developed to assist in integrating sustainable mental health care into obstetric practices. The ACOG Clinical Practice Guidelines Committee – Obstetrics expanded the scope of perinatal mental health screening and treatment, and in 2023, published two new clinical practice guidelines (CPGs). 1, 30 These guidelines specifically note that addressing perinatal mental health is within the scope of practice of obstetric care clinicians and detail clear recommendations and clear practice points regarding the screening, diagnosis and treatment of perinatal mental health conditions. Additionally, in 2023, the Alliance for Innovation on Maternal Health (AIM) published its revised and updated perinatal mental health conditions patient safety bundle, making it one of its core bundles. 37 This bundle focuses on the 5Rs: readiness, recognition and prevention, response, reporting and systems learning and respectful, equitable and supportive care for patients with perinatal mental health disorders. 37 The bundle is accompanied by a change package led by the Institute of Health Care Improvement (IHI) to promote complete bundle implementation. 37 ACOG along with AIM and the Lifeline for Moms Program at UMass Chan Medical School worked together to create an E-module called “Addressing Perinatal Mental Health Conditions in Obstetric Settings”. 38 This is a self-paced course that focuses on detection, assessment, treatment and follow-up of patients with different perinatal mental health conditions. 38 Access to such resources as the E-module, CPGs and AIM Patient Safety Bundle provide critical information and training for perinatal providers in an effort to increase provider comfort with caring for perinatal mental health conditions. This study surveyed trainees from a broad range of program sizes and geographic locations and included both family medicine and OBGYN trainees which increases the generalizability of the results. This study’s findings were limited by a low response rate to the survey. The results may reflect a selection bias towards those trainees who are more interested in perinatal mental health and therefore more likely to complete the survey. Similarly, more than half of the respondents were located in the North East, which may be particularly relevant as perinatal psychiatry access programs originated in the North East and thus have the greatest longstanding history. This may further highlight that an even smaller portion of all obstetric trainees across diverse geographies may feel confident in treating perinatal mental health and substance use disorders in general. Furthermore, the survey invitation was sent to program directors or coordinators to forward to their trainees. Given the anonymity of the survey, we cannot determine whether the survey invitation was actually forwarded to trainees and if so, whether some programs are over-represented in the responses. Despite these limitations, this study helps to inform contemporary trends in obstetric care clinician training for perinatal mental health and substance use disorders. Didactics alone are not sufficient to prepare trainees. Ultimately, it is likely than an intentional and purposeful combination of the several available training modalities need to be used to educate trainees how to master the several steps along the comprehensive perinatal mental health care pathway, along with continued support through resources like Access Programs. Increasing education on screening for these disorders in the perinatal period must be seen as a vital first step along the mental health pathway but cannot be the endpoint. Training the obstetric workforce to initially manage these conditions is paramount to ensuring sustainable improvements in perinatal outcomes. CONCLUSIONS Despite an increase in awareness about and training on perinatal mental health and substance use disorders, obstetric trainees feel underprepared, and desire more training, to address these disorders in their practice. Perinatal Psychiatry Access Programs may be uniquely suited to meet this need through education and on-going consultative support, resource and referrals, and technical assistance that can be incorporated into training programs and beyond in order to improve perinatal mental health care in the U.S. 39 Declarations Ethics approval and consent to participate: This study was reviewed by the UMass Chan Medical School IRB and was found to be exempt. Electronic consent was obtained using Qualtrics prior to survey completion. Consent for publication: The authors of this manuscript consent BMC Pregnancy and Childbirth to publish this manuscript and will transfer all copyrights to BMC Pregnancy and Childbirth. Data availability: The data from this study are available upon request from the authors. Declaration of Interest Tiffany Moore Simas is the obstetric engagement liaison as consultant to the Massachusetts Child Psychiatry Access Program for Moms (MCPAP for Moms) and thus receives a stipend from the Massachusetts Department of Mental Health via Beacon Health Options. She is also Obstetric Director of the Lifeline for Moms Program at UMass Chan Medical School. She is Co-PI of the Lifeline for Moms National Network of Perinatal Psychiatry Access Programs, and MPI, or co-I on several extramurally funded grants focused on intervention or resource development and evaluation related to perinatal mental health. She is co-chair of the American College of Obstetricians and Gynecologists’ (ACOG) Maternal Mental Health Expert Work Group, and member on the Clinical Practice Guidelines – Obstetrics Committee having led the development of and authored two guidelines and a practice advisory related to perinatal mental health. She led the Alliance on Innovation in Maternal Health’s (AIM) perinatal mental health conditions patient safety bundle development work group and was lead faculty for the Institute of Healthcare Innovation’s (IHI) associated change package work group. She is a commissioner on the MA postpartum depression commission and will lead the MA perinatal quality collaborative, Perinatal Neonatal Quality Improvement Network (PNQIN), in implementing the AIM perinatal mental health conditions bundle across the state. She has served on the board of directors and is currently president elect of the Society of Academic Specialists in General Obstetrics and Gynecology and is a board examiner for the American Board of Obstetrics and Gynecology. She has received honoraria and travel coverage from speaking engagements with ACOG, AIM, NEOGS, and Miller Medical Communications. Dr. Byatt has received salary and/or funding support from Massachusetts Department of Mental Health via the Massachusetts Child Psychiatry Access Program for Moms (MCPAP for Moms). She is also the Medical Director of Research and Evaluation for MCPAP for Moms and the Executive Director of the Lifeline for Families Center at UMass Chan Medical School. She has served as a consultant for The Kinetix Group, VentureWell, and JBS International. All other authors of this study report no conflicts of interest. Funding Statement This research did not receive any specific grant from funding agencies in the public, commercial or not-for-profit sectors. Authors contributions: AW assisted with data synthesis and manuscript preparation. JT generated the hypothesis, assisted with data collection manuscript preparation. IQ assisted with data collection. KL performed statistical analysis and assisted with manuscript preparation. KC and TK assisted in methodology and hypothesis development. MC lead methodology development and data synthesis. NB and TMS assisted in methodology, data synthesis and manuscript preparation. All authors reviewed the manuscript prior to submission. Acknowledgements: Not applicable. References Screening and Diagnosis of Mental Health Conditions During Pregnancy and Postpartum. ACOG Clinical Practice Guideline 4. Obstet Gynecol Jun. 2023;1(6):1232–61. 10.1097/AOG.0000000000005200 . Trost SL, Beauregard JL, Smoots AN, et al. Preventing Pregnancy-Related Mental Health Deaths: Insights From 14 US Maternal Mortality Review Committees, 2008-17. Health Aff (Millwood) Oct. 2021;40(10):1551–9. 10.1377/hlthaff.2021.00615 . Trost SLBJ, Nijie F. Pregnancy-related deaths: data from Maternal Mortality Review Committees in 36 US States, 2017–2019. 2023. https://www.cdc.gov/reproductivehealth/maternal-mortality/erase-mm/data-mmrc.html . Byatt N, Xiao RS, Dinh KH, Waring ME. Mental health care use in relation to depressive symptoms among pregnant women in the USA. Arch Womens Ment Health Feb. 2016;19(1):187–91. 10.1007/s00737-015-0524-1 . Results from the 2015 National Survey on Drug Use and Health: Detailed Tables. 2016. September 8, 2016. Gosdin LK, Deputy NP, Kim SY, Dang EP, Denny CH. Alcohol Consumption and Binge Drinking During Pregnancy Among Adults Aged 18–49 Years - United States, 2018–2020. MMWR Morb Mortal Wkly Rep Jan. 2022;7(1):10–3. 10.15585/mmwr.mm7101a2 . 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Elevated risk of adverse obstetric outcomes in pregnant women with depression. Arch Womens Ment Health Dec. 2013;16(6):475–82. 10.1007/s00737-013-0371-x . Whelan AR, Wagner-Schuman M, Ghelani S, Majewski E, Summers S, Class QA. Associations between inpatient psychiatric admissions during pregnancy and adverse obstetrical and birth outcomes. Am J Obstet Gynecol MFM Sep. 2021;3(5):100413. 10.1016/j.ajogmf.2021.100413 . Letourneau NL, Dennis CL, Cosic N, Linder J. The effect of perinatal depression treatment for mothers on parenting and child development: A systematic review. Depress Anxiety Oct. 2017;34(10):928–66. 10.1002/da.22687 . Dubber S, Reck C, Muller M, Gawlik S. Postpartum bonding: the role of perinatal depression, anxiety and maternal-fetal bonding during pregnancy. Arch Womens Ment Health Apr. 2015;18(2):187–95. 10.1007/s00737-014-0445-4 . Deave T, Heron J, Evans J, Emond A. The impact of maternal depression in pregnancy on early child development. BJOG Jul. 2008;115(8):1043–51. 10.1111/j.1471-0528.2008.01752.x . Byatt N, Levin LL, Ziedonis D, Moore Simas TA, Allison J. Enhancing Participation in Depression Care in Outpatient Perinatal Care Settings: A Systematic Review. Obstet Gynecol Nov. 2015;126(5):1048–58. 10.1097/AOG.0000000000001067 . Dietrich AJ, Williams JW Jr., Ciotti MC, et al. Depression care attitudes and practices of newer obstetrician-gynecologists: a national survey. Am J Obstet Gynecol Jul. 2003;189(1):267–73. 10.1067/mob.2003.410 . Kendig S, Keats JP, Hoffman MC, et al. Consensus Bundle on Maternal Mental Health: Perinatal Depression and Anxiety. Obstet Gynecol Mar. 2017;129(3):422–30. 10.1097/AOG.0000000000001902 . Force USPST, Barry MJ, Nicholson WK, et al. Screening for Depression and Suicide Risk in Adults: US Preventive Services Task Force Recommendation Statement. JAMA Jun. 2023;20(23):2057–67. 10.1001/jama.2023.9297 . Force USPST, Curry SJ, Krist AH, et al. Interventions to Prevent Perinatal Depression: US Preventive Services Task Force Recommendation Statement. JAMA Feb. 2019;12(6):580–7. 10.1001/jama.2019.0007 . Maternal Mental Health: Depression and Anxiety. Counsel on Patient Safety in Women’s Health Care. Accessed March 2. 2021, https://safehealthcareforeverywoman.org/council/patient-safety-bundles/maternal-safety-bundles/maternal-mental-health-depression-and-anxiety/ . Obstetric Care for Women with Opioid Use Disorder. Counsel on Patient Safety in Women’s Health Care. https://safehealthcareforeverywoman.org/aim/patient-safety-bundles/maternal-safety-bundles/obstetric-care-for-women-with-opioid-use-disorder-aim/ . Council on Resident Education in Obstetrics and Gynecology (CREOG). Educational Objectives 12th edition. American College of Obstetricians and Gynecologists; 2020. Physicians AAoF. Curriculum Guideline No. 261 Maternity Care. 2018. Bennett S, Rodger S, Fitzgerald C, Gibson L. Simulation in Occupational Therapy Curricula: A literature review. Aust Occup Ther J Aug. 2017;64(4):314–27. 10.1111/1440-1630.12372 . Kraus CK, Greenberg MR, Ray DE, Dy SM. Palliative Care Education in Emergency Medicine Residency Training: A Survey of Program Directors, Associate Program Directors, and Assistant Program Directors. J Pain Symptom Manage May. 2016;51(5):898–906. 10.1016/j.jpainsymman.2015.12.334 . Byatt N, Xu W, Levin LL, Moore Simas TA. Perinatal depression care pathway for obstetric settings. Int Rev Psychiatry May. 2019;31(3):210–28. 10.1080/09540261.2018.1534725 . Data from. Number of Active MD Residents, by Race/Ethnicity (Alone or In Combination) and GME Specialty. 2021. Treatment and Management of Mental Health Conditions During Pregnancy and Postpartum. ACOG Clinical Practice Guideline 5. Obstet Gynecol Jun. 2023;1(6):1262–88. 10.1097/AOG.0000000000005202 . Anderson BL, Dang EP, Floyd RL, Sokol R, Mahoney J, Schulkin J. Knowledge, opinions, and practice patterns of obstetrician-gynecologists regarding their patients' use of alcohol. J Addict Med Jun. 2010;4(2):114–21. 10.1097/ADM.0b013e3181b95015 . Taouk LH, Matteson KA, Stark LM, Schulkin J. Prenatal depression screening and antidepressant prescription: obstetrician-gynecologists' practices, opinions, and interpretation of evidence. Arch Womens Ment Health Feb. 2018;21(1):85–91. 10.1007/s00737-017-0760-7 . Opioid Use Disorder. American College of Obstetricians and Gynecologists. Updated 2022. Accessed January 18, 2024. https://www.acog.org/education-and-events/creog/curriculum-resources/additional-curricular-resources/opiate-use-disorder . Masters GA, Yuan Y, Li NC, Straus J, Moore Simas TA, Byatt N. Improving front-line clinician capacity to address depression and bipolar disorder among perinatal individuals: a longitudinal analysis of the Massachusetts Child Psychiatry Access Program (MCPAP) for Moms. Arch Womens Ment Health Jun. 2023;26(3):401–10. 10.1007/s00737-023-01324-1 . Schaefer AJ, Mackie T, Veerakumar ES, et al. Increasing Access To Perinatal Mental Health Care: The Perinatal Psychiatry Access Program Model. Health Aff (Millwood) Apr. 2024;43(4):557–66. 10.1377/hlthaff.2023.01439 . Byatt N, Brenckle L, Sankaran P, et al. Effectiveness of two systems-level interventions to address perinatal depression in obstetric settings (PRISM): an active-controlled cluster-randomised trial. Lancet Public Health Jan. 2024;9(1):e35–46. 10.1016/S2468-2667(23)00268-2 . Alliance for Innovation on Maternal Health. Perinatal Mental Health Conditions.: American College of Obstetricians and Gynecologists.. Perinatal Mental Health Tool Kit. Updated 2023. Accessed January 19, 2024. https://www.acog.org/programs/perinatal-mental-health . Deichen Hansen ME, Londono Tobon A, Kamal Haider U, et al. The role of perinatal psychiatry access programs in advancing mental health equity. Gen Hosp Psychiatry May-Jun. 2023;82:75–85. 10.1016/j.genhosppsych.2023.03.001 . Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4432536","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":308190835,"identity":"985d997d-f92c-4071-9d02-0cfbc1631191","order_by":0,"name":"Anna R. 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Moore Moore Simas","email":"","orcid":"","institution":"University of Massachusetts Chan Medical School, UMass Memorial Health","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Tiffany","middleName":"A. Moore Moore","lastName":"Simas","suffix":""}],"badges":[],"createdAt":"2024-05-16 17:13:37","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4432536/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4432536/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":65862183,"identity":"73e81a14-e9db-464c-832e-ceb3e172785a","added_by":"auto","created_at":"2024-10-03 16:23:35","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1200410,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4432536/v1/7bc02c43-0e94-4985-9324-d1cfc669467b.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Perinatal Mood, Anxiety, and Substance Use Disorders: Are Future U.S. Obstetric Physicians Being Trained to Address the Most Common Complications of Pregnancy?","fulltext":[{"header":"INTRODUCTION","content":"\u003cp\u003eMental health conditions are the leading general and preventable causes of pregnancy-related morbidity and mortality in the United States.\u003csup\u003e1\u0026ndash;3\u003c/sup\u003e These disorders affect 1 in 5 perinatal individuals, with perinatal depression and anxiety being the most common.\u003csup\u003e1\u003c/sup\u003e Among those who screen positive for perinatal depression, almost a quarter have bipolar disorder.\u003csup\u003e4\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eIn addition to mood and anxiety disorders, substance use disorders have become increasingly prevalent in pregnancy. Data from the Center for Disease Control and Prevention and National Center for Health Statistics demonstrate that 7\u0026ndash;16% of individuals smoke cigarettes during pregnancy, 14% drink alcohol and 5% use illicit substances during pregnancy.\u003csup\u003e5\u0026ndash;7\u003c/sup\u003e Perinatal mental health disorders and substance use disorders are often co-morbid. Pregnant individuals who use alcohol and/or tobacco are 1.7\u0026ndash;2 times more likely to have experienced a major depressive episode in the 12 months prior, compared to pregnant individuals who do not use these substances.\u003csup\u003e8\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eWhen left untreated, perinatal mental health and substance use disorders can have devastating short- and long-term impacts on the perinatal individual, their child, and families. Both perinatal mental disorders and substance use disorders are associated with adverse obstetric and neonatal outcomes including preterm birth, preeclampsia, low birth weight, fetal alcohol syndrome, and neonatal abstinence syndrome.\u003csup\u003e9\u0026ndash;13\u003c/sup\u003e Additionally, mental health and substance use disorders impair social function, interfere with maternal-infant bonding, and increase a child\u0026rsquo;s lifetime risk for behavioral, cognitive, and mental health disorders.\u003csup\u003e14\u0026ndash;16\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eDespite the high prevalence and significant negative consequences of these conditions, many cases go unrecognized and even if recognized, untreated or undertreated. Existing literature indicates less than a quarter of perinatal individuals with recognized depression receive treatment.\u003csup\u003e17\u003c/sup\u003e Although most obstetric care clinicians agree that they are responsible for detecting and treating perinatal mental health and substance use disorders, historically a minority have felt prepared to do so upon completing residency.\u003csup\u003e18\u003c/sup\u003e A 2003 survey of Ob/Gyn residency graduates found that less than a third of respondents felt that residency prepared them to diagnose depression and less than 10% felt prepared to treat depression with medications or counseling.\u003csup\u003e18\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eSince 2015, significant national attention has been brought to and resources have been developed regarding increasing diagnosis and treatment of perinatal mental health and substance use disorders. The American College of Obstetricians and Gynecologists (ACOG), the Alliance on Innovation in Maternal Health (AIM), and the US Preventative Services Task Force (USPSTF) all recommend to screen for perinatal mental health and substance use disorders in the context of systems that facilitate subsequent assessment, diagnosis, treatment, follow-up, and moitoring.\u003csup\u003e10, 19\u0026ndash;23\u003c/sup\u003e Both the Council on Resident Education in Obstetrics and Gynecology (CREOG) and the American Academy of Family Physicians (AAFP) Curriculum Guideline Number 261 \u0026ldquo;Maternity Care\u0026rdquo; outline that graduating residents should be competent at diagnosing and treating perinatal mood, anxiety and substance use disorders.\u003csup\u003e24, 25\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eTo our knowledge, no evaluation of resident training in diagnosing and treating perinatal mental health and substance use disorders has occurred since 2015. This study surveyed obstetric care trainees including Obstetrics and Gynecology (Ob/Gyn) residents, Family Medicine (FM) residents, and Maternal Fetal Medicine (MFM) fellows to identify current training modalities that are being utilized to educate trainees on perinatal mental health and substance use disorders. We aimed to understand approaches and unmet needs to inform how to strengthen obstetric education such that graduates feel confident in recognizing and treating these common complications of pregnancy.\u003c/p\u003e"},{"header":"METHODS","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eSurvey Design\u003c/h2\u003e \u003cp\u003eWe designed a web-based cross-sectional anonymous survey about residency and fellowship training approaches for training providers to screen and treat perinatal mood, anxiety, and substance use disorders. As no previously validated surveys on this topic were identified, existing survey-based literature was reviewed to help inform survey design as well as distribution methods.\u003csup\u003e26, 27\u003c/sup\u003e The survey was developed and modified with input from faculty with subject matter and curriculum expertise in obstetrics, psychiatry and survey methods.\u003c/p\u003e \u003cp\u003eThe initial part of the survey asked about post-graduate year of respondents, program type (OBGYN or Family Medicine), number of residents, program affiliation (for example academic, community, military) and program geographic location.\u003c/p\u003e \u003cp\u003eNext, respondents were asked about exposure to eight different teaching modalities regarding perinatal mood and anxiety disorders. Modalities inquired about were: didactics, bedside teaching, assigned readings, paper decision support aids/toolkits, electronic decision support aids/toolkits, online self-directed modules, mentoring from psychiatry providers, and rotation in psychiatry.\u003c/p\u003e \u003cp\u003eParticipants were then asked to rate their confidence in performing steps along the perinatal mental health care pathway to treat perinatal mood and anxiety disorders including: (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e) detecting, assessing, treating depression, (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e) detecting assessing, treating anxiety, (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e) screening and referring for bipolar disorder, (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e) assessing risk of harm to self or others, (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e) determining when to refer for therapy, (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e) determining when/how to start medications for depression/ anxiety, and (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e) monitoring depression/ anxiety and adjusting medications.\u003csup\u003e28\u003c/sup\u003e Additionally, participants were asked about their confidence in screening, treating and monitoring substance use disorders in perinatal patients. Respondents were asked to rate their confidence, on a scale of 0 to 5 (0\u0026thinsp;=\u0026thinsp;not at all confident, 3\u0026thinsp;=\u0026thinsp;moderately confident, 5\u0026thinsp;=\u0026thinsp;very confident). Answers of \u0026ge;\u0026thinsp;3 on the Likert scale indicated moderate to high confidence.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eSelection of Participants\u003c/h2\u003e \u003cp\u003eThe study population included Obstetrics and Gynecology (Ob/Gyn) residents, Family Medicine (FM) residents, and Maternal-Fetal Medicine (MFM) fellows enrolled in programs accredited by the Accreditation Committee of Graduate Medical Education (ACGME), at the time of survey distribution. The ACGME website provided a list of all accredited programs. The names and contact information for each program\u0026rsquo;s director and/or coordinator were obtained through the ACGME website as well as through searching the websites of individual residency and fellowship programs. This resulted in a list of 282 Ob/Gyn residency programs, 455 FM residency programs, and 93 MFM fellowship programs.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eSurvey Administration\u003c/h2\u003e \u003cp\u003eThe surveys were distributed via e-mail invitation on 10/01/2019 to program directors and/or coordinators for each potential participating program. The program directors and coordinators received e-mail invitations that included a description of the study and web link to the survey. The directors and coordinators were asked to forward the invitation e-mail to their residents and fellows. The e-mail invitations stated that participation was voluntary and informed consent would be implied by completing the survey. Reminder e-mails were sent to all participating programs 15 days and 100 days after original distribution. The survey was active from 10/1/2019 until 1/15/2020. Given this approach, the total population of trainees that this survey opportunity reached is not fully known, however the maximum based on current available residency slots would be 4,631 Ob/Gyn residents, 8,929 FM residents, and 330 MFM fellows.\u003csup\u003e29\u003c/sup\u003e\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eData Collection\u003c/h2\u003e \u003cp\u003eThe data were collected through Qualtrics Software (Reference).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003eHuman Ethics and Consent to Participate\u003c/h2\u003e \u003cp\u003eParticipants completed a consent to participate prior to completing the survey. As an anonymous survey of educational curriculum, the study met exemption criteria when reviewed by the institutional review board of the University of Massachusetts Chan Medical School.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eData analysis\u003c/h2\u003e \u003cp\u003eDescriptive statistics were used to describe participant characteristics and survey responses overall and by specialty type (Ob/Gyn vs. FM) using frequency with percent for categorical variables and median with interquartile range (25th percentile \u0026ndash; 75th percentile) for continuous variables. Comparisons across specialties were made using Fisher\u0026rsquo;s exact test for categorical variables or Wilcoxon rank sum test for continuous variables. Confidence performing the tasks associated with diagnosis and treatment of perinatal mental health and substance use disorders (collected as a 6-point Likert scale 0\u0026ndash;5 with 0\u0026thinsp;=\u0026thinsp;Not at all confident and 5\u0026thinsp;=\u0026thinsp;very confident) were compared using Wilcoxon rank sum test. Confidence ratings were collapsed to \u0026lt;\u0026thinsp;3 or 3\u0026thinsp;+\u0026thinsp;and compared across specialties using the Chi square test. Confidence performing the tasks associated with diagnosis and treatment of perinatal mental health and substance use disorders PMAD pathway was assessed using a 0\u0026ndash;5 Likert scale. We calculated Spearman\u0026rsquo;s rank correlation coefficients and p-values. P-values\u0026thinsp;\u0026lt;\u0026thinsp;0.05 were considered statistically significant and were not adjusted for multiple comparisons. All analyses were performed using Stata MP 16.1(College Station, TX, USA, 2019).\u003c/p\u003e \u003c/div\u003e"},{"header":"RESULTS","content":"\u003cp\u003eOf the 125 respondents who completed the survey, 69.6% (n\u0026thinsp;=\u0026thinsp;87) were Ob/Gyn, and 30.4% (n\u0026thinsp;=\u0026thinsp;38) were Family Medicine (FM) trainees. The majority (74%) of Ob/Gyn respondents were from university-based programs, while the majority (84%) of Family Medicine respondents were from university-affiliated community-based (48%) or community-based (36%) programs. All regions of the country were represented in the sample (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDemographic characteristics of respondents\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003cp\u003e(N\u0026thinsp;=\u0026thinsp;125)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eOBGYN\u003c/p\u003e \u003cp\u003e(N\u0026thinsp;=\u0026thinsp;87)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eFM\u003c/p\u003e \u003cp\u003e(N\u0026thinsp;=\u0026thinsp;38)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eP-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e \u003cp\u003ePGY year\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"5\" rowspan=\"6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePGY-1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e25 (22%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e14 (18%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e11 (33%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePGY-2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e30 (27%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e15 (19%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e15 (45%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePGY-3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e26 (23%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e20 (25%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6 (18%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePGY-4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e13 (12%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e12 (15%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFellow (PGY 5\u0026ndash;7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e18 (16%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e18 (23%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1 ( 3%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e \u003cp\u003eProgram type\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCommunity-based\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e20 (18.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8 (10%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e12 (36%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUniversity-based\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e62 (56%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e58 (74%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4 (12%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMilitary-based\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1 ( 1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0 ( 0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1 ( 3%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCommunity-based University-affiliated\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e28 (25%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e12 (15%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e16 (48%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e \u003cp\u003eProgram location\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"6\" rowspan=\"7\"\u003e \u003cp\u003e0.726\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNew England\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e16 (14%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e12 (15%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4 (12%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMid \u0026amp; South Atlantic\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e42 (37%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e30 (38%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e12 (36%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNorth Central\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e28 (25%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e19 (24%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e9 (27%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSouth Central\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e10 ( 9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5 ( 6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5 (15%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMountain\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5 ( 4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4 ( 5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1 ( 3%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePacific\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e11 (10%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9 (11%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2 ( 6%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e \u003cp\u003eNumber of residents/fellows per class\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1\u0026ndash;5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e34 (31%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e31 (39%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3 ( 9%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e6\u0026ndash;10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e61 (55%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e40 (51%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e21 (66%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e11\u0026ndash;15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e11 (10%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6 ( 8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5 (16%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMore than 16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5 ( 5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0 ( 0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3 ( 9%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003e\u003cb\u003eA. Reported Training Modalities Utilized for Perinatal Mood, Anxiety, and Substance Use Disorders.\u003c/b\u003e Participants were instructed to check all that apply\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTraining Modality\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003cp\u003e(N\u0026thinsp;=\u0026thinsp;125)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eOBGYN\u003c/p\u003e \u003cp\u003e(N\u0026thinsp;=\u0026thinsp;87)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eFM\u003c/p\u003e \u003cp\u003e(N\u0026thinsp;=\u0026thinsp;38)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eP-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e \u003cp\u003ePerinatal Mood and Anxiety Disorders\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDidactics (seminars, lectures, case conferences)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e94 (75%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e70 (80%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e24 (63%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.046\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBedside teaching\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e58 (46%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e41 (47%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e17 (45%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.847\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAssigned readings (textbooks, chapters, articles, reading lists)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e36 (29%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e27 (31%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e9 (24%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.520\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePaper decision support aids and toolkits\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e26 (21%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e18 (21%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e8 (21%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.999\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eElectronic decision support aids and toolkits\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e24 (19%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e13 (15%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e11 (29%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.085\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOnline self-directed modules\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e11 ( 9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8 ( 9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3 ( 8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.999\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMentoring from psychiatry providers\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e11 ( 9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4 ( 5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7 (18%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.033\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUnknown\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e11 ( 9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7 (8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4 (11%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.734\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRotation in psychiatry\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e10 ( 8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0 ( 0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e10 (26%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOther\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4 ( 3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3 ( 3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1 ( 3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.999\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNumber of training modalities selected (median (IQR))\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2 (\u003cspan additionalcitationids=\"CR2\" citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2 (\u003cspan additionalcitationids=\"CR2\" citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.5 (\u003cspan additionalcitationids=\"CR2 CR3\" citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.534\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePerinatal Substance Use Disorders\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDidactics (seminars, lectures, case conferences)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e85 (68%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e62 (71%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e23 (61%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.298\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBedside teaching\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e49 (39%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e36 (41%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e13 (34%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.551\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBuprenorphine waiver training\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e37 (30%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e24 (28%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e13 (34%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.524\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMentoring from providers trained in addiction medicine\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e33 (26%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e21 (24%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e12 (32%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.387\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAssigned readings (textbooks, chapters, articles, reading lists)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e29 (23%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e24 (28%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5 (13%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.107\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOnline self-directed modules\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e25 (20%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e17 (20%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e8 (21%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.813\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eElectronic decision support aids and toolkits\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e14 (11%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9 (10%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5 (13%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.759\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUnknown\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e13 (10%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8 ( 9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5 (13%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.532\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRotation in addiction med/psychiatry\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e9 ( 7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0 ( 0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e9 (24%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePaper decision support aids and toolkits\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e8 ( 6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6 ( 7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2 ( 5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.999\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOther\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1 ( 1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1 ( 1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0 ( 0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.999\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNumber of training modalities selected\u003c/p\u003e \u003cp\u003e(median (IQR))\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2 (0\u0026ndash;4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2 (\u003cspan additionalcitationids=\"CR2 CR3\" citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2 (0.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.855\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \n \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab6\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003eB. Training modalities respondents reported as having found or would find helpful in learning to address PMAD and perinatal SUD.\u003c/span\u003e Participants were instructed to check all that apply.\u003c/div\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eTraining modality\u003c/div\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003eTotal\u003c/div\u003e \u003cdiv class=\"SimplePara\"\u003e(N\u0026thinsp;=\u0026thinsp;125)\u003c/div\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003eOBGYN\u003c/div\u003e \u003cdiv class=\"SimplePara\"\u003e(N\u0026thinsp;=\u0026thinsp;87)\u003c/div\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003eFM\u003c/div\u003e \u003cdiv class=\"SimplePara\"\u003e(N\u0026thinsp;=\u0026thinsp;38)\u003c/div\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cdiv class=\"SimplePara\"\u003eP-value\u003c/div\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eMentoring from experienced providers\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e83 (66%)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e58 (67%)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e25 (66%)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.999\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eDidactics\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e82 (66%)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e53 (61%)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e29 (76%)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.106\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eBuprenorphine waiver training\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e71 (57%)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e51 (59%)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e20 (53%)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.561\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eBedside teaching\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e53 (43%)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e37 (43%)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e16 (42%)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.999\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eRotation in addiction medicine/psychiatry\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e42 (34%)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e26 (30%)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e16 (42%)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.219\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eElectronic decision support aids and toolkits\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e42 (34%)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e28 (32%)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e14 (37%)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.682\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eOnline self-directed modules\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e32 (26%)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e23 (26%)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e9 (24%)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.826\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eAssigned readings\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e27 (22%)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e19 (22%)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e8 (21%)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.999\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003ePaper decision support aids and toolkits\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e22 (18%)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e15 (17%)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e7 (18%)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.999\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eRotation in psychiatry\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e22 (18%)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e11 (13%)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e11 (29%)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.040\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003cbr/\u003e\n\u003cp\u003eMost trainees (75%) reported that their programs provided didactic sessions on perinatal mood and anxiety disorders, followed by bedside teaching, assigned readings, and electronic or paper decision support aids (Table\u0026nbsp;\u003cspan refid=\"Tab6\" class=\"InternalRef\"\u003e2\u003c/span\u003eA).Twenty-six percent of Family Medicine trainees reported completing a psychiatry rotation, while no Ob/Gyn trainees did.\u003c/p\u003e \u003cp\u003eIn terms of perinatal substance use disorder training, didactic sessions were most commonly reported by trainee (68%). Almost a quarter of Family Medicine trainees reported completing a rotation in addiction medicine whereas no Ob/Gyn trainees did (Table\u0026nbsp;\u003cspan refid=\"Tab6\" class=\"InternalRef\"\u003e2\u003c/span\u003eA).\u003c/p\u003e \u003cp\u003eThe majority of respondents felt that they should have \u0026lsquo;more\u0026rsquo; or \u0026lsquo;a lot more\u0026rsquo; training in perinatal depression and anxiety disorders (78% Ob/Gyn, 61% FM) and substance use disorders (91% Ob/Gyn, 79% FM) than currently provided in their programs.\u003c/p\u003e \u003cp\u003eThe majority of participants reported at least moderate confidence detecting, assessing, and treating depression (82%) and anxiety (72%). While only 39% of participants felt at least moderately confident in screening for bipolar disorder. The majority of respondents (77%) felt at least moderately confident at assessing risk of harm to self or others and felt at least moderately confident in determining when to refer for therapy (81%). More than half (67%) of respondents felt at least moderately confident in determining when and how to start medications for depression and anxiety, whereas fewer (51%) respondents felt at least moderately confident in monitoring depression or anxiety and adjusting medications (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eReported Confidence Levels in Various Aspects of Addressing Perinatal Mood, Anxiety, and Substance Use Disorders\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eConfidence level (Likert scale 0\u0026ndash;5 with 0\u0026thinsp;=\u0026thinsp;Not at all Confident and 5\u0026thinsp;=\u0026thinsp;Very Confident)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;125)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eOBGYN\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;87)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eFM\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;38)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eP-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePerinatal Mood and Anxiety Disorders\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDetecting, assessing, treating depression (n (%)\u0026thinsp;\u0026ge;\u0026thinsp;3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e97 (82%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e66 (78%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e31 (91%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.086\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMedian (IQR)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3 (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3 (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4 (\u003cspan additionalcitationids=\"CR4\" citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.009\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDetecting assessing, treating anxiety (n (%)\u0026thinsp;\u0026ge;\u0026thinsp;3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e83 (72%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e56 (66%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e27 (87%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.025\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMedian (IQR)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3 (\u003cspan additionalcitationids=\"CR3\" citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3 (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4 (3-4.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.002\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eScreening for bipolar disorder and referring (n (%)\u0026thinsp;\u0026ge;\u0026thinsp;3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e43 (39%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e22 (28%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e21 (66%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMedian (IQR)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2 (\u003cspan additionalcitationids=\"CR2\" citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2 (\u003cspan additionalcitationids=\"CR2\" citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3 (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.002\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAssessing risk of harm to self/others (n (%)\u0026thinsp;\u0026ge;\u0026thinsp;3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e92 (77%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e66 (77%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e26 (79%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.812\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMedian (IQR)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4 (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4 (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4 (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.556\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDetermining when to refer for therapy (n (%)\u0026thinsp;\u0026ge;\u0026thinsp;3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e96 (81%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e67 (78%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e29 (88%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.217\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMedian (IQR)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4 (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3 (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4 (\u003cspan additionalcitationids=\"CR4\" citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.019\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDetermining when/how to start meds for depression/anxiety (n (%)\u0026thinsp;\u0026ge;\u0026thinsp;3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e80 (67%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e53 (62%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e27 (82%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.036\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMedian (IQR)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3 (\u003cspan additionalcitationids=\"CR3\" citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3 (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4 (\u003cspan additionalcitationids=\"CR4\" citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMonitoring depression/anxiety and adjusting meds (n (%)\u0026thinsp;\u0026ge;\u0026thinsp;3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e58 (51%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e31 (38%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e27 (82%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMedian (IQR)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2 (\u003cspan additionalcitationids=\"CR2 CR3\" citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2 (\u003cspan additionalcitationids=\"CR2\" citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4 (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePerinatal Substance Use Disorders\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDetecting, assessing, treating SUD (n (%)\u0026thinsp;\u0026ge;\u0026thinsp;3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e64 (60%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e47 (63%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e17 (53%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.357\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMedian (IQR)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3 (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3 (2-3.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3 (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.362\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDetermining when to refer for therapy for SUD (n (%)\u0026thinsp;\u0026ge;\u0026thinsp;3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e69 (64%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e51 (68%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e18 (56%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.245\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMedian (IQR)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3 (\u003cspan additionalcitationids=\"CR3\" citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3 (\u003cspan additionalcitationids=\"CR3\" citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3 (\u003cspan additionalcitationids=\"CR3\" citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.600\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDetermining when/how to start medication treatment for SUD (n (%)\u0026thinsp;\u0026ge;\u0026thinsp;3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e32 (38%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e24 (43%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e8 (29%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.204\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMedian (IQR)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2 (\u003cspan additionalcitationids=\"CR2\" citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2 (\u003cspan additionalcitationids=\"CR2\" citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1 (\u003cspan additionalcitationids=\"CR2\" citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.646\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMonitoring SUD \u0026amp; adjusting medications (n (%)\u0026thinsp;\u0026ge;\u0026thinsp;3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e33 (43%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e24 (47%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e9 (36%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.361\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMedian (IQR)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1 (\u003cspan additionalcitationids=\"CR2\" citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1 (\u003cspan additionalcitationids=\"CR2 CR3\" citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1 (\u003cspan additionalcitationids=\"CR2\" citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.556\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eReferring patients to treatment for SUD (n (%)\u0026thinsp;\u0026ge;\u0026thinsp;3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e79 (73%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e58 (76%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e21 (66%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.252\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMedian (IQR)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4 (\u003cspan additionalcitationids=\"CR3 CR4\" citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4 (\u003cspan additionalcitationids=\"CR4\" citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3 (\u003cspan additionalcitationids=\"CR3\" citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.192\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eWhile 64% of respondents reported screening greater than 75% of their pregnant and postpartum patients for mood and anxiety disorders at least once during their pregnancy and first year postpartum using a validated tool, only 48% of respondents reported doing the same for substance use disorders. Additionally, participants generally self-reported lower confidence in their abilities to treat perinatal substance use disorders. While 73% of respondents felt confident in knowing when to refer patients for treatment for substance use disorder, only 38% of respondents felt confident in their ability to determine when and how to start medication treatment for substance use disorder (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe eight training modalities were correlated with steps along the comprehensive perinatal mental health care pathway. Psychiatry mentoring had the strongest correlation (0.333) with determining when or how to start medications for depression or anxiety (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003eA). Buprenorphine waiver training had the strongest correlation (0.321) with monitoring and adjusting medications for substance use disorder (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003eB).\u003c/p\u003e \n\u003cp\u003e\u003cstrong\u003eTable 4A. Correlation Between Training Modalities Utilized and the Reported Confidence Level at Performing the Steps Along the Comprehensive Perinatal Mental Health Care Pathway to Address Perinatal Mood and Anxiety Disorders\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"697\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"18.05157593123209%\" rowspan=\"2\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003cstrong\u003eConfidence Level at Performing the Steps Along the Comprehensive Perinatal Mental Health Care Pathway\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"81.9484240687679%\" colspan=\"9\" valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003eTraining Modalities Used for Perinatal Mood and Anxiety Disorders\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"10.507880910683012%\" valign=\"bottom\"\u003e\n \u003cp\u003eDidactics\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.507880910683012%\" valign=\"bottom\"\u003e\n \u003cp\u003eOnline self-directed modules\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.558669001751314%\" valign=\"bottom\"\u003e\n \u003cp\u003ePaper decision support aids/ toolkits\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.558669001751314%\" valign=\"bottom\"\u003e\n \u003cp\u003eElectronic decision support aids/ toolkits\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.507880910683012%\" valign=\"bottom\"\u003e\n \u003cp\u003eAssigned readings\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.507880910683012%\" valign=\"bottom\"\u003e\n \u003cp\u003eBedside teaching\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.558669001751314%\" valign=\"bottom\"\u003e\n \u003cp\u003ePsychiatry rotation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.558669001751314%\" valign=\"bottom\"\u003e\n \u003cp\u003eMentoring from psychiatry providers\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.733800350262698%\" valign=\"bottom\"\u003e\n \u003cp\u003eOther\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"18.077474892395983%\" valign=\"bottom\"\u003e\n \u003cp\u003eDetecting, assessing, treating depression (CC)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.60832137733142%\" valign=\"bottom\"\u003e\n \u003cp\u003e0.154\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.60832137733142%\" valign=\"bottom\"\u003e\n \u003cp\u003e0.046\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.469153515064562%\" valign=\"bottom\"\u003e\n \u003cp\u003e0.189*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.469153515064562%\" valign=\"bottom\"\u003e\n \u003cp\u003e0.230*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.60832137733142%\" valign=\"bottom\"\u003e\n \u003cp\u003e0.230*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.60832137733142%\" valign=\"bottom\"\u003e\n \u003cp\u003e0.243*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.469153515064562%\" valign=\"bottom\"\u003e\n \u003cp\u003e0.089\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.469153515064562%\" valign=\"bottom\"\u003e\n \u003cp\u003e0.150\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.612625538020087%\" valign=\"bottom\"\u003e\n \u003cp\u003e0.112\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"18.077474892395983%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u003c/p\u003e\n \u003cp\u003eMedian (IQR)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.60832137733142%\" valign=\"bottom\"\u003e\n \u003cp\u003e4 (3-4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.60832137733142%\" valign=\"bottom\"\u003e\n \u003cp\u003e3 (3-5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.469153515064562%\" valign=\"bottom\"\u003e\n \u003cp\u003e4 (3-5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.469153515064562%\" valign=\"bottom\"\u003e\n \u003cp\u003e4 (3-4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.60832137733142%\" valign=\"bottom\"\u003e\n \u003cp\u003e4 (3-4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.60832137733142%\" valign=\"bottom\"\u003e\n \u003cp\u003e4 (3-4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.469153515064562%\" valign=\"bottom\"\u003e\n \u003cp\u003e4 (3-5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.469153515064562%\" valign=\"bottom\"\u003e\n \u003cp\u003e4 (3-5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.612625538020087%\" valign=\"bottom\"\u003e\n \u003cp\u003e4 (3.5-4)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"18.077474892395983%\" valign=\"bottom\"\u003e\n \u003cp\u003eDetecting assessing, treating anxiety (CC)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.60832137733142%\" valign=\"bottom\"\u003e\n \u003cp\u003e0.130\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.60832137733142%\" valign=\"bottom\"\u003e\n \u003cp\u003e0.076\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.469153515064562%\" valign=\"bottom\"\u003e\n \u003cp\u003e0.226*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.469153515064562%\" valign=\"bottom\"\u003e\n \u003cp\u003e0.087\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.60832137733142%\" valign=\"bottom\"\u003e\n \u003cp\u003e0.292*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.60832137733142%\" valign=\"bottom\"\u003e\n \u003cp\u003e0.207*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.469153515064562%\" valign=\"bottom\"\u003e\n \u003cp\u003e0.113\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.469153515064562%\" valign=\"bottom\"\u003e\n \u003cp\u003e0.262*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.612625538020087%\" valign=\"bottom\"\u003e\n \u003cp\u003e-0.074\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"18.077474892395983%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u003c/p\u003e\n \u003cp\u003eMedian (IQR)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.60832137733142%\" valign=\"bottom\"\u003e\n \u003cp\u003e3 (2-4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.60832137733142%\" valign=\"bottom\"\u003e\n \u003cp\u003e3 (3-4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.469153515064562%\" valign=\"bottom\"\u003e\n \u003cp\u003e3 (3-4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.469153515064562%\" valign=\"bottom\"\u003e\n \u003cp\u003e3 (3-4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.60832137733142%\" valign=\"bottom\"\u003e\n \u003cp\u003e3 (3-4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.60832137733142%\" valign=\"bottom\"\u003e\n \u003cp\u003e3 (3-4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.469153515064562%\" valign=\"bottom\"\u003e\n \u003cp\u003e4 (3-4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.469153515064562%\" valign=\"bottom\"\u003e\n \u003cp\u003e4 (3-5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.612625538020087%\" valign=\"bottom\"\u003e\n \u003cp\u003e2.5 (2-3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"18.077474892395983%\" valign=\"bottom\"\u003e\n \u003cp\u003eScreening for BD and referring (CC)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.60832137733142%\" valign=\"bottom\"\u003e\n \u003cp\u003e0.203*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.60832137733142%\" valign=\"bottom\"\u003e\n \u003cp\u003e0.134\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.469153515064562%\" valign=\"bottom\"\u003e\n \u003cp\u003e0.158\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.469153515064562%\" valign=\"bottom\"\u003e\n \u003cp\u003e0.237*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.60832137733142%\" valign=\"bottom\"\u003e\n \u003cp\u003e0.103\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.60832137733142%\" valign=\"bottom\"\u003e\n \u003cp\u003e0.225*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.469153515064562%\" valign=\"bottom\"\u003e\n \u003cp\u003e0.253*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.469153515064562%\" valign=\"bottom\"\u003e\n \u003cp\u003e0.173\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.612625538020087%\" valign=\"bottom\"\u003e\n \u003cp\u003e-0.034\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"18.077474892395983%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u003c/p\u003e\n \u003cp\u003eMedian (IQR)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.60832137733142%\" valign=\"bottom\"\u003e\n \u003cp\u003e2 (2-3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.60832137733142%\" valign=\"bottom\"\u003e\n \u003cp\u003e3 (2-3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.469153515064562%\" valign=\"bottom\"\u003e\n \u003cp\u003e2.5 (2-3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.469153515064562%\" valign=\"bottom\"\u003e\n \u003cp\u003e3 (2-3.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.60832137733142%\" valign=\"bottom\"\u003e\n \u003cp\u003e2 (2-3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.60832137733142%\" valign=\"bottom\"\u003e\n \u003cp\u003e2 (2-3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.469153515064562%\" valign=\"bottom\"\u003e\n \u003cp\u003e3 (3-4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.469153515064562%\" valign=\"bottom\"\u003e\n \u003cp\u003e3 (2-4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.612625538020087%\" valign=\"bottom\"\u003e\n \u003cp\u003e2 (1-3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"18.077474892395983%\" valign=\"bottom\"\u003e\n \u003cp\u003eAssessing risk of harm to self/others (CC)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.60832137733142%\" valign=\"bottom\"\u003e\n \u003cp\u003e0.234*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.60832137733142%\" valign=\"bottom\"\u003e\n \u003cp\u003e0.162\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.469153515064562%\" valign=\"bottom\"\u003e\n \u003cp\u003e0.220*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.469153515064562%\" valign=\"bottom\"\u003e\n \u003cp\u003e0.203*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.60832137733142%\" valign=\"bottom\"\u003e\n \u003cp\u003e0.173\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.60832137733142%\" valign=\"bottom\"\u003e\n \u003cp\u003e0.204*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.469153515064562%\" valign=\"bottom\"\u003e\n \u003cp\u003e0.051\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.469153515064562%\" valign=\"bottom\"\u003e\n \u003cp\u003e0.003\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.612625538020087%\" valign=\"bottom\"\u003e\n \u003cp\u003e-0.147\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"18.077474892395983%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u003c/p\u003e\n \u003cp\u003eMedian (IQR)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.60832137733142%\" valign=\"bottom\"\u003e\n \u003cp\u003e4 (3-4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.60832137733142%\" valign=\"bottom\"\u003e\n \u003cp\u003e4 (3-5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.469153515064562%\" valign=\"bottom\"\u003e\n \u003cp\u003e4 (3-5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.469153515064562%\" valign=\"bottom\"\u003e\n \u003cp\u003e4 (3.5-4.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.60832137733142%\" valign=\"bottom\"\u003e\n \u003cp\u003e4 (3-4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.60832137733142%\" valign=\"bottom\"\u003e\n \u003cp\u003e4 (3-4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.469153515064562%\" valign=\"bottom\"\u003e\n \u003cp\u003e4 (3-4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.469153515064562%\" valign=\"bottom\"\u003e\n \u003cp\u003e4 (2-4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.612625538020087%\" valign=\"bottom\"\u003e\n \u003cp\u003e2.5 (2-3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"18.077474892395983%\" valign=\"bottom\"\u003e\n \u003cp\u003eDetermining when to refer for therapy (CC)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.60832137733142%\" valign=\"bottom\"\u003e\n \u003cp\u003e0.191*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.60832137733142%\" valign=\"bottom\"\u003e\n \u003cp\u003e0.081\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.469153515064562%\" valign=\"bottom\"\u003e\n \u003cp\u003e0.169\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.469153515064562%\" valign=\"bottom\"\u003e\n \u003cp\u003e0.093\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.60832137733142%\" valign=\"bottom\"\u003e\n \u003cp\u003e0.056\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.60832137733142%\" valign=\"bottom\"\u003e\n \u003cp\u003e0.217*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.469153515064562%\" valign=\"bottom\"\u003e\n \u003cp\u003e0.120\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.469153515064562%\" valign=\"bottom\"\u003e\n \u003cp\u003e0.200*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.612625538020087%\" valign=\"bottom\"\u003e\n \u003cp\u003e0.014\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"18.077474892395983%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eMedian (IQR)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.60832137733142%\" valign=\"bottom\"\u003e\n \u003cp\u003e4 (3-4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.60832137733142%\" valign=\"bottom\"\u003e\n \u003cp\u003e4 (3-5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.469153515064562%\" valign=\"bottom\"\u003e\n \u003cp\u003e4 (3-5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.469153515064562%\" valign=\"bottom\"\u003e\n \u003cp\u003e4 (3-4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.60832137733142%\" valign=\"bottom\"\u003e\n \u003cp\u003e4 (3-4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.60832137733142%\" valign=\"bottom\"\u003e\n \u003cp\u003e4 (3-5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.469153515064562%\" valign=\"bottom\"\u003e\n \u003cp\u003e4 (3-5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.469153515064562%\" valign=\"bottom\"\u003e\n \u003cp\u003e5 (3-5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.612625538020087%\" valign=\"bottom\"\u003e\n \u003cp\u003e3.5 (3-4)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"18.077474892395983%\" valign=\"bottom\"\u003e\n \u003cp\u003eDetermining when/how to start meds for depression/ anxiety (CC)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.60832137733142%\" valign=\"bottom\"\u003e\n \u003cp\u003e0.153\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.60832137733142%\" valign=\"bottom\"\u003e\n \u003cp\u003e0.099\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.469153515064562%\" valign=\"bottom\"\u003e\n \u003cp\u003e0.099\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.469153515064562%\" valign=\"bottom\"\u003e\n \u003cp\u003e0.193*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.60832137733142%\" valign=\"bottom\"\u003e\n \u003cp\u003e0.202*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.60832137733142%\" valign=\"bottom\"\u003e\n \u003cp\u003e0.130\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.469153515064562%\" valign=\"bottom\"\u003e\n \u003cp\u003e0.200*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.469153515064562%\" valign=\"bottom\"\u003e\n \u003cp\u003e0.333*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.612625538020087%\" valign=\"bottom\"\u003e\n \u003cp\u003e-0.007\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"18.077474892395983%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eMedian (IQR)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.60832137733142%\" valign=\"bottom\"\u003e\n \u003cp\u003e3 (2-4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.60832137733142%\" valign=\"bottom\"\u003e\n \u003cp\u003e3 (3-5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.469153515064562%\" valign=\"bottom\"\u003e\n \u003cp\u003e3.5 (2-5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.469153515064562%\" valign=\"bottom\"\u003e\n \u003cp\u003e3 (3-4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.60832137733142%\" valign=\"bottom\"\u003e\n \u003cp\u003e3 (3-4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.60832137733142%\" valign=\"bottom\"\u003e\n \u003cp\u003e3 (2-4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.469153515064562%\" valign=\"bottom\"\u003e\n \u003cp\u003e4.5 (3-5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.469153515064562%\" valign=\"bottom\"\u003e\n \u003cp\u003e5 (3-5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.612625538020087%\" valign=\"bottom\"\u003e\n \u003cp\u003e2.5 (2-3.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"18.077474892395983%\" valign=\"bottom\"\u003e\n \u003cp\u003eMonitoring depression/ anxiety and adjusting meds (CC)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.60832137733142%\" valign=\"bottom\"\u003e\n \u003cp\u003e0.093\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.60832137733142%\" valign=\"bottom\"\u003e\n \u003cp\u003e0.083\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.469153515064562%\" valign=\"bottom\"\u003e\n \u003cp\u003e0.116\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.469153515064562%\" valign=\"bottom\"\u003e\n \u003cp\u003e0.231*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.60832137733142%\" valign=\"bottom\"\u003e\n \u003cp\u003e0.145\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.60832137733142%\" valign=\"bottom\"\u003e\n \u003cp\u003e0.073\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.469153515064562%\" valign=\"bottom\"\u003e\n \u003cp\u003e0.216*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.469153515064562%\" valign=\"bottom\"\u003e\n \u003cp\u003e0.175\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.612625538020087%\" valign=\"bottom\"\u003e\n \u003cp\u003e-0.061\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"18.077474892395983%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u003c/p\u003e\n \u003cp\u003eMedian (IQR)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.60832137733142%\" valign=\"bottom\"\u003e\n \u003cp\u003e3 (1-4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.60832137733142%\" valign=\"bottom\"\u003e\n \u003cp\u003e3 (2-4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.469153515064562%\" valign=\"bottom\"\u003e\n \u003cp\u003e3 (1-4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.469153515064562%\" valign=\"bottom\"\u003e\n \u003cp\u003e3 (2-4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.60832137733142%\" valign=\"bottom\"\u003e\n \u003cp\u003e3 (2-4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.60832137733142%\" valign=\"bottom\"\u003e\n \u003cp\u003e2.5 (1-4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.469153515064562%\" valign=\"bottom\"\u003e\n \u003cp\u003e4 (3-5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.469153515064562%\" valign=\"bottom\"\u003e\n \u003cp\u003e3 (2-4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.612625538020087%\" valign=\"bottom\"\u003e\n \u003cp\u003e2 (1.5-2)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eThe Confidence level (Likert scale 0-5 with 0=Not at all Confident and 5=Very Confident)\u003c/p\u003e\n\u003cp\u003e(CC)=Correlation Coefficient\u003c/p\u003e\n\u003cp\u003e*P\u0026lt;0.05\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 4B. \u0026nbsp; Correlation between Training Modalities Utilized and the Reported Confidence Level at Performing the Steps Along the Comprehensive Perinatal Mental Health Care Pathway to Address Perinatal Substance Use Disorders\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"694\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"14.676258992805755%\" rowspan=\"2\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp; \u003cstrong\u003eConfidence Level at Performing the Steps Along the Comprehensive Perinatal Mental Health Care Pathway\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"85.32374100719424%\" colspan=\"10\" valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003eTraining Modalities Used for Substance Use Disorders \u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"11.298482293423271%\" valign=\"bottom\"\u003e\n \u003cp\u003eBuprenorphine waiver\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.780775716694773%\" valign=\"bottom\"\u003e\n \u003cp\u003eDidactics\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.937605396290051%\" valign=\"bottom\"\u003e\n \u003cp\u003eOnline self-directed modules\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.780775716694773%\" valign=\"bottom\"\u003e\n \u003cp\u003ePaper decision support aids/ toolkits\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.780775716694773%\" valign=\"bottom\"\u003e\n \u003cp\u003eElectronic decision support aids/ toolkits\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.780775716694773%\" valign=\"bottom\"\u003e\n \u003cp\u003eAssigned readings\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.094435075885329%\" valign=\"bottom\"\u003e\n \u003cp\u003eBedside teaching\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.961214165261383%\" valign=\"bottom\"\u003e\n \u003cp\u003eRotation in addiction med / psychiatry\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.647554806070826%\" valign=\"bottom\"\u003e\n \u003cp\u003eMentoring from providers trained in addiction medicine\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.937605396290051%\" valign=\"bottom\"\u003e\n \u003cp\u003eOther\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"14.676258992805755%\" valign=\"bottom\"\u003e\n \u003cp\u003eDetecting, assessing, treating (CC)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.640287769784173%\" valign=\"bottom\"\u003e\n \u003cp\u003e0.208*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.345323741007194%\" valign=\"bottom\"\u003e\n \u003cp\u003e0.264*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.625899280575539%\" valign=\"bottom\"\u003e\n \u003cp\u003e0.215*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.345323741007194%\" valign=\"bottom\"\u003e\n \u003cp\u003e0.045\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.345323741007194%\" valign=\"bottom\"\u003e\n \u003cp\u003e0.236*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.345323741007194%\" valign=\"bottom\"\u003e\n \u003cp\u003e0.036\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.906474820143885%\" valign=\"bottom\"\u003e\n \u003cp\u003e0.125\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.352517985611511%\" valign=\"bottom\"\u003e\n \u003cp\u003e0.071\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.79136690647482%\" valign=\"bottom\"\u003e\n \u003cp\u003e0.192\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.625899280575539%\" valign=\"bottom\"\u003e\n \u003cp\u003e0.119\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"14.676258992805755%\" valign=\"bottom\"\u003e\n \u003cp\u003eMedian (IQR)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.640287769784173%\" valign=\"bottom\"\u003e\n \u003cp\u003e3 (2-4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.345323741007194%\" valign=\"bottom\"\u003e\n \u003cp\u003e3 (2-3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.625899280575539%\" valign=\"bottom\"\u003e\n \u003cp\u003e3 (2-4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.345323741007194%\" valign=\"bottom\"\u003e\n \u003cp\u003e2.5 (2-3.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.345323741007194%\" valign=\"bottom\"\u003e\n \u003cp\u003e3 (2-5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.345323741007194%\" valign=\"bottom\"\u003e\n \u003cp\u003e3 (2-3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.906474820143885%\" valign=\"bottom\"\u003e\n \u003cp\u003e3 (2-3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.352517985611511%\" valign=\"bottom\"\u003e\n \u003cp\u003e3 (3-4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.79136690647482%\" valign=\"bottom\"\u003e\n \u003cp\u003e3 (2-4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.625899280575539%\" valign=\"bottom\"\u003e\n \u003cp\u003e4 (4-4)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"14.676258992805755%\" valign=\"bottom\"\u003e\n \u003cp\u003eDetermining when to refer for therapy (CC)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.640287769784173%\" valign=\"bottom\"\u003e\n \u003cp\u003e0.141\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.345323741007194%\" valign=\"bottom\"\u003e\n \u003cp\u003e0.317*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.625899280575539%\" valign=\"bottom\"\u003e\n \u003cp\u003e0.203\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.345323741007194%\" valign=\"bottom\"\u003e\n \u003cp\u003e0.210*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.345323741007194%\" valign=\"bottom\"\u003e\n \u003cp\u003e0.201\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.345323741007194%\" valign=\"bottom\"\u003e\n \u003cp\u003e0.124\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.906474820143885%\" valign=\"bottom\"\u003e\n \u003cp\u003e0.167\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.352517985611511%\" valign=\"bottom\"\u003e\n \u003cp\u003e0.153\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.79136690647482%\" valign=\"bottom\"\u003e\n \u003cp\u003e0.253*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.625899280575539%\" valign=\"bottom\"\u003e\n \u003cp\u003e0.153\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"14.676258992805755%\" valign=\"bottom\"\u003e\n \u003cp\u003eMedian (IQR)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.640287769784173%\" valign=\"bottom\"\u003e\n \u003cp\u003e3 (2-4.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.345323741007194%\" valign=\"bottom\"\u003e\n \u003cp\u003e3 (2-4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.625899280575539%\" valign=\"bottom\"\u003e\n \u003cp\u003e3 (3-4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.345323741007194%\" valign=\"bottom\"\u003e\n \u003cp\u003e4 (3-4.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.345323741007194%\" valign=\"bottom\"\u003e\n \u003cp\u003e4 (3-4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.345323741007194%\" valign=\"bottom\"\u003e\n \u003cp\u003e3 (3-4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.906474820143885%\" valign=\"bottom\"\u003e\n \u003cp\u003e3 (2-4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.352517985611511%\" valign=\"bottom\"\u003e\n \u003cp\u003e4 (3-5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.79136690647482%\" valign=\"bottom\"\u003e\n \u003cp\u003e4 (3-5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.625899280575539%\" valign=\"bottom\"\u003e\n \u003cp\u003e5 (5-5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"14.676258992805755%\" valign=\"bottom\"\u003e\n \u003cp\u003eDetermining when/how to start medication treatment (CC)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.640287769784173%\" valign=\"bottom\"\u003e\n \u003cp\u003e0.287*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.345323741007194%\" valign=\"bottom\"\u003e\n \u003cp\u003e0.138\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.625899280575539%\" valign=\"bottom\"\u003e\n \u003cp\u003e0.189\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.345323741007194%\" valign=\"bottom\"\u003e\n \u003cp\u003e0.125\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.345323741007194%\" valign=\"bottom\"\u003e\n \u003cp\u003e0.256*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.345323741007194%\" valign=\"bottom\"\u003e\n \u003cp\u003e0.004\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.906474820143885%\" valign=\"bottom\"\u003e\n \u003cp\u003e0.021\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.352517985611511%\" valign=\"bottom\"\u003e\n \u003cp\u003e0.010\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.79136690647482%\" valign=\"bottom\"\u003e\n \u003cp\u003e0.267*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.625899280575539%\" valign=\"bottom\"\u003e\n \u003cp\u003e0.088\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"14.676258992805755%\" valign=\"bottom\"\u003e\n \u003cp\u003eMedian (IQR)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.640287769784173%\" valign=\"bottom\"\u003e\n \u003cp\u003e2 (1-4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.345323741007194%\" valign=\"bottom\"\u003e\n \u003cp\u003e2 (1-3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.625899280575539%\" valign=\"bottom\"\u003e\n \u003cp\u003e2 (1-4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.345323741007194%\" valign=\"bottom\"\u003e\n \u003cp\u003e3 (1-4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.345323741007194%\" valign=\"bottom\"\u003e\n \u003cp\u003e3 (2-4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.345323741007194%\" valign=\"bottom\"\u003e\n \u003cp\u003e2 (1-3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.906474820143885%\" valign=\"bottom\"\u003e\n \u003cp\u003e1 (1-3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.352517985611511%\" valign=\"bottom\"\u003e\n \u003cp\u003e2 (1-3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.79136690647482%\" valign=\"bottom\"\u003e\n \u003cp\u003e2.5 (1-4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.625899280575539%\" valign=\"bottom\"\u003e\n \u003cp\u003e3 (3-3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"14.676258992805755%\" valign=\"bottom\"\u003e\n \u003cp\u003eMonitoring \u0026amp; adjusting medications (CC)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.640287769784173%\" valign=\"bottom\"\u003e\n \u003cp\u003e0.321*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.345323741007194%\" valign=\"bottom\"\u003e\n \u003cp\u003e0.181\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.625899280575539%\" valign=\"bottom\"\u003e\n \u003cp\u003e0.126\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.345323741007194%\" valign=\"bottom\"\u003e\n \u003cp\u003e0.145\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.345323741007194%\" valign=\"bottom\"\u003e\n \u003cp\u003e0.279*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.345323741007194%\" valign=\"bottom\"\u003e\n \u003cp\u003e0.114\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.906474820143885%\" valign=\"bottom\"\u003e\n \u003cp\u003e0.039\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.352517985611511%\" valign=\"bottom\"\u003e\n \u003cp\u003e-0.070\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.79136690647482%\" valign=\"bottom\"\u003e\n \u003cp\u003e0.249*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.625899280575539%\" valign=\"bottom\"\u003e\n \u003cp\u003e0.139\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"14.676258992805755%\" valign=\"bottom\"\u003e\n \u003cp\u003eMedian (IQR)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.640287769784173%\" valign=\"bottom\"\u003e\n \u003cp\u003e3 (1-4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.345323741007194%\" valign=\"bottom\"\u003e\n \u003cp\u003e2 (1-4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.625899280575539%\" valign=\"bottom\"\u003e\n \u003cp\u003e2 (1-4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.345323741007194%\" valign=\"bottom\"\u003e\n \u003cp\u003e3 (1-3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.345323741007194%\" valign=\"bottom\"\u003e\n \u003cp\u003e3 (2-4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.345323741007194%\" valign=\"bottom\"\u003e\n \u003cp\u003e2 (1-3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.906474820143885%\" valign=\"bottom\"\u003e\n \u003cp\u003e1 (1-3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.352517985611511%\" valign=\"bottom\"\u003e\n \u003cp\u003e1 (1-3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.79136690647482%\" valign=\"bottom\"\u003e\n \u003cp\u003e3 (1-4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.625899280575539%\" valign=\"bottom\"\u003e\n \u003cp\u003e4 (4-4)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"14.676258992805755%\" valign=\"bottom\"\u003e\n \u003cp\u003eReferring patients to treatment (CC)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.640287769784173%\" valign=\"bottom\"\u003e\n \u003cp\u003e0.164\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.345323741007194%\" valign=\"bottom\"\u003e\n \u003cp\u003e0.316*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.625899280575539%\" valign=\"bottom\"\u003e\n \u003cp\u003e0.088\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.345323741007194%\" valign=\"bottom\"\u003e\n \u003cp\u003e0.199\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.345323741007194%\" valign=\"bottom\"\u003e\n \u003cp\u003e0.096\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.345323741007194%\" valign=\"bottom\"\u003e\n \u003cp\u003e0.093\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.906474820143885%\" valign=\"bottom\"\u003e\n \u003cp\u003e0.042\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.352517985611511%\" valign=\"bottom\"\u003e\n \u003cp\u003e0.103\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.79136690647482%\" valign=\"bottom\"\u003e\n \u003cp\u003e0.172\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.625899280575539%\" valign=\"bottom\"\u003e\n \u003cp\u003e0.132\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"14.676258992805755%\" valign=\"bottom\"\u003e\n \u003cp\u003eMedian (IQR)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.640287769784173%\" valign=\"bottom\"\u003e\n \u003cp\u003e4 (3-5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.345323741007194%\" valign=\"bottom\"\u003e\n \u003cp\u003e4 (3-5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.625899280575539%\" valign=\"bottom\"\u003e\n \u003cp\u003e4 (3-4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.345323741007194%\" valign=\"bottom\"\u003e\n \u003cp\u003e4 (3.5-5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.345323741007194%\" valign=\"bottom\"\u003e\n \u003cp\u003e4 (3-4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.345323741007194%\" valign=\"bottom\"\u003e\n \u003cp\u003e4 (3-5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.906474820143885%\" valign=\"bottom\"\u003e\n \u003cp\u003e4 (3-4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.352517985611511%\" valign=\"bottom\"\u003e\n \u003cp\u003e4 (3-5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.79136690647482%\" valign=\"bottom\"\u003e\n \u003cp\u003e4 (3-5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.625899280575539%\" valign=\"bottom\"\u003e\n \u003cp\u003e5 (5-5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eThe Confidence level (Likert scale 0-5 with 0=Not at all Confident and 5=Very Confident)\u003c/p\u003e\n\u003cp\u003e(CC)=Correlation Coefficient\u003c/p\u003e\n\u003cp\u003e*P\u0026lt;0.05\u003c/p\u003e\n\u003cp\u003eParticipants felt that the main barriers they faced when caring for patients with perinatal anxiety, mood and substance disorders are inadequate personal knowledge(80%) as well as lack of training (80%) (Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e).\u003c/p\u003e \n\u003cdiv class=\"gridtable\"\u003e\n \u003cp\u003e\u003cstrong\u003eTable 5. Barriers reported as at least somewhat affecting a respondent\u0026rsquo;s ability to effectively address perinatal mood, anxiety, and substance use disorders.\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\u003ctable id=\"Taba\" border=\"1\"\u003e\n \u003ccolgroup cols=\"5\"\u003e\u003c/colgroup\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003cp\u003e(N\u0026thinsp;=\u0026thinsp;125)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eOBGYN\u003c/p\u003e\n \u003cp\u003e(N\u0026thinsp;=\u0026thinsp;87)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eFM\u003c/p\u003e\n \u003cp\u003e(N\u0026thinsp;=\u0026thinsp;38)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eP-value\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eInadequate personal knowledge\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e100 (80%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e71 (81%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e29 (76%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.612\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eLack of training\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e100 (80%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e74 (85%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e26 (68%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.010\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eLack of access to support/referral services\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e74 (59%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e54 (62%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e20 (52%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.378\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eConcerns about negatively affecting the patient-physician relationship\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e35 (28%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e21 (24%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e14 (37%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.108\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eThis survey of OBGYN and Family Medicine trainees found that the majority of respondents felt well equipped to screen patients for perinatal mental health and substance use disorders. Participants also felt moderately comfortable with the initial treatment of depression and anxiety and when to refer for substance use disorder treatment. Almost all respondents felt they could benefit from further training in terms of treatment for mental health and substance use disorders.\u003c/p\u003e \u003cp\u003eMental health and substance use disorders are among the most common complications of pregnancy and the postpartum period and contribute significantly to maternal morbidity and mortality as the leading overall and preventable causes.\u003csup\u003e1, 3\u003c/sup\u003e Obstetric physicians are in a unique position to diagnose and treat these disorders given the frequency of prenatal care visits\u003csup\u003e1, 30\u003c/sup\u003e. Prior studies have examined the practices, confidence, and self-efficacy of practicing Ob/Gyns around perinatal mental health issues, but none have studied current residency or fellowship program curricula and training modalities.\u003csup\u003e17, 31, 32\u003c/sup\u003e In a 2003 survey, less than one half of recent Ob/Gyn graduates felt that treating depression was their responsibility.\u003csup\u003e17\u003c/sup\u003e Between 2003 and the present, a major paradigm shift has occurred, with significant national attention from professional societies being brought to the role of obstetric care clinicians in, and the importance of, recognizing and treating perinatal mental health disorders. As of 2020, both the Council on Resident Education in Obstetrics and Gynecology (CREOG) and the American Academy of Family Physicians (AAFP) national curricula include learning objectives that trainees should be able to diagnose and treat perinatal mental health and substance use disorders.\u003csup\u003e24, 25, 33\u003c/sup\u003e Consistent with these recommendations, the majority of respondents in our study reported at least some formal didactics about addressing perinatal mental health, though the amount and type of training varied widely.\u003c/p\u003e \u003cp\u003eThe perinatal mental health care pathway is composed of (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e) screening, (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e) assessment, (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e) triage and referral, (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e) treatment access, (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e) treatment initiation, (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e) symptom monitoring, and (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e) adaptation of treatment based on measurement until symptoms remit\u003csup\u003e28\u003c/sup\u003e. While most respondents reported confidence with steps 1\u0026ndash;3, they also indicated the need for significant changes in current training to address steps 4\u0026ndash;7. Consultation from providers with experience in treatment of perinatal mental health disorders is critical in comprehensive training of obstetric care clinicians, and could be used to address the gaps in trainee knowledge and confidence in the latter steps of the perinatal mental healthcare pathway.\u003csup\u003e34\u003c/sup\u003e In fact, two-third of participants in this study felt that mentoring/consultation from experienced mental health providers would be, or has been, useful in learning to address perinatal mood and anxiety disorders. Unfortunately, only 9% of respondents had access to such mentorship experiences.\u003c/p\u003e \u003cp\u003eOne way to increase access to education/consultation from experienced perinatal mental health professionals to obstetrics trainees is through the use of perinatal psychiatry access programs. Perinatal psychiatry access programs aim to build providers' capacity to address perinatal mental health and substance use disorder through (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e) trainings and toolkits on depression screening, assessment and treatment; (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e) telephonic access to perinatal psychiatric consultation for providers serving pregnant and postpartum women; (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e) One-time patient facing consultation with perinatal psychiatry expert (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e) care coordination to link women with individual psychotherapy and support groups; and (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e) technical assistance.\u003csup\u003e4, 35\u003c/sup\u003e A major tenet of these psychiatry access programs is education and sustainability; they are driven to interact and engage with obstetric training programs. Furthermore, the data support that perinatal psychiatry access programs are highly utilized. One study of the Massachusetts Child Psychiatry Access Program (MCPAP) for Moms \u0026ndash; the first such access program \u0026ndash; showed that 77% of obstetric programs in the state were trained and enrolled. A recent study of the effectiveness of MCPAP for Moms demonstrated a significant sustained improvement in depression symptoms from enrollment through 13 months postpartum.\u003csup\u003e36\u003c/sup\u003e While initially most clinician consultations were focused on treating unipolar depression, over time those utilizing the access program became more comfortable providing direct mental healthcare to patients for more complex perinatal mental health disorders including bipolar disorder.\u003csup\u003e34\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eSince this survey, additional resources have been developed to assist in integrating sustainable mental health care into obstetric practices. The ACOG Clinical Practice Guidelines Committee \u0026ndash; Obstetrics expanded the scope of perinatal mental health screening and treatment, and in 2023, published two new clinical practice guidelines (CPGs).\u003csup\u003e1, 30\u003c/sup\u003e These guidelines specifically note that addressing perinatal mental health is within the scope of practice of obstetric care clinicians and detail clear recommendations and clear practice points regarding the screening, diagnosis and treatment of perinatal mental health conditions. Additionally, in 2023, the Alliance for Innovation on Maternal Health (AIM) published its revised and updated perinatal mental health conditions patient safety bundle, making it one of its core bundles.\u003csup\u003e37\u003c/sup\u003e This bundle focuses on the 5Rs: readiness, recognition and prevention, response, reporting and systems learning and respectful, equitable and supportive care for patients with perinatal mental health disorders.\u003csup\u003e37\u003c/sup\u003e The bundle is accompanied by a change package led by the Institute of Health Care Improvement (IHI) to promote complete bundle implementation.\u003csup\u003e37\u003c/sup\u003e ACOG along with AIM and the Lifeline for Moms Program at UMass Chan Medical School worked together to create an E-module called \u0026ldquo;Addressing Perinatal Mental Health Conditions in Obstetric Settings\u0026rdquo;.\u003csup\u003e38\u003c/sup\u003e This is a self-paced course that focuses on detection, assessment, treatment and follow-up of patients with different perinatal mental health conditions.\u003csup\u003e38\u003c/sup\u003e Access to such resources as the E-module, CPGs and AIM Patient Safety Bundle provide critical information and training for perinatal providers in an effort to increase provider comfort with caring for perinatal mental health conditions.\u003c/p\u003e \u003cp\u003eThis study surveyed trainees from a broad range of program sizes and geographic locations and included both family medicine and OBGYN trainees which increases the generalizability of the results. This study\u0026rsquo;s findings were limited by a low response rate to the survey. The results may reflect a selection bias towards those trainees who are more interested in perinatal mental health and therefore more likely to complete the survey. Similarly, more than half of the respondents were located in the North East, which may be particularly relevant as perinatal psychiatry access programs originated in the North East and thus have the greatest longstanding history. This may further highlight that an even smaller portion of all obstetric trainees across diverse geographies may feel confident in treating perinatal mental health and substance use disorders in general. Furthermore, the survey invitation was sent to program directors or coordinators to forward to their trainees. Given the anonymity of the survey, we cannot determine whether the survey invitation was actually forwarded to trainees and if so, whether some programs are over-represented in the responses.\u003c/p\u003e \u003cp\u003eDespite these limitations, this study helps to inform contemporary trends in obstetric care clinician training for perinatal mental health and substance use disorders. Didactics alone are not sufficient to prepare trainees. Ultimately, it is likely than an intentional and purposeful combination of the several available training modalities need to be used to educate trainees how to master the several steps along the comprehensive perinatal mental health care pathway, along with continued support through resources like Access Programs. Increasing education on screening for these disorders in the perinatal period must be seen as a vital first step along the mental health pathway but cannot be the endpoint. Training the obstetric workforce to initially manage these conditions is paramount to ensuring sustainable improvements in perinatal outcomes.\u003c/p\u003e"},{"header":"CONCLUSIONS","content":"\u003cp\u003eDespite an increase in awareness about and training on perinatal mental health and substance use disorders, obstetric trainees feel underprepared, and desire more training, to address these disorders in their practice. Perinatal Psychiatry Access Programs may be uniquely suited to meet this need through education and on-going consultative support, resource and referrals, and technical assistance that can be incorporated into training programs and beyond in order to improve perinatal mental health care in the U.S.\u003csup\u003e39\u003c/sup\u003e\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate:\u003c/strong\u003e\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003eThis study was reviewed by the UMass Chan Medical School IRB and was found to be exempt.\u003c/li\u003e\n \u003cli\u003eElectronic consent was obtained using Qualtrics prior to survey completion.\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication:\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003eThe authors of this manuscript consent BMC Pregnancy and Childbirth to publish this manuscript and will transfer all copyrights to BMC Pregnancy and Childbirth.\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003e\u003cstrong\u003eData availability:\u003c/strong\u003e\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003eThe data from this study are available upon request from the authors.\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003e\u003cstrong\u003eDeclaration of Interest\u003c/strong\u003e\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003eTiffany Moore Simas is the obstetric engagement liaison as consultant to the Massachusetts Child Psychiatry Access Program for Moms (MCPAP for Moms) and thus receives a stipend from the Massachusetts Department of Mental Health via Beacon Health Options. She is also Obstetric Director of the Lifeline for Moms Program at UMass Chan Medical School. She is Co-PI of the Lifeline for Moms National Network of Perinatal Psychiatry Access Programs, and \u0026nbsp;MPI, or co-I on several extramurally funded grants focused on intervention or resource development and evaluation related to perinatal mental health. She is co-chair of the American College of Obstetricians and Gynecologists\u0026rsquo; (ACOG) Maternal Mental Health Expert Work Group, and member on the Clinical Practice Guidelines \u0026ndash; Obstetrics Committee having led the development of and authored two guidelines and a practice advisory related to perinatal mental health. She led the Alliance on Innovation in Maternal Health\u0026rsquo;s (AIM) perinatal mental health conditions patient safety bundle development work group and was lead faculty for the Institute of Healthcare Innovation\u0026rsquo;s (IHI) associated change package work group. She is a commissioner on the MA postpartum depression commission and will lead the MA perinatal quality collaborative, Perinatal Neonatal Quality Improvement Network (PNQIN), in implementing the AIM perinatal mental health conditions bundle across the state. She has served on the board of directors and is currently president elect of the Society of Academic Specialists in General Obstetrics and Gynecology and is a board examiner for the American Board of Obstetrics and Gynecology. She has received honoraria and travel coverage from speaking engagements with ACOG, AIM, NEOGS, and Miller Medical Communications.\u003c/li\u003e\n \u003cli\u003eDr. Byatt has received salary and/or funding support from Massachusetts Department of Mental Health via the Massachusetts Child Psychiatry Access Program for Moms (MCPAP for Moms). She is also the Medical Director of Research and Evaluation for MCPAP for Moms and the Executive Director of the Lifeline for Families Center at UMass Chan Medical School. She has served as a consultant for The Kinetix Group, VentureWell, and JBS International. \u0026nbsp;\u003c/li\u003e\n \u003cli\u003eAll other authors of this study report no conflicts of interest.\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003e\u003cstrong\u003eFunding Statement\u003c/strong\u003e\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003eThis research did not receive any specific grant from funding agencies in the public, commercial or not-for-profit sectors.\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors contributions:\u003c/strong\u003e\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003eAW assisted with data synthesis and manuscript preparation. JT generated the hypothesis, assisted with data collection manuscript preparation. IQ assisted with data collection. KL performed statistical analysis and assisted with manuscript preparation. KC and TK assisted in methodology and hypothesis development. MC lead methodology development and data synthesis. NB and TMS assisted in methodology, data synthesis and manuscript preparation. All authors reviewed the manuscript prior to submission.\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements:\u003c/strong\u003e Not applicable.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eScreening and Diagnosis of Mental Health Conditions During Pregnancy and Postpartum. ACOG Clinical Practice Guideline 4. 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Number of Active MD Residents, by Race/Ethnicity (Alone or In Combination) and GME Specialty. 2021.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTreatment and Management of Mental Health Conditions During Pregnancy and Postpartum. ACOG Clinical Practice Guideline 5. Obstet Gynecol Jun. 2023;1(6):1262\u0026ndash;88. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1097/AOG.0000000000005202\u003c/span\u003e\u003cspan address=\"10.1097/AOG.0000000000005202\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAnderson BL, Dang EP, Floyd RL, Sokol R, Mahoney J, Schulkin J. Knowledge, opinions, and practice patterns of obstetrician-gynecologists regarding their patients' use of alcohol. 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Gen Hosp Psychiatry May-Jun. 2023;82:75\u0026ndash;85. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.genhosppsych.2023.03.001\u003c/span\u003e\u003cspan address=\"10.1016/j.genhosppsych.2023.03.001\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Perinatal mental health, substance use disorder, perinatal depression, perinatal anxiety, bipolar disorder, screening and treatment for perinatal mental health disorders","lastPublishedDoi":"10.21203/rs.3.rs-4432536/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4432536/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground/Objective:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003ePerinatal mental health conditions and substance use disorders are the most common complications of pregnancy and the leading cause of overall and preventable maternal mortality. These conditions remain under-detected and under-treated. Both the Council on Resident Education in Ob/Gyn and the American Academy of Family Physicians expect graduating residents to be competent at diagnosing and treating perinatal mental health and substance use disorders. This study surveyed contemporary obstetric trainees to understand training modalities being utilized and confidence addressing steps in the perinatal mental health care pathway to understand current state, unmet needs, and educational opportunities.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWeb-based cross-sectional anonymous survey developed and distributed via Qualtrix in October 2019 to Ob/Gyn and Family Medicine (FM) residents in U.S. programs accredited by the Accreditation Committee of Graduate Medical Education (ACGME; 282 Ob/Gyn, 455 FM, and 93 MFM programs). Respondents self-reported exposure to 8 modes of training and separately, their confidence addressing perinatal mental health and substance use disorders on 6-point Likert scales.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTotal respondents (n=125) included 69.6% Ob/Gyn and 30.4% FM trainees representing all U.S. regions. For both perinatal mental health and substance use disorders the majority (75% and 68% respectively) trained via didactic sessions. Most respondents felt at least moderate confidence detecting, assessing, and treating both depression and anxiety (82% and 72% respectively). A majority reported at least moderate confidence in determining when to refer for therapy (81%), when and how to start medications for depression and anxiety (67%). In general, smaller proportions were calculated across the pathway for substance use disorders. The majority responded they should have ‘more’ or ‘a lot more’ training in depression and anxiety disorders (78% Ob/Gyn, 61% FM) and substance use disorder (91% Ob/Gyn, 79% FM).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTo make significant progress in increasing detection, assessment, and treatment access for perinatal mental health and substance use disorders, the next generation of clinicians need more training and greater confidence in their abilities. Graduate medical education for obstetric clinicians has a critical opportunity to address perinatal mental health and substance use disorders and thus improve intergenerational outcomes and decrease maternal morbidity and mortality.\u003c/p\u003e","manuscriptTitle":"Perinatal Mood, Anxiety, and Substance Use Disorders: Are Future U.S. Obstetric Physicians Being Trained to Address the Most Common Complications of Pregnancy?","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-05-31 14:07:34","doi":"10.21203/rs.3.rs-4432536/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"93a5ac47-5798-4e0e-b72b-36b706e5af9b","owner":[],"postedDate":"May 31st, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2024-10-03T16:23:10+00:00","versionOfRecord":[],"versionCreatedAt":"2024-05-31 14:07:34","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4432536","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4432536","identity":"rs-4432536","version":["v1"]},"buildId":"omnImTCwR2MFx8CMYfrG7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}