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PROPOSAL MILESTONE 3: LITERATURE REVIEW

Proposal Milestone 3: Literature Review

Navjeet Lehal and Andrea Padilla

Pacific Northwest University of Health Sciences

OTH 540: Foundations of Inquiry II

Dr. Malcom Cutchin

February 27th, 2024

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PROPOSAL MILESTONE 3: LITERATURE REVIEW
The Problem/Issue in Broad Terms

Substance use disorders (SUDs) and mental health conditions are common worldwide

and affect many populations (Bright et al., 2022). The Substance Abuse and Mental Health

Services Administration found that 10% of pregnant women reported the use of alcohol and

tobacco while 6% reported the use of illicit drugs (Bright et al., 2022). SUDs present many

challenges including poor health outcomes that affect one's ability to participate in meaningful

activities. One of those activities being parenting. There is also an increased risk of

developmental problems, including mental health disorders. Furthermore, they pose an economic

burden on society.

Many pregnant and parenting mothers recovering from addiction and mental health

conditions experience comorbidity and need treatment. Outcomes for opioid-dependent pregnant

women can be improved by providing treatments for family, social, and psychiatric problems

(Fitzsimons et al., 2007). Comorbidities that exist within residential treatment settings, for

substance use or mental health conditions, include post-traumatic stress disorder (PTSD), eating

disorders, obsessive-compulsive disorder (OCD), anxiety, and depression. Research also

indicates that 25% reported having two comorbidities and 8.5% of people reported having five

comorbidities (Robison et al., 2022). Although there are other health conditions that pregnant

and parenting mothers face, there is a limited amount of research that shows what those other

conditions are.

Women experience many health and mental health conditions postpartum and during

pregnancy such as gestational diabetes and mood disorders (Taylor et al., 2013). The mental

health conditions prevalent in these women are depression, anxiety, and post-traumatic stress

disorder. There is a strong correlation between fatigue and depressive symptoms in two years
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PROPOSAL MILESTONE 3: LITERATURE REVIEW
postpartum (Wilson et al., 2019). Another study focused on the physical health conditions

postpartum. They found that gestational diabetes mellitus (GMD) is one of the most common

conditions during pregnancy (Sharma et al. 2022). Overall, these studies show that women

present with several mental health conditions postpartum. These women are facing mental health

challenges along with new conditions that develop during pregnancy.

Significance
Drug use and mental health challenges have long-lasting effects for mothers and their

children. Infants who were born to mothers with mood disorders experience longer stays in the

neonatal intensive care unit (NICU) (Benningfield et al., 2010). Effects of using drugs during

pregnancy can be long term and lead to birth defects, low birth weight, premature birth, small

head circumference, and sudden infant death syndrome (National Institute on Drug Abuse,

2020). These conditions can have long lasting effects on the mother and child interaction and

relationship. Breast feeding allows the mother and infant to bond. This is significant for women

who cannot breast feed due to the risk of passing substances to their baby. Because women are

going through a difficult recovery process, being emotionally available can be challenging. The

ability to breastfeed can help overcome some of these challenges (Liu et al., 2013).

There is an association between hospitalization rates of people who have comorbidities,

chronic diseases, and SUDs. There is a higher prevalence of hospitalization among those with

comorbidities compared to those without it (Wu et al., 2021). The more conditions a person

presents with leads to an increase in hospitalization. There is a correlation between liver damage

due to drug intake specifically in pregnant women (Kamath et al., 2021). Idiosyncratic liver

injury is common in pregnant women. Comorbidities intensify the risk of drug-induced liver
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injury (DILI). These studies highlight the importance of understanding how comorbidities can

have negative health outcomes.

Scientific Knowledge About the Problem

There is knowledge about why pregnant women seek treatment and the actions they take

before pursuing it (Frazer et al., 2019; O’Rourke, 1990; Van Scoyoc et al., 2017). This is

important because we need to know what brings these women to treatment. If we know why, we

can make sure the treatment addresses that concern. Reasons for coming to treatment include that

they did not want their baby to be poorly affected by the substance use and they wanted to

practice healthy behaviors to prevent harm to the baby. Positive outcomes include improved

health of the mother and baby, lower substance use, better occupational balance, and an

increased motivation by the mother to be healthy for the sake of her baby (Haines et al., 2023;

Van Scoyoc et al., 2017).

There are barriers to receiving treatment for pregnant and parenting women. There are

several reasons women have trouble receiving treatment. A common theme was the fear of

losing their child due to substance use. Some women would rather spend time with their child or

significant other. Additionally, there is a stigma around receiving care (Bright et al., 2022). Some

women do not have someone to watch over their child or have transportation to the residential

treatment center (Frazer et al., 2019). At times women do not get diagnosed because they fear the

consequences of disclosing their drug use (Lee King et al., 2015). Some women report that they

did not get the care they deserved because of the stigma around their substance use problem by

healthcare professionals (Stone, 2015). This highlights the importance of healthcare providers

being aware of the challenges women face to provide comprehensive care.

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PROPOSAL MILESTONE 3: LITERATURE REVIEW
It is important to understand the experiences and views relating to the treatment of

postpartum women with substance use problems. Using drugs while pregnant can cause their

child to become addicted to the same substances. Women stated they had problems accessing

credible articles about the negative effects of using drugs while pregnant, which can influence if

they get treatment (Van Scoyoc et al., 2017). Acknowledging the experience of these women is

imperative to understand what components the treatment should have to increase participation in

the recovery process. Women face difficulty finding treatment, only 20% of those who need it

receive it. Their problems around addiction and mental health conditions influence if, where, and

when they start treatment. If the treatment facility is too far, they may not be able to find

transportation to get there. Another factor influencing participation in treatment is whether

mothers can find childcare or a residential treatment setting that will let them bring their child

(Troop, 2021). Participation in the recovery process is also affected by whether the treatment

decreases drug use.

Key Gaps in the Evidence Base/Scientific Knowledge

There is a limited amount of literature on women who suffer from more than one

condition. Studying women with more than one health or medical condition is key to

understanding how women can benefit from distinct kinds of treatment. There are examples of

psychosocial treatments for comorbid mental illness and SUDs, but there are no holistic

treatments for this population (Horsfall et al., 2009; Wouldes et al. 2013). There is literature

about mental health comorbidities, but not much on physical chronic conditions (Haines et al.,

2023).

Past adverse experiences have an influence on mental health and drug use. Individuals

with a history of childhood trauma are more likely to report substance abuse (Khoury et al.,
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2010). Some examples of childhood traumas include sexual, physical, and emotional abuse

(Khoury et al., 2010). When women seek help there is little known about their past experiences

which include adverse childhood events, trauma, and interpersonal violence (Choi et al., 2022). It

is important to understand these experiences so women can receive the proper care they need to

be successful in their treatment.

Gaps
This study will address is the different medical conditions that women face in residential

treatment settings. While doing our research we came across articles that talk about postpartum

fatigue and how that correlates with anxiety and depression. While there was much about mental

health conditions, the literature was scarce on physical comorbidities. (Horsfall et al., 2009).

Understanding the different health conditions that are prevalent in women in residential

treatment settings will allow occupational therapists to offer a holistic treatment approach to best

serve each client in the recovery process.

Given that occupational therapy is not well established in mental health treatment, our

understanding of patient participation in the recovery process is limited. Understanding the

factors that are preventing women from physically engaging in treatment would be key to

understanding the influence their complex health conditions have in the recovery process. There

is some literature about barriers that women are facing, but there is not much on how long they

are actively participating in the intervention. This will allow us to explore motivating factors that

contribute to participation in the recovery process. Women will be more likely to participate in

treatment if they have education, dietary support, social workers, and housing assistance (Choi et

al., 2022).
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PROPOSAL MILESTONE 3: LITERATURE REVIEW
There is a lack of literature regarding the referral process from agencies or self-referral

for women wanting to receive treatment in a residential setting. Women need referrals so they

can get appropriate care for their conditions. When women self-refer, they may not know how to

access treatment or what is available. Referrals from non-health care settings come with concerns

of stigma, money, and privacy. Some women may not want to be referred by the criminal justice

system due to fear of incarceration or having their child taken away. This referral system can

come with judgment by families or communities because of their drug use. Some women may

not tell community agencies because they do not want their drug use to be known. Also, it may

be beyond the agency's scope to refer them (Choi et al., 2022).

Aims

An aim of study is to address the barriers women face when trying to access treatment.

Additionally, we would like to highlight methods that will increase participation in the recovery

process. These aims will contribute to the gap of the knowledge of barriers that affect women's

participation in residential treatment settings. The purpose of this study is to explore what

comorbidities pregnant and parenting women present with and how those might affect their

participation in the recovery process.

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PROPOSAL MILESTONE 3: LITERATURE REVIEW
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