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Lack of Workplace Support for Obstetric Complications is Associated with Greater Postpartum Depression Among Female Surgeons
Manuel Castillo-Angeles1, Rachel B. Atkinson1, Sarah R. Easter1, Ankush Gosain2, Yue-Yung Hu3, Zara Cooper1, Eugene Kim4, Erika Rangel1
1Surgery, Brigham and Women"s Hospital, Boston, Massachusetts, United States, 2Surgery, University of Tennessee Health Science Center, Children"s Foundation Research Institute, Le Bonheur Children"s Hospital, Memphis, Tennessee, United States, 3Surgery, Ann & Robert Lurie Children"s Hospital, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States, 4Surgery, Children"s Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, California, United States

Objective:Prior studies show female surgeons have greater risk of obstetric complications and postpartum depression (PPD) compared to sociodemographically similar women. Although the risk of complications is associated with rigorous schedules, pregnant surgeons experiencing complications are less likely to reduce their workload than controls. In the general population, PPD is associated with stress and low social support during pregnancy and carries significant long-term maternal and infant health implications. We sought to assess whether lack of workplace support (LOWS) for work reductions for obstetric concerns is associated with surgeon PPD.


Setting:Self-administered survey.

Participants:Childbearing female surgeons


Main Outcome Measures: Among surgeons with obstetric concerns, LOWS was defined as:(1) disagreeing that colleagues/leadership were supportive of bedrest;(2) disagreeing that colleagues/leadership were supportive of clinical duty reduction;(3)feeling unable to reduce clinical duties despite wanting to due to concerns for financial penalties, being perceived as "weak", burdening colleagues, being required to pay back call, or not being accommodated by the workplace. Additionally, financial losses from pregnancy-related work restrictions were reported.

Results: 692 surgeons participated. 72.92% perceived LOWS. Surgeons perceiving LOWS were at higher risk of PPD than those who did not perceive LOWS (OR:2.15,95%CI:1.06-4.36), controlling for age, race, career stage, practice setting, and presence of pregnancy complications. 22.60% surgeons with obstetric-related work restrictions experienced financial loss, with 38.46% reporting >$50,000 loss.

Conclusions: LOWS for women surgeons with obstetric-related concerns may increase risk of PPD. To promote the health and safety of mothers and their infants, institutional policies should encourage reduction of clinical volume for surgeons with obstetric concerns without financial penalty or requirement to make up missed work. Compensation and recognition of colleagues covering clinical duties may help avoid resentment.

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