Reproductive health - a blind spot in psychotherapeutic treatment? Evidence of insufficient consideration of reproductive factors in routine care.

INTRODUCTION: Reproductive health impacts mental health. Consequently, reproductive factors should be assessed in psychotherapy to ensure correct differential diagnosis, precise case conceptualisation and efficient treatment. It has not been analysed to which extent psychotherapists assess reproductive factors in routine care.

METHODS: Analyses were based on data from Germany-wide surveys with n = 390 psychotherapists and n = 291 patients. From their respective perspective, we examined how frequently psychotherapists proactively assessed whether patients experienced a menstrual cycle, menopause, used hormonal contraception, experienced a pregnancy, fertility treatment, or birth, whether these factors were associated with patients' symptoms, and how relevant they were perceived to be. Further, we examined how psychotherapists acquired knowledge about the reproductive factors and which psychotherapist characteristics increased the likelihood of considering them.

RESULTS: We identified a gap between low proactive assessment and high perceived relevance of reproductive factors. Psychotherapists acquired their knowledge through personal experience rather than clinical training or further education. Greater knowledge and perceived relevance increased the likelihood of proactively assessing reproductive factors.

CONCLUSIONS: There is a clear need to incorporate a standardised, proactive assessment of reproductive factors into routine care. The responsibility to disclose them should not be left to the patients. Developing appropriate teaching content and tailored anamnestic instruments can help to overcome the neglect.