Reproductive Psychiatry Training Grows in US Residencies but Gaps Persist, National Survey Finds

The years surrounding pregnancy, childbirth, menstruation, and menopause can dramatically reshape a person’s mental health, yet the psychiatrists expected to treat these conditions often receive little formal preparation for them. A new national survey of US psychiatry residency programs, published in Academic Psychiatry, reveals that while reproductive psychiatry education has expanded meaningfully over the past decade, training remains inconsistent, largely elective, and constrained by the same fundamental obstacles that researchers identified years ago. The findings arrive at a moment of surging public interest in perinatal mental health, following landmark treatment approvals and growing recognition that reproductive transitions are among the most psychiatrologically vulnerable periods of life.

Reproductive psychiatry, sometimes described as an emerging subspecialty, focuses on the assessment and treatment of mental illness across the reproductive lifespan. Hormonal fluctuations tied to the menstrual cycle, pregnancy, the postpartum period, and perimenopause can precipitate or exacerbate mood, anxiety, and psychotic disorders, and the clinical evidence linking these transitions to psychiatric onset is robust. Perinatal mental illness is a leading contributor to maternal morbidity and mortality, and untreated illness carries consequences for both parent and child. Despite this, reproductive psychiatry has never been embedded as a standardized requirement in graduate medical education, leaving programs to decide individually how much, if any, of this content their residents will encounter.

The new study, led by Kristen Chalmers of the University of Washington with colleagues at the University of Chicago, Harvard Medical School and Brigham and Women’s Hospital, and the University of Colorado, was designed as a follow-up to a 2018 national survey that documented substantial gaps in residency education. That earlier work, published by Osborne and colleagues in Academic Psychiatry, established a baseline showing that exposure to reproductive psychiatry varied enormously from program to program. To measure change over time, the research team distributed a 30-item cross-sectional survey between January and March 2025 to all 315 US general psychiatry residency program directors identified through the American Medical Association FREIDA database.

The survey instrument covered program characteristics, didactic and clinical training opportunities, pathways toward specialization, anticipated curricular changes, and perceived barriers to expansion. Thirty-five programs responded, corresponding to an 11 percent response rate, a limitation the authors acknowledge but one consistent with typical rates for national program director surveys. Descriptive statistics were used to summarize responses, and the institutional review board of The University of Chicago Medicine granted an exemption for the work. The reported data therefore represent a snapshot of the field as seen from the administrative vantage point of residency leadership.

The headline finding is one of cautious progress. A large majority of responding programs now report offering didactic education in reproductive psychiatry, at 88 percent, and clinical exposure, at 79 percent. Both figures represent growth compared with prior national assessments, suggesting that advocacy from faculty, fellows, and trainees has gradually moved reproductive mental health into the mainstream of residency curricula. Didactic content most commonly addressed perinatal mood, anxiety, and psychotic disorders, reflecting the weight of evidence and public attention surrounding postpartum depression and related conditions. The scope and structure of this teaching, however, varied widely across programs, with no uniform standard governing what must be taught or how competence should be measured.

Beneath the encouraging headline numbers lies a more complicated picture of uneven coverage. Topics such as menstrual-related mood disorders, including premenstrual dysphoric disorder, perimenopausal depression, reproductive loss, LGBTQ+ reproductive health, and sexual health were covered far less consistently than perinatal conditions. This means a resident graduating from one program may feel confident managing postpartum depression while remaining unprepared to evaluate cyclical mood symptoms or support a patient navigating pregnancy after loss. Outpatient reproductive psychiatry clinics were the most common clinical setting for hands-on learning, which concentrates experience in a single context and may leave residents with limited exposure to inpatient perinatal psychiatry, consultation-liaison work on obstetric units, or integrated care within reproductive health services.

One of the most striking signals of momentum involves formal specialization. Twenty-six percent of responding programs reported offering a dedicated track, pathway, or certificate in reproductive psychiatry, a structure that allows motivated residents to pursue concentrated training alongside core requirements. Among programs without such an opportunity, nearly half expressed interest in developing one. This appetite mirrors the slow but steady growth of reproductive psychiatry fellowships nationally, which were first systematically characterized by Nagle-Yang and colleagues in 2018. The development of tracks and certificates suggests that reproductive psychiatry is following a recognizable institutional path toward subspecialty maturity, similar to trajectories seen in geriatric psychiatry and addiction psychiatry, although it has not yet achieved formal board recognition.

Yet the barriers that constrained training a decade ago remain stubbornly familiar. Program directors most frequently cited limited faculty expertise, at 30 percent, and insufficient curricular time, also at 30 percent, followed by a lack of specialized clinical sites, at 26 percent. These constraints are interlocking in ways that make them difficult to untangle. Without faculty trained in reproductive psychiatry, programs cannot easily build didactics or supervise clinical experiences. Without dedicated clinical sites such as perinatal outpatient clinics or reproductive psychiatry consult services, there is nowhere for residents to practice the skills even when enthusiasm exists. And within an already crowded four-year residency curriculum, adding content requires removing something else, a trade-off that programs facing competing accreditation demands are often reluctant to make.

The workforce implications of these findings extend beyond residency walls. Recent research published in JAMA Network Open by Koire and colleagues documented the prevalence of community perinatal psychiatrists in the United States and found access to this expertise to be scarce in many regions, particularly outside major academic centers. When residency training is heterogeneous and elective, the pipeline of psychiatrists equipped to manage psychiatric illness during pregnancy and postpartum remains thin, and patients in underserved areas face the longest waits for specialized care. Other work, including a trainee needs assessment by Koire and colleagues published in Psychiatric Quarterly, indicates that residents themselves often perceive these gaps and want more education in women’s mental health than their programs currently deliver.

The authors conclude that while training opportunities have expanded since 2018, they remain heterogeneous and largely optional, and they argue that greater standardization of foundational training could better prepare psychiatrists to address mental health needs across reproductive life stages. In practice, standardization could mean requiring core didactic content on perinatal, menstrual-related, and perimenopausal disorders within accreditation milestones, embedding reproductive psychiatry exposure into required rotations rather than electives, and expanding faculty development pipelines to cultivate the expertise that programs say they lack. The Milestones 2.0 framework adopted for graduate medical education offers a potential mechanism for such change, and scholarship on systems-based practice has emphasized the importance of training physicians to recognize structural and equity dimensions of reproductive health. As demand for perinatal mental health services continues to climb and public awareness grows, the survey suggests the specialty is at an inflection point, with clear interest among programs and trainees, demonstrated feasibility at a quarter of residencies, and a well-defined set of barriers that, if addressed, could transform an emerging interest into an educational guarantee.

Subject of Research: Reproductive psychiatry training and barriers in US psychiatry residency programs

Article Title: Reproductive Psychiatry Training in Psychiatry Residencies: A 10-Year National Update on Persistent Barriers and Emerging Interest

Article References: Reproductive Psychiatry Training in Psychiatry Residencies: A 10-Year National Update on Persistent Barriers and Emerging Interest. (n.d.). https://doi.org/10.1007/s40596-026-02439-0

Image Credits: AI Generated

DOI: 10.1007/s40596-026-02439-0

Keywords: reproductive psychiatry, psychiatry residency, perinatal mental health, graduate medical education, postpartum depression, perimenopause, curriculum, fellowship training, program directors, women's mental health, Reproductive, Psychiatry