Strategies for improving perinatal depression treatment in North American outpatient obstetric settings

Department of Psychiatry and Ob/Gyn.
Journal of Psychosomatic Obstetrics & Gynecology (Impact Factor: 1.88). 12/2012; 33(4):143-61. DOI: 10.3109/0167482X.2012.728649
Source: PubMed


To identify core barriers and facilitators to addressing perinatal depression and review clinical, programmatic, and system level interventions that may optimize perinatal depression treatment.

Eighty-four MEDLINE/PubMed searches were conducted using the terms perinatal depression, postpartum depression, antenatal depression, and prenatal depression in association with 21 other terms. Of 7768 papers yielded in the search, we identified 49 papers on barriers and facilitators, and 17 papers on interventions in obstetric settings aimed to engage women and/or providers in treatment.

Barriers include stigma, lack of obstetric provider training, lack of resources and limited access to mental health treatment. Facilitators include validating and empowering women during interactions with health care providers, obstetric provider and staff training, standardized screening and referral processes, and improved mental health resources.

Specific clinical, program, and system level changes are recommended to help change the culture of obstetric care settings to optimize depression treatment.

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    • "It may be that this timeframe was not a long enough time period to identify provider intervention behaviors given the infrequency of patient MS clinic visits in our Center (typically every 3–6 months) or that non-psychiatric medical providers are not always confident about treating depression (Liu, Lu, & Lee, 2008) and may need to witness depression symptoms across several successive appointments to be confident that positive depression screens are indicative of psychological distress severe enough to warrant intervention (Hickie, Davenport & Ricci, 2002). Although our study is not able to determine if any of these provider factors contribute to instances where individuals with true positive screens may go untreated, it is a concern in documented in the literature (e.g., Byatt et al., 2012) and for our Center providers and patients. Fortunately, educational interventions targeted at providers in medical settings are being developed and have evinced increased rates of screening, identification, and treatment planning as well as improved outcomes (Alschuler et al., 2008; Gilbody et al., 2003; Hoodin et al., 2013; Turner et al., 2006) Psychologists in medical settings are in an especially good position to be meaningful contributors to such endeavors. "
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    ABSTRACT: Depression, a frequent concomitant disorder in multiple sclerosis (MS), can impact MS treatment adherence and quality of life. Depression screening in MS care settings may facilitate needed intervention when providers are responsive to screening findings. This study sought to examine the relationship between depression screening results and provider depression treatment recommendations documented in the medical records of 283 patients receiving care in an integrated MS clinic. Forty-six percent of patients screening positive for depression received a treatment recommendation; females, those with past mental health diagnoses, on psychotropic medications, and those with higher symptom severity were more likely to receive a treatment recommendation. On subsequent screenings, patients reported fewer depressive symptoms regardless of whether a formal treatment recommendation was documented. These findings suggest that while depression screening does lead to depression related intervention in many cases, more research is necessary to determine who is most likely to benefit and under what conditions.
    Full-text · Article · Sep 2014 · Journal of Clinical Psychology in Medical Settings
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    • "2) Only a few, small studies have explored the views of mental health and healthcare among pregnant and postpartum women and their care providers [6,7,16-18]. Findings of these studies suggest that the most prominent attitudes toward mental health differ from studies conducted in the general population, and warrant a separate investigation. "
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    ABSTRACT: We used population-based data to determine the public's views of prenatal and postnatal mental health and to identify predictors of those views. A computer-assisted telephone survey was conducted by the Population Health Laboratory (University of Alberta) with a random sample of participants from the province of Alberta, Canada. Respondents were eligible to participate if they were: 1) >=18 years; and 2) contacted by direct dialing. Questions were drawn from the Perinatal Depression Monitor, an Australian population-based survey on perinatal mental health; additional questions were developed and tested to reflect the Canadian context. Descriptive and multivariable regression analyses were conducted. Among the 1207 respondents, 74.7% had post-secondary education, 16.3% were in childbearing years, and over half (57.4%) reported knowing a woman who had experienced postpartum depression. Significantly more respondents had high levels of knowledge of postnatal (87.4%) than prenatal (70.5%) mental health (p < .01). Only 26.6% of respondents accurately identified that prenatal anxiety/depression could negatively impact child development. Personal knowledge of a woman with postpartum depression was a significant predictor of prenatal and postnatal mental health knowledge. While the public's knowledge of postnatal mental health is high, knowledge regarding prenatal mental health and its influence on child development is limited. Strategies for improving perinatal mental health literacy should target these knowledge deficits.
    Full-text · Article · Feb 2014 · BMC Pregnancy and Childbirth
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    • "In other words, respondents who understood the nature of perinatal mental health problems recognized the benefit of both non-pharmacologic and pharmacologic treatment approaches. The association between knowledge of perinatal mental health and acceptability of pharmacologic therapy is important to note in that women’s low acceptability of pharmacologic therapy during the perinatal period can be a significant barrier to improvement in women for whom medication may be beneficial [16,25]. "
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    ABSTRACT: At a prevalence rate of 13-25%, mental health problems are among the most common morbidities of the prenatal and postnatal periods. They have been associated with increased risk of preterm birth and low birthweight, child developmental delay, and poor child mental health. However, very few pregnant and postpartum women proactively seek help or engage in treatment and less than 15% receive needed mental healthcare. While system-related barriers limit accessibility and availability of mental health services, personal barriers, such as views of mental health and its treatment, are also cited as significant deterrents of obtaining mental healthcare. The purposes of this population-based study were to identify the public's views regarding mental health screening and treatment in pregnant and postpartum women, and to determine factors associated with those views. A computer-assisted telephone survey was conducted by the Population Research Laboratory with a random sample of adults in Alberta, Canada. Questions were drawn from the Perinatal Depression Monitor, an Australian population-based survey on perinatal mental health; additional questions were developed and tested to reflect the Canadian context. Interviews were conducted in English and were less than 30 minutes in duration. Descriptive and multivariable regression analyses were conducted. Among the 1207 respondents, 74.8% had post-secondary education, 16.3% were 18-34 years old, and two-thirds (66.1%) did not have children <18 years living at home. The majority of respondents strongly agreed/agreed that all women should be screened in the prenatal (63.0%) and postpartum periods (72.7%). Respondents reported that when seeking help and support their first choice would be a family doctor. Preferred treatments were talking to a doctor or midwife and counseling. Knowledge of perinatal mental health was the main factor associated with different treatment preferences. The high acceptability of universal perinatal mental health screening among the public provides a strong message regarding the public value for routine screening during pregnancy and postpartum periods. Perinatal mental health literacy is the most prominent determinant of screening and treatment acceptability and preference. Efforts to enhance population literacy as part of a multifaceted perinatal mental health strategy may optimize pregnant and postpartum women's mental health.
    Full-text · Article · Feb 2014 · BMC Pregnancy and Childbirth
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