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

Abstract

Objective: To identify core barriers and facilitators to addressing perinatal depression and review clinical, programmatic, and system level interventions that may optimize perinatal depression treatment. Method: 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. Results: 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. Conclusion: Specific clinical, program, and system level changes are recommended to help change the culture of obstetric care settings to optimize depression treatment.

Keywords::

• Depression
• facilitators
• perinatal
• postpartum
• pregnancy

Declaration of interest: The first author has received grant support for perinatal depression research from the Meyers Primary Care Institute/Rosalie Wolf Interdisciplinary Geriatric Healthcare Research Center Small Grants Initiative. The second author has no declarations of interest. This third author’s spouse is a research scientist working in the pharmaceutical industry. He currently works for Infinity Pharmaceuticals and in the past five years has worked for Biogen and Pfizer.

The fourth author has no declarations of interest. The fifth author has received research funding support from the NIH, Legacy Foundation, Massachusetts Department of Mental Health, Connecticut Department of Public Health, and SAMHSA.

Current knowledge on this subject

• Despite the deleterious effects of perinatal depression, barriers hinder screening, assessment, and treatment in the outpatient obstetrical setting.

• Depression is often not fully integrated into obstetrical care.

• Major changes in current practice patterns are needed to improve treatment for perinatal depression.

What this manuscript adds

• Identifies barriers to addressing perinatal depression, including lack of provider training, limited mental health resources, and fears among women and providers.

• Identifies facilitators to perinatal depression treatment including validating and empowering interactions with health care providers for women, obstetric provider training, standardized screening and referral processes, and improved mental health resources.

• We critically reviewed clinical, programmatic, and systems level interventions regarding perinatal depression and based on available literature, recommend changes at each level for optimization of recognition and treatment in obstetric settings.