Perinatal depression care pathway for obstetric settings

Abstract

Perinatal depression is common and can have deleterious effects on mothers, infants, children, partners, and families. Despite this, few women who screen positive for depression receive psychiatric treatment. A comprehensive perinatal depression care pathway includes: (1) screening, (2) assessment, (3) triage and referral, (4) treatment access, (5) treatment initiation, (6) symptom monitoring, and (7) adaptation of treatment based on measurement until symptoms remit. This depression care pathway provides a scaffold on which to frame the challenges encountered when, and the opportunities that exist for, addressing depression in obstetric settings. Comprehensive interventions that address each step on the care pathway are needed to support obstetric practices in providing high-quality, evidence-based, effective treatment including pro-active follow-up for depression management. Despite recent attention being brought to, and significant progress in the field of maternal mental health, gaps in care persist. Ultimately, depression care needs to be fully integrated into obstetric care. Additionally, more targeted maternal mental health support and structure are needed for integration to occur and ultimately be optimized. Specific areas requiring more attention include consistency of screening, evaluation of patients with a positive depression screen for bipolar disorder, anxiety or substance use disorders, and monitoring of symptom improvement.

Keywords:

• Depression
• perinatal
• treatment
• obstetric
• access

Disclosure statement

The first and fourth authors have received salary and/or funding support from Massachusetts Department of Mental Health via the Massachusetts Child Psychiatry Access Program for Moms (MCPAP for Moms). The first author is also the statewide Medical Director of MCPAP for Moms and Executive Director of Lifeline4Moms. The first author has served on the Perinatal Depression Advisory Board for the Janssen Disease Interception Accelerator Program, and Advisory Boards for Sage Therapeutics. She has served as a council member for Gerson Lerhman Group, has served as a speaker for Sage Therapeutics, a consultant to Sage Therapeutics or their agents, and has served as a consultant to Ovia Health. She has also received honoraria from Miller Medical Communications and Medscape. The fourth author is the Engagement Director for MCPAP for Moms and Medical Director of Lifeline4Moms. She has served on Advisory Boards for Sage Therapeutics and is a consultant to Sage Therapeutics and Ovia Health.