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Pathways to Take care of Perinatal Depression: Marked Differences Between Women With and Without Histories of Psychiatric Illness

Depression affects one in seven women while pregnant and the postpartum period. Despite intense efforts to extend awareness amongst patients and providers, perinatal depression continues to be underdiagnosed and undertreated. Individuals with any variety of psychiatric history are at even greater risk for perinatal depression, however it is unclear if their experiences with referral and treatment for depression differ from individuals with out a psychiatric history.



Given a history of psychiatric illness prior to pregnancy, it might be easier for these individuals to discover the symptoms of perinatal depression and to acknowledge the necessity for treatment. Past experiences may make it easier to navigate the healthcare system, and a few individuals with histories of psychiatric illness may have access to previous providers.

On this study, the researchers conducted a secondary evaluation evaluating care access and barriers to care in perinatal individuals who screened positive for depression using the Edinburgh Postnatal Depression Scale (N = 280). Data were analyzed from the PRogram in Support of Mothers (PRISM) study, where it was really useful that participants be screened with the EPDS once while pregnant and throughout the postpartum period.

Individuals with no psychiatric history prior to pregnancy (N = 113) were compared with those with a history (N = 167). The researchers observed that individuals with no psychiatric history were less prone to be screened for perinatal depression and were less prone to be offered a therapy referral.

In examining how these differences affected outcomes, the researchers found that those with out a psychiatric history had a 46% lower odds of attending therapy (95% confidence interval [CI]: 0.19-1.55), a 79% lower odds of taking medication (95% CI: 0.08-0.54), and a 80% lower odds of receiving any look after depression (95% CI: 0.08-0.47). 

Barriers to care were similar across the 2 groups; nonetheless, those with no histories were more prone to report concerns regarding available treatments and to specific beliefs in regards to the resolution of symptoms with none treatment.

What Can We Do to Improve Diagnosis and Treatment of Perinatal Depression?

The findings of the present study indicate that, in comparison with individuals with histories of psychiatric illness prior to pregnancy, perinatal individuals with out a prepregnancy psychiatric history were less prone to be screened, less prone to be referred, and fewer prone to be treated for depression. While the findings of the study aren’t surprising, the difference between the 2 groups was not subtle; women without histories of psychiatric illness were about 80% less prone to receive treatment. The knowledge from this study indicates that we must make every effort to make sure universal screening for depression in perinatal populations. Moreover, future studies are needed to raised understand easy methods to increase referrals and treatment uptake in women without histories of psychiatric illness. 

The Center for Women’s Mental Health at MGH recently launched a research study, funded by the Marriott Foundation, which goals to evaluate screening to treatment pathways in individuals with postpartum depression across the Mass General Brigham (MGB) hospital system: Screening and Treatment Enhancement Program For Postpartum Depression within the MGB System or STEPS for PPD. In collaboration with multiple obstetric clinics across MGB, the STEPS project will assess clinical and treatment outcomes of postpartum screening and explore barriers and facilitators to screening and treating PPD. 

STEPS builds on previous research to analyze systems of PPD screening, referral, and treatment. Ultimately, we hope that findings from the project will be certain that patients are universally screened for postpartum depression and, in the event that they do screen positive, are referred in order that they will receive adequate care and treatment of symptoms. The knowledge gained from this study will illuminate aspects related to utilization of treatment services for postpartum depression and may inform how best to extend access and uptake of services for future patients.

Ruta Nonacs, MD PhD

References

McNicholas E, Boama-Nyarko E, Julce C, Nunes AP, Flahive J, Byatt N, Moore Simas TA. Understanding Perinatal Depression Care Gaps by Examining Care Access and Barriers in Perinatal Individuals With and Without Psychiatric History. J Womens Health (Larchmt). 2023 Oct;32(10):1111-1119.

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