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Analysis

Follow New Recommendations to Treat Perinatal Depression

By Christopher Cheney  
   March 07, 2019

Two forms of psychological therapy have been found effective in reducing perinatal depression.

The U.S. Preventive Services Task Force has issued new recommendations to treat perinatal depression.

One of the most common complications of pregnancy and the postpartum period, perinatal depression affects as many as 1 in 7 pregnant women, with both short-term and long-term impacts on the woman and the child.

Task Force member Karina Davidson, PhD, MSc, says adequate data has been gathered to indicate best practices for perinatal depression care.

"The Task Force was interested in whether sufficient evidence had become available to demonstrate that we can effectively address this serious public health issue, and we are glad that we can now make a recommendation about how clinicians can help women who are at risk of perinatal depression," says Davidson, senior vice president of research and dean of academic affairs at Northwell Health's Feinstein Institute for Medical Research.

The Task Force is recommending that women who are at risk of perinatal depression should receive counseling interventions from their clinicians or get referrals for counseling.

  • Risk factors for perinatal depression include individual or family history of depression, physical or sexual abuse, unplanned or unwanted pregnancy, stressful life events, and pregestational or gestational diabetes
     
  • Cognitive behavioral therapy and interpersonal therapy are considered best-suited for treatment of perinatal depression
     
  • The Task Force found counseling interventions reduced the likelihood of perinatal depression 39%

The optimal timing to offer counseling or a referral is unclear, Task Force members wrote in the Journal of the American Medical Association.

"There are no data on the ideal timing for offering or referral to counseling interventions; however, most were initiated during the second trimester of pregnancy. Ongoing assessment of risks that develop in pregnancy and the immediate postpartum period would be reasonable, and referral could occur at any time," they wrote.

Detection challenge
 

Screening for perinatal depression is a significant challenge for clinicians, Davidson says.

"Unfortunately, there is no accurate, formal screening tool available to identify individuals at risk for perinatal depression. This can make it tricky for clinicians and other healthcare professionals to decide who will benefit most from these preventive interventions," she says.

Assessing risk factors is crucial in deciding whether to provide perinatal depression counseling services to pregnant or postpartum women, Davidson says.

"Since there is limited data on the best way to identify who is at risk, the Task Force suggests that clinicians provide or refer counseling interventions to those with risk factors including a history of depression, current depressive symptoms, socioeconomic risk factors, recent intimate partner violence, and other mental health-related factors."

Providing leadership
 

Leaders at health systems, hospitals, and physician practices should embrace counseling interventions for women who are at increased risk for perinatal depression, Davidson says.

"Healthcare professionals working at the organizational level should ensure their staff is aware of the research backing these interventions, and they should make sure that clinicians are committed to identifying people who are at increased risk for perinatal depression and thus might benefit from these interventions."

Christopher Cheney is the senior clinical care​ editor at HealthLeaders.


KEY TAKEAWAYS

Perinatal depression is one of the most common complications of pregnancy.

Research shows that counseling reduces the likelihood of perinatal depression 39%.

Screening is a major challenge in perinatal depression care.


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