Barriers to mental health treatment among obstetric patients at risk for depression

Study protocol for a randomized, controlled, superiority trial comparing the clinical and cost- effectiveness of integrated online mental health assessment-referral-care in pregnancy to usual prenatal care on prenatal and postnatal mental health and infant health and development: the Integrated Maternal Psychosocial Assessment to Care Trial (IMPACT)

“…However, despite recommendations [25,26] and acceptance by both healthcare providers [27-30] and women [31-33], psychosocial assessments are routinely conducted by fewer than 20% of prenatal care providers [34]. In systems without linkages between assessment, referral, and mental healthcare, only 18% of pregnant and postpartum women who are assessed as having mental health problems actually follow up with a referral that they have been given [35], and fewer than 15% of those needing care receive some form of treatment [35,36]. The problem is further complicated by evidence that most women do not voluntarily disclose mental health concerns [22,37,38] (despite the fact that <4% refuse provider-initiated assessment) [39,40].…”

“…Standardized psychosocial assessment is feasible [31,35,49,50], improves detection [51,52] and facilitates triaging of women by symptom severity to ensure that women receive appropriate services [1]. However, serious resource limitations (for example, lack of time and assessment tools) constrain many primary care providers from routine assessment of mental health problems.…”

“…A meta-analysis reported that online CBT produces moderate to large effects, is as effective as face-to-face CBT, and has lower attrition rates (20%) than group-based CBT (40 to 50%) [7,84]. Although not tested in pregnant women, online CBT is an ideal treatment because it can overcome major deterrents to mental healthcare cited by pregnant/postpartum women, including: long wait times [35], inaccessibility [35], lack of time [35], finding childcare [24,85], stigma of attending care [24], and treatment expense [35]. Online CBT satisfies the majority (93%) of distressed women’s preference for self-help [24] and should improve aspects of psychological health (for example, mastery, resilience) related to poor pregnancy outcomes [86].…”

PROYECTO MAMÁFELIZ: Estudio sobre la Salud Mental prenatal a través de Internet

“…Lograr dicha evaluación psicosocial es algo factible (Gordon et al, 2006;Kim et al, 2010a (Flynn et al, 2006b) y el 62,5% (Miller et al, 2009) con unas tasas de rechazo bajas (<4%), lo cual demuestra la aceptación por parte de las mujeres de las tareas de detección y seguimiento de los cuidados (Miller et al, 2009). …”

“…Algunos autores afirman que un conjunto de intervenciones clínicas bien establecidas, un programa integral que incluya estrategias de screening estandarizado y un ajuste de los recursos a nivel de sistema sanitario, pueden ser herramientas útiles para ayudar a los programas obstétricos ambulatorios a un mejor abordaje de la depresión perinatal (Kim et al, 2010a;Sword et al, 2008;Ziedonis, 2004 Por ser el tema que nos atañe en este punto, nos detendremos en explicar los argumentos y las conclusiones a las que llegan este grupo de autores en cuanto a los cambios organizacionales en los recursos que precisan las intervenciones dirigidas a la atención de la depresión perinatal.…”