Enhancing Participation in Depression Care in Outpatient Perinatal Care Settings

Abstract

Objective To examine a wide range of study designs and outcomes to estimate the extent to which interventions in outpatient perinatal care settings are associated with an increase in the uptake of depression care. Data Sources PubMed, CINAHL, PsycINFO, ClinicalTrials.gov, and Scopus (EMBASE) were searched for studies published between 1999 and 2014 that evaluated mental health care use after screening for depression in perinatal care settings. Methods of Study Selection Inclusion criteria were: 1) English language; 2) pregnant and postpartum women who screened positive for depression; 3) exposure (validated depression screening in outpatient perinatal care setting); and, 4) outcome (mental health care use). Searches yielded 392 articles, 42 met criteria for full text review, and 17 met inclusion criteria. Study quality was assessed using a modified Downs and Black scale. Tabulation, Integration, and Results Articles were independently reviewed by two abstractors and consensus reached. Study design, intervention components and mental health care use were defined and categorized. Seventeen articles representing a range of study designs, including one randomized controlled trial (RCT) and one cluster RCT, were included. The average quality rating was 61% (31.0-90.0%). When no intervention was in place, an average of 22% (13.8-33.0%) of women who screened positive for depression had at least one mental health visit. The average rate of mental health care use was associated with a doubling of this rate with patient engagement strategies (44%, 29.0-90.0%), on-site assessments (49%, 25.2-90.0%), and perinatal care provider training (54%, 1.0-90.0%). High rates of mental health care use (81%, 72.0-90.0%) was associated with implementation of additional interventions, including resource provision to women, perinatal care provider training, on-site assessment, and access to mental health consultation for perinatal care providers. Conclusion Screening alone was associated with 22% mental health care use among women who screened positive for depression; however, implementation of additional interventions was associated with a 2-4 fold increased use of mental health care. While definitive studies are still needed, screening done in conjunction with interventions that target patient, provider and practice-level barriers are associated with increased improved rates of depression detection, assessment, referral, and treatment in perinatal care settings.

Interventions to Increase Depression Treatment Initiation in Primary Care Patients: a Systematic Review

“…60 Identifying effective engagement strategies is essential to optimizing the effectiveness of depression treatment. 61 Our study confirms that collaborative/integrated care, long shown to be effective in improving depression treatment and depressive symptoms in primary care settings, 9,[62][63][64][65]66,67,68 is an important complex, multilevel strategy for increasing treatment initiation. We also found some evidence that case management, another complex but patient-level strategy, may improve treatment initiation, similar to its effect on other health behaviors.…”

Risk Factors for Postpartum Depression: An Umbrella Review

“…It is estimated that only 15% of women with PPD symptoms seek professional care, leaving 85% of affected women untreated . Of those women who screen positive for PPD, it is estimated that only 22% follow up with professional mental health services . This leaves a critical gap between those women who suffer from PPD symptoms and those who receive treatment.…”

Survivors of Child Maltreatment and Postpartum Depression: An Integrative Review

“…Women with PPD face significant barriers to treatment, including a woman's fear of stigma and a lack of skilled professionals who can provide

specialized care . One systematic review found that, on average, only 22% of women who screened positive for PPD received at least one mental health visit . Therefore, awareness of risk factors for PPD may result in better monitoring and quicker treatment for at‐risk women.…”

“…19 One systematic review found that, on average, only 22% of women who screened positive for PPD received at least one mental health visit. 20 Therefore, awareness of risk factors for PPD may result in better monitoring and quicker treatment for at-risk women. A better understanding of the association between maternal history of child maltreatment and subsequent PPD can deepen women's health care providers' sensitivity to these issues and help further guide practice.…”