Integrating behavioral and medical services: preventing postpartum depression

The New York Times published a commentary on 10-19-14 about preventing postpartum depression. The article, “Treating Depression Before It’s Postpartum,” was written by David Borenstein, who is not a mental health professional but is a journalist who appears to have thoroughly researched the issues related to postpartum depression.  

He notes, “depression is the most common health problems women face. As many as one in four will experience it during their lifetimes, and about one in seven will experience postpartum depression.” He goes on to review the current thinking in the medical field about postpartum depression. I learned that it is often assumed to be associated with hormonal changes related to pregnancy, but in fact “only a small fraction of these depressions are hormonally based.” He quotes an expert who cited research findings that tell us that a significant portion of postpartum depressions starts during pregnancy. Research also tells us that only about 20 to 30% of women who experience postpartum depression in the US get treatment.  

Mr. Bornstein goes on to review the symptoms and impairments caused by postpartum depression. He goes on to briefly review the evidence-based treatments for depression, but also documents current barriers to accessing these services. He notes, “many primary care doctors fail to recognize when their patients are depressed. Even when they do, it’s not easy to connect patients with treatment.”  

He summarizes these concerns by stating, “all this suggests that new research and treatment models are needed,” and goes on to describe three interesting programs. All include early screening and prompt referral to different levels of mental health treatment, and all have emerging outcomes data that support the benefits of this approach.

 My take: psychologists and other mental health professionals who want to expand their practice good potentially reach out to gynecologists and primary care physicians to offer resources for helping them screen there pregnant patients, and prompt treatment openings for women who are identified to be at risk.

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