Depression affects one in seven women during pregnancy and the postpartum period. Despite intense efforts to increase awareness among patients and providers, perinatal depression continues to be underdiagnosed and undertreated. Individuals with any type of psychiatric history are at even greater risk for perinatal depression, but it is unclear if their experiences with referral and treatment for depression differ from individuals without a psychiatric history.
Given a history of psychiatric illness prior to pregnancy, it may be easier for these individuals to identify the symptoms of perinatal depression and to acknowledge the need for treatment. Past experiences may also make it easier to navigate the healthcare system, and some individuals with histories of psychiatric illness may also have access to previous providers.
In this study, the researchers conducted a secondary analysis 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 Moms (PRISM) study, where it was recommended that participants be screened with the EPDS once during pregnancy and during 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 likely to be screened for perinatal depression and were less likely to be offered a therapy referral.
In examining how these differences affected outcomes, the researchers found that those without 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 care for depression (95% CI: 0.08-0.47).
Barriers to care were similar across the two groups; however, those with no histories were more likely to report concerns regarding available treatments and to express beliefs about the resolution of symptoms without any treatment.
What Can We Do to Improve Diagnosis and Treatment of Perinatal Depression?
The findings of the current study indicate that, compared to individuals with histories of psychiatric illness prior to pregnancy, perinatal individuals without a prepregnancy psychiatric history were less likely to be screened, less likely to be referred, and less likely to be treated for depression. While the findings of the study are not surprising, the difference between the two groups was not subtle; women without histories of psychiatric illness were about 80% less likely to receive treatment. The information from this study indicates that we must make every effort to ensure universal screening for depression in perinatal populations. Furthermore, future studies are needed to better understand how 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 aims to assess 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 in 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 investigate systems of PPD screening, referral, and treatment. Ultimately, we hope that findings from the project will ensure that patients are universally screened for postpartum depression and, if they do screen positive, are referred so that they can receive adequate care and treatment of symptoms. The knowledge gained from this study will illuminate factors associated with utilization of treatment services for postpartum depression and can inform how best to increase access and uptake of services for future patients.
Ruta Nonacs, MD PhD
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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