Mass General Hospital

Harvard Medical School

Effectiveness of Psychological Interventions for Postpartum Depression in Primary Care

 

Postpartum depression (PPD) has been identified as the “most under-recognized, under-diagnosed, and under-treated obstetrical complication in America”, affecting approximately 10-15% of new mothers. In addition to affecting maternal mental health during a critical time in a woman’s life, there are are a number of downstream effects associated with undiagnosed or untreated PPD such as impaired bonding with the baby, shorter duration of breastfeeding, and marital difficulties.

Currently, nearly every state in the US has implemented a screening tool to help identify women at risk for PPD but recent research shows that we are coming up short in terms of diagnosing PPD, connecting affected women to accessible treatment, and adequately treating PPD. Essentially, at each step of the journey to wellness, we are not doing well enough.

Researchers from Brighton and Sussex Medical School in the UK conducted a meta-analysis to examine the effectiveness of psychological interventions implemented within primary care for PPD. Their search led to ten different reports between 2000 and 2013, 4 from Australia, 3 from the US, 2 from the UK, and 1 from Taiwan. The interventions included modalities such as Cognitive Behavioral Therapy, Interpersonal Therapy, and counseling. Some interventions were delivered individually and others were delivered in group settings. Therapies were typically offered by trained nurses and health visitors (common outside of the US). Interventions varied from 4 weeks to 8 months in duration. The researchers carried out a number of statistical manipulations to control for heterogeneity among the studies.

The meta-analysis found significant benefit in favor of psychological intervention compared to control. The psychological interventions resulted in lower levels of depressive symptomatology with no difference in effectiveness observed between individual or group therapies.

Given that nearly 90% of all PPD cases in the UK are managed by primary care, these results are support the notion that effective strategies for PPD can be implemented by primary care physicians. The results are less generalizable here in the US where women may not have much contact with their primary care providers during the postpartum period. Instead, they interact mainly with their obstetrician and child’s pediatrician. Further study is required to determine how these interventions might be integrated into postpartum care here in the US.

 

Alexandra Sosinsky, BS

 

Stephens S, Ford E, Paudyal P, Smith H. Effectiveness of Psychological Interventions for Postnatal Depression in Primary Care: A Meta-Analysis. Annals Family Medicine. 2016;14:1463-472.

Cox EQ, Sowa NA, Meltzer-Brody SE, Gaynes BN. The Perinatal Depression Treatment Cascade: Baby Steps Toward Improving Outcomes. J Clin Psychiatry. 2016 Sep;77(9):1198-1200.

Pearlstein T, Howard M, Salisbury A, Zlotncik C. Postpartum Depression. Am J Obstet Gynecol. 2009 Apr; 200(4): 357-364.

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