We are clearly making big strides in terms of increasing public awareness of perinatal mood and anxiety disorders, but we still have a long way to go when it comes to providing access to mental health professionals with expertise in this area. We have demonstrated that screening for perinatal depression can be carried out successfully in a variety of settings, but we have also learned that screening alone does not necessarily translate into treatment or improvement in outcomes for women with perinatal mood disorders.
In order to improve the identification and treatment of women with perinatal mood and anxiety disorders, the Massachusetts Child Psychiatry Access Project (MCPAP) for Moms was developed and implemented. This low-cost population-based program was designed to help providers address providers’ capacity to address perinatal depression through (1) trainings and toolkits on depression screening, assessment and treatment; (2) access by telephone to perinatal psychiatric consultation for providers caring for pregnant and postpartum women; and (3) care coordination to help women connect with individual psychotherapy, support groups, and resources in the community.
According to a recent report analyzing the first 18 months, MCPAP for Moms enrolled 87 Ob/Gyn practices, conducted 100 trainings and served 1123 women. Of the telephone consultations provided, 64% were with obstetric providers/midwives and 16% were with psychiatrists. It was estimated that MCPAP for Moms costs $8.38 per perinatal woman per year and would cost about $600,000 in order to cover 71,618 deliveries annually in Massachusetts.
The data presented here indicates that MCPAP for Moms is a feasible, acceptable and potentially sustainable approach that can help frontline providers effectively identify and manage perinatal depression. We are eager to find out how this approach works in terms of treatment rates and maternal and child outcomes. While this program is promising in terms of the number of women it can potentially reach, we have typically seen low levels of follow-up and treatment of pregnant and postpartum women identified as being depressed.
Dr. Nancy Byatt and colleagues published an analysis of 17 intervention studies where women were screened for perinatal depression, and they assessed levels of subsequent treatment. Among women who were screened for depression but received no specific follow-up, overall rates of treatment were low. An average of 22% (13.8-33.0%) of women who screened positive for depression received at least one mental health visit.
The authors noted that the use of mental health services increased significantly when interventions targeted both patient- and health care provider-derived barriers to treatment by using 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%). One of the strengths of MCPAP for Moms is that it builds upon the existing system of perinatal care. Pregnant and postpartum women have an ongoing, and ideally trusting, relationship with their perinatal providers. The MCPAP for Moms models uses these providers as a bridge to mental health treatment. By providing education and support to these frontline providers, we decrease potential barriers to accessing mental health treatment and hopefully increase the number of women who ultimately receive the care and support they need.
Ruta Nonacs, MD PhD
Byatt N, Biebel K, Moore Simas TA, Sarvet B, Ravech M, Allison J, Straus J. Improving perinatal depression care: the Massachusetts Child Psychiatry Access Project for Moms. Gen Hosp Psychiatry. 2016 May-Jun;40:12-7.