It is clear that screening for perinatal depression substantially improves detection; however, screening alone does not appear to improve rates of treatment or outcomes. What we find is that many, if not most, women with perinatal depression do not receive adequate care. There appear to be many obstacles: stigma associated with mental illness, lack of insurance coverage for mental health services, inability to find appropriately trained providers, inadequate child care. How can we best deliver care to this vulnerable population of women?
A recent study has looked at the efficacy of a telephone-delivered intervention. In this prospective, nonrandomized study, postpartum women meeting DSM-IV-TR criteria for major depression were identified through screening in several obstetric practices. Women with postpartum major depression received either eight 50 minute telephone sessions of interpersonal psychotherapy (IPT) administered by a certified nurse-midwife trained in IPT or were referred to a mental health professional.
- Of the 41 participants receiving telephone IPT, all attended at least one session. The mean number of sessions completed was 6.22.
- Of the 20 participants referred to a mental health provider, only 50% (10/20) attended an appointment and, on average, received 2.85 sessions.
- Women receiving IPT had significantly lower mean scores on the Hamilton Depression Rating Scale at 8 weeks (7.92 vs. 12.30), compared to those referred to mental health providers.
While larger studies are required to fully assess the efficacy of this intervention, this study confirms what we have seen in many other studies. Many women with PPD, even when referred to mental health providers, do not actually receive the care they need. Providing telephone-based therapy might be one method of overcoming some of the obstacles that women with PPD may encounter in accessing mental health services.
Ruta Nonacs, MD PhD
Posmontier B, Neugebauer R, Stuart S, Chittams J, Shaughnessy R. J Midwifery Womens Health. 2016 Jul;61(4):456-66.