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Mental health disorders among women during the perinatal period are common and cause significant morbidity, yet precise reasons why some women develop depression during this period, and others do not, are, as yet, unknown. Pregnancy may burden populations of women differently, and sociological variables, such as finances, social position, interpersonal resources; and extreme events, the coronavirus disease 2019 (COVID-19) pandemic for example, may be as significant as biological determinants. However, current treatment for depression remains focused on the individual woman as the main agent for change. Incorporating a systems-wide approach to diagnosing and treating perinatal depression by addressing structural and systemic determinants may be a more effective way to treat this illness. In this paper, we explore social determinants of health and their correlation with clinical depression in the antenatal period. We also investigate broader, society-wide interventions that may reduce this significant morbidity among women of reproductive age, in both developed and developing nations.

BackgroundThe demand for endocrinology services is growing worldwide, particularly among minority and underserved populations, mainly due to the rapid global increase of diabetes. The medical education of endocrinologists is a resource consuming process and is mainly hospital-based. Yet, given the chronic nature of endocrine morbidity, the greatest demand for endocrinology services is in the community. However, an isolated endocrinologist cannot cope with the rapid changes in the field. Limited funding of hospital facilities does not allow for the establishment of a freestanding endocrine-center; thus, the Community- Hospital Integrative Model of Healthcare (Co-HIMH) was developed and implemented in an Israeli government hospital and is presented as an approach for achieving excellence in endocrinology care.AimTo describe the design, function and challenges of the Co-HIMH.Model descriptionOriginally, three pillars: 1) the hospital unit as a regional expertise resource, 2) Co-HIMH endocrine providers participating in both community and hospital services, and 3) integrated information flow between health-care providers, supported the integration between hospital and community networks.ResultsThe community and hospital endocrine human resources were increased to create attainable and accessible endocrine services in the community and hospital. Collaborative interaction between healthcare providers increased both continuity of care and efficient patient navigation. Endocrine hospital referrals for specialized procedures have grown. Within this area of low socioeconomic status, continued medical endocrine education was conducted introducing state-of-the-art treatments. The essence of these achievements was maintained by continuous training of fellows. During the years that the Co-HIMH operated, it certified 14 % of all endocrinology fellows in Israel. Unresolved issues regarding employee rights and formalization of the Co-HIMH status are significant challenges.ConclusionsIn the era of limited resources and increased healthcare demand, creative infrastructures are required. This article provides a successful example of a preliminary model and proposes future needed modifications.

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