Postpartum depression screening: Treatment engagement, barriers to care, and change in depressive symptoms

Vanderkruik, Rachel; Freeman, Marlene P.; Claypoole, Lauren D.; Arakelian, Miranda; Kaimal, Anjali J; Nadel, Hiyam; Cohen, Lee S.

doi:10.12788/acp.0044

Cited by 3 publications

(2 citation statements)

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“…The high prevalence is made more acute by cumulative shortcomings in clinical recognition, initiation and adequacy of treatment, as well as in treatment response and the lack Food and Drug Administration (FDA)-approved treatment options for PPD [ 3 ]; collectively these are known as the “perinatal depression treatment cascade.” [ 4 ] The current, sole FDA-approved treatment is expensive, administered as an intravenous infusion, and requires multiday hospitalization. In addition, concerns over negative side effects and risks of commonly prescribed, off-label psychotropic medications in the postpartum period [ 5 , 6 ], especially among women who breastfeed their infants [ 3 ], are additional challenges to effective treatment. Although a variety of interventions aimed at preventing PPD have been proposed, rigorous studies evaluating their effectiveness are limited, especially across a range of settings and participant populations.…”

Section: Introductionmentioning

confidence: 99%

Comparison of placenta consumers’ and non-consumers’ postpartum depression screening results using EPDS in US community birth settings (n=6038): a propensity score analysis

Benyshek

Bovbjerg

Cheyney

2023

BMC Pregnancy Childbirth

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Background Preventing postpartum depression (PPD) is the most common self-reported motivation for human maternal placentophagy, yet very little systematic research has assessed mental health following placenta consumption. Our aim was to compare PPD screening scores of placenta consumers and non-consumers in a community birth setting, using propensity score matching to address anticipated extensive confounding. Methods We used a medical records-based data set (n = 6038) containing pregnancy, birth, and postpartum information for US women who planned and completed community births. We first compared PPD screening scores as measured by the Edinburgh Postpartum Depression Scale (EPDS) of individuals who consumed their placenta to those who did not, with regard to demographics, pregnancy characteristics, and history of mental health challenges. Matching placentophagic (n = 1876) and non-placentophagic (n = 1876) groups were then created using propensity scores. The propensity score model included more than 90 variables describing medical and obstetric history, demographics, pregnancy characteristics, and intrapartum and postpartum complications, thus addressing confounding by all of these variables. We then used logistic regression to compare placentophagic to non-placentophagic groups based on commonly-cited EPDS cutoff values (≥ 11; ≥ 13) for likely PPD. Results In the unmatched and unadjusted analysis, placentophagy was associated with an increased risk of PPD. In the matched sample, 9.9% of women who ate their placentas reported EPDS ≥ 11, compared to 8.4% of women who did not (5.5% and 4.8%, respectively, EPDS ≥ 13 or greater). After controlling for over 90 variables (including prior mental health challenges) in the matched and adjusted analysis, placentophagy was associated with an increased risk of PPD between 15 and 20%, depending on the published EPDS cutoff point used. Numerous sensitivity analyses did not alter this general finding. Conclusions Placentophagic individuals in our study scored higher on an EPDS screening than carefully matched non-placentophagic controls. Why placentophagic women score higher on the EPDS remains unclear, but we suspect reverse causality plays an important role. Future research could assess psychosocial factors that may motivate some individuals to engage in placentophagy, and that may also indicate greater risk of PPD.

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Section: Introductionmentioning

confidence: 99%

Comparison of placenta consumers’ and non-consumers’ postpartum depression screening results using EPDS in US community birth settings (n=6038): a propensity score analysis

Benyshek

Bovbjerg

Cheyney

2023

BMC Pregnancy Childbirth

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“…In Chile, although effective detection and treatment protocols are available for new mothers, only a minority (i.e., approximately 29%) of women who are at-risk of developing PND access treatment. 5,13 Some of the barriers that prevent women to access or adhere to treatment in the country include negative beliefs about PND and the available interventions, stigma, and limited access to mental health care. With regard to health professionals, limited information about perinatal mental health, insufficient time during consultations, and lack of coordination between health providers are also described.…”

Section: Introductionmentioning

confidence: 99%

Online intervention to prevent postnatal depression and anxiety in Chilean new mothers: Protocol for a feasibility trial

Pérez

Aldoney

García

et al. 2022

Health Informatics J

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Symptoms of postpartum depression and anxiety in new mothers are prevalent and negatively impact maternal emotional wellbeing and infant development. Barriers to accessing treatment prevent women from receiving mental health care, a situation that has worsened due to the COVID-19 pandemic. mHealth interventions hold the potential to support women during the transition to parenthood despite these barriers and to promote the use of preventive interventions. This study uses a mixed methods design to assess the feasibility and preliminary effectiveness of a psychoeducational, guided mHealth intervention to prevent postpartum mental health difficulties in women who receive care in primary health centers in Chile. The study will contribute to evidence-based research on the effectiveness of mHealth interventions for new mothers from an understudied cultural background. The findings will also enable the development of a larger randomized controlled trial to assess the effectiveness of the intervention, which, if effective, could significantly contribute to the emotional wellbeing of women and their families.

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Barriers and facilitators for referring women with positive perinatal depression screening results in China: a qualitative study

Xue

Cheng

Liu

et al. 2023

BMC Pregnancy Childbirth

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Background Timely screening and referral can improve the outcomes of perinatal depression (PND). However, uptake rates of referral after PND screening are low in China and the reasons are unclear. The aim of this article is to explore the barriers and facilitators for referring women with positive results of PND screening in the Chinese primary maternal health care system. Methods Qualitative data were collected from four primary health centers located in four different provinces of China. Each of the four investigators conducted 30 days of participant observations in the primary health centers from May to August 2020. Data were collected via participant observations and semi-structured in-depth interviews with new mothers who had positive results of PND screening, their family members, and primary health providers. Two investigators analyzed qualitative data independently. A thematic analysis was conducted, and data were framed using the social ecological model. Results A total of 870 hours of observation and 46 interviews were carried out. Five themes were identified: individual (new mothers’ knowledge of PND, perceived need to seek help), interpersonal (new mothers’ attitudes towards providers, family support), institutional (providers’ perception of PND, lack of training, time constraints), community (accessibility to mental health services, practical factors), and public policy (policy requirements, stigma). Conclusions The likelihood of new mothers accepting PND referral is related to factors in five areas. Intervention strategies can be developed around these themes and may include educating new mothers and their families about PND, training primary health providers to improve their awareness of condition and indication for referral, building mental health support in routine postpartum home visits, and providing support through mobile technology.

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Postpartum depression screening: Treatment engagement, barriers to care, and change in depressive symptoms

Cited by 3 publications

References 0 publications

Comparison of placenta consumers’ and non-consumers’ postpartum depression screening results using EPDS in US community birth settings (n=6038): a propensity score analysis

Comparison of placenta consumers’ and non-consumers’ postpartum depression screening results using EPDS in US community birth settings (n=6038): a propensity score analysis

Online intervention to prevent postnatal depression and anxiety in Chilean new mothers: Protocol for a feasibility trial

Barriers and facilitators for referring women with positive perinatal depression screening results in China: a qualitative study

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