February 18, 2019

Preventing Perinatal Depression

Counseling Deemed a Preventive Service by the US Preventive Services Task Force

perinatal-dep_650x450

By Rebecca Starck, MD

Advertisement

Cleveland Clinic is a non-profit academic medical center. Advertising on our site helps support our mission. We do not endorse non-Cleveland Clinic products or services. Policy

Last week, the US Preventive Services Task Force (USPSTF) published new recommendations based on its evaluation of interventions to prevent perinatal depression. Defined as a depressive episode that occurs during pregnancy or in the 12 months following delivery, perinatal depression is a pervasive disorder that can have long-lasting effects on the health and well-being of mothers and infants.

After evaluating a variety of interventions, including cognitive behavioral therapy, exercise, education and pharmacological approaches, the USPSTF found adequate evidence to support only counseling as a preventive measure that provides moderate benefit and little harm for women at increased risk.

One of the things I like about the USPSTF recommendation is that it is unrelated to presenting symptoms. If your patient has one or more of the risk factors, she gets referred. Clinical risk factors, according to the USPSTF report, include a personal or family history of depression, history of physical or sexual abuse, having an unplanned pregnancy, current stressful life events, diabetes or complications with the pregnancy. Other, more social factors include low income, partner violence, a lack of social support or being young or a single parent.

Perinatal depression is fairly common

We know that 10-15% of women will experience significant post-partum depression, which can have adverse effects on the mother and infant. Symptoms can include lethargy, hopelessness, feeling disconnected from infant and social supports, fluctuations in weight, difficulty sleeping and suicidal ideation. Evidence suggests women with perinatal depression have higher levels of negative maternal behaviors and significantly lower levels of positive maternal behaviors, which can impact bonding. Women with perinatal depression may interact less positively with their infants; they may praise or play less frequently. Perinatal depression is also associated with breastfeeding difficulties, headaches and other health stressors, as well as an inability to focus or pay attention upon return to work.

As providers, we are constantly seeking ways to reduce the burden of disease – to improve quality of life for our patients and their families. While other mental health interventions may complement counseling, the USPSTF did not find enough evidence of their efficacy to recommend them as effective preventive measures. Only counseling interventions, such as cognitive behavioral therapy and interpersonal therapy, met the organization’s evidence threshold.

Advertisement

USPSTF statement means no co-pay for counseling interventions in at-risk women

Recommendations at this level from the USPSTF have significant societal impact. Insurers must cover such evidence-based services, with no cost-sharing. This is great news for women and their children, and really, our society as a whole.

The challenge, however, is that we will still see barriers to patients’ ability to effectively seek mental health services in a timely manner. Caregiving demands may make it difficult to keep an appointment. It might take a while to establish rapport with a counselor. Some people will seek help from several counselors before they find the right one. Finally, we may not have enough mental health providers to keep up with a surge in demand.

Destigmatizing Perinatal Depression

There is stigma associated with depression and counseling. Whether the stigma is a result of societal pressures or self-perceived failure, it can feel embarrassing to seek help. Hopefully this new practice will go a long way toward destigmatizing perinatal depression, but change at this level will not happen overnight.

As healthcare providers, we must counsel and educate our patients (and their family members) about perinatal depression and its associated risk factors. Overall, the important thing for me is that, as a society, we recognize the stressors that can impact mood disorders, and that we work toward changing what we can change in those environments.

It seems that mental health has become more recognized as an overall health and wellness priority. I encourage all patients to address any mental health and psychosocial stressors that they may experience at any stage of their lives. Whether they are adolescents, prenatal, post-partum or menopausal, counseling can help.

Advertisement

Dr. Starck is President of Cleveland Clinic Avon Hospital and practices obstetrics and gynecology at Avon Pointe Family Health Center.

Related Articles

23-WHI-4322159-OGI-CQD-Sustainability-in-OR
November 13, 2023
Striving for Sustainability in Ob-Gyn Care

Researchers examine waste and implore colleagues to take action

Biohazard waste
November 28, 2022
Surgeons Must Be Sustainability Leaders

Adjusting practices and spreading knowledge will help reduce greenhouse gas emissions

650×450-Karamlou
June 30, 2022
Female Surgeons Need Better Equipment Design

Instruments still present a barrier as more women join the field

WHI_2956676_05-13-22_033_SG_lowres
April 15, 2022
Ergonomics Play Key Role in Well-Being of Surgeons

Optimizing the environment can measurably reduce physical strain

Woman checks blood pressure with home monitoring device
April 30, 2021
The Menopause Transition and Cardiovascular Disease Risk

On the importance of monitoring a woman’s reproductive aging process

20-WHI-1974839_CQD_650x450_ (1)
November 12, 2020
Rigor and Opportunity in Tracking Residency Program

Postgraduate training is a top priority for the Ob/Gyn & Women’s Health Institute

20-WHI-1965253 CQD WHI YIR_CQD_650x450_1239406102
November 5, 2020
Complicated Pregnancies Benefit From a Team Approach

What’s next for maternal-fetal medicine?

20-PAI-1885621 CQD Truan_Post-Cesarean Pain and Breastfeeding_650x450_147318731 (1)
September 16, 2020
The Future of Maternal-Fetal Medicine

A conversation with Giancarlo Mari, MD

Ad