Round 3: Who Should Be Responsible for Identifying Postpartum Depression (PPD)?

In the third round of this debate, the doctors deliberate on who should be responsible for identifying PPD.

Transcript:

Dr Jennifer Payne: Hello and welcome back to this Great Debates in Psychiatry Series, brought to you by Psych Congress Network. In our third round of this debate, we'll discuss who should be responsible for identifying postpartum depression. Dr Barrett, can you get us started?

Dr Melanie Barrett: Postpartum depression can have a significant impact on the mother and infant, as well as the entire family and the community. I think we need to think about this question from two perspectives. How do we identify women who are currently experiencing postpartum depression? Who should be doing this, and then what should be done once PPD is identified? And to take it a step further, how do we identify women who are at an increased risk for developing PPD but might not be presenting with symptoms at the current time? Who should be doing this, and what can be done to mitigate risk factors? Maternal depression represents a public health crisis and is underrecognized and undertreated, and we must all work together to address it.

Dr Jennifer Payne: Completely agree. The short answer is everyone. Postpartum depression is a serious complication of pregnancy and, in fact, is the most common complication of childbirth. It can have serious repercussions, not only for the woman but for the exposed infant. Studies show that postpartum depression has harmful effects on the infant's language development and psychological outcomes. The problem we face here is that obstetricians often feel that they were not trained in how to identify and treat depression and that they need psychiatry and other mental health professionals to help them. They're right, but there's a serious shortage of mental health professionals in the United States. The waiting list to see a psychiatrist is often months long. Therefore, we need to empower other clinicians to identify and treat postpartum depression. This includes obstetricians, pediatricians, family doctors, and internal medicine doctors. Maternal mental health is so important that everyone should be aware of this complication of childbirth.

Dr Melanie Barrett: The American College of Obstetricians and Gynecologists, ACOG, recommends that all perinatal women should be screened for mental health conditions. The American Academy of Pediatrics, the AAP, recommends that pediatricians screen mothers for postpartum depression at the infant's well-child visits for the first 6 months after delivery. The American Psychiatric Association holds the position that pregnant and postpartum women should be assessed for the presence of and risks for a psychiatric disorder. Universal screening of all pregnant and postpartum women for depression is a good start, but we must also be equipped to manage depression once we've identified it. We also need to focus on identifying those at higher risk for developing PPD and intervening to prevent it. A recent study looked at pathways to care for perinatal depression and found that compared to individuals with histories of psychiatric illness prior to pregnancy, perinatal individuals without a pre-pregnancy psychiatric history were less likely to be screened, less likely to be referred, and less likely to be treated for depression. Women without histories of psychiatric illness were about 80% less likely to receive treatment. The collaborative care model is an effective approach to perinatal mental health care delivery that can involve OBGYNs, psychiatry, pediatrics, and primary care to all work together to quickly identify and manage postpartum depression to reduce its impact.

Dr Jennifer Payne: I agree that all physicians need to be aware of the possibility of postpartum depression and learn to identify and treat postpartum depression. In addition, family members and perinatal women need to be educated about this important complication and encouraged to seek out evaluation and treatment. If they are concerned they are developing postpartum depression, one area that's likely to be helpful in the future is research into identifying who is at elevated risk prior to the onset of symptoms. For example, as I've mentioned, my work has identified two blood-based biomarkers that are predictive of who's at risk for postpartum depression. So, we can take blood in the third trimester and predict if a woman is at high risk or low risk. We can then start to take steps to prevent the onset of postpartum depression. This could be by using psychotherapy, increased social support, and medications. I would like to see psychiatry as a field moving from reactive to preventative.

Dr Jennifer Payne: In addition to being predictive. Having a blood-based test for a future mental illness for the development of postpartum depression after delivery will allow obstetricians time to refer a patient to a mental health professional and to put into place other supports that can decrease both the risk of postpartum depression and the effects of postpartum depression on the infant. Dr Barrett, thank you so much for this conversation. This concludes round three of this installment of our great debate series. Be sure to tell us who you think won this round by answering the poll questions you see on the next screen. And please be sure to tune in next time for round four, where we will talk about the future of care and postpartum depression.