"And in some cases, we're the best option:" A qualitative study of community-based doula support for black perinatal mental health.

Addressing the Maternal Mental Health Crisis Through a Novel Tech-Enabled Peer-to-Peer Driven Perinatal Collaborative Care Model

Addressing Maternal Mental Health: Progress, Challenges, and Potential Solutions

Finding a Medical Home for Perinatal Depression: How Can We Bridge the Postpartum Gap?

Perinatal depression and anxiety are common yet underdiagnosed and undertreated. There are limited data on screening rates, severity, and treatment, and thus an urgent need to estimate accurately perinatal depression and anxiety over time, to inform timely and efficacious interventions. To evaluate screening and treatment rates, prevalence, and symptom trajectories over time of perinatal depression and anxiety in a large urban medical center. This retrospective cohort study included electronic health records of all patients who gave birth at NewYork-Presbyterian (NYP)/Weill Cornell Medical Center or NYP Lower Manhattan Hospital between December 1, 2020, and February 1, 2024. In March 2023, a mandatory Edinburgh Postnatal Depression Scale (EPDS) screening policy was implemented in 3 clinics covering 35% of deliveries in the hospital. Completion of mental health screening during the perinatal period. The study included 3 primary mental health measures: depression severity (Patient Health Questionnaire-9 [PHQ-9]), anxiety severity (Generalized Anxiety Disorder-7 [GAD-7]), and perinatal depression severity (EPDS). Percentage of women screened, prevalence of clinically meaningful symptoms, as well as rates and frequency of mental health services were examined. Furthermore, symptom changes 1 year before and after delivery were tested using mixed effects models, and whether patient characteristics and mental health services were associated with symptom change was determined. The study included data from medical records of 27 393 women who gave birth during the study period. The final sample included 3051 women (mean [SD] age, 34.3 [5.2] years; age range, 14-54 years) who completed perinatal depression or anxiety screening within 1 year before and after birth. A total of 723 women (3.0%) were administered depression screening (PHQ-9), and 472 (2.0%) completed anxiety (GAD-7) screening. Following a mandatory screening policy, EPDS screening rates increased from 1.0% (274 women) before March 2023 to 14.2% (2304 women) after March 2023. Of those screened, 23.2% (95% CI, 21.7%-24.8%) reported clinically meaningful depression symptoms and 8.8% (95% CI, 7.2%-10.8%) endorsed suicidality; 17.1% of women (523 women) screened received mental health services. Treated women were mostly seen 4 months before and after birth for psychosocial interventions, had faster depression reductions over time (PHQ-9, F1,1504 = 9.6; P = .002), and a sustained decline in depression severity postpartum, compared with untreated women (F1,5166 = 33.8; P < .001). These findings underscore the need for routine and consistent screening, monitoring, and treatment of perinatal depression and anxiety. Women who received mental health services had faster reductions in depression over time, highlighting the potential impact for scalable and efficacious interventions during this critical period.

Better community mental health literacy is associated with positive help-seeking behaviours and reduced stigma. There are relatively few published surveys of perinatal mental health literacy. To provide a profile of current awareness, knowledge and attitudes in relation to the mental health of women and men in the perinatal period. A cross-sectional online survey (n = 1,201) of adults (⩾ 18 years) in each state and territory of Australia was conducted in early 2016. Survey questions were based on a previous 2009 survey, with the addition of several novel items designed to assess knowledge around both perinatal anxiety and men's perinatal mental health. Depression (including postnatal depression) was the most frequently cited general health problem for women in the first postnatal year (52% of spontaneous first responses). Over 70% of adults believed that postnatal depression requires specialised treatment and checks for depressive symptoms should occur routinely in pregnancy and the first postnatal year. Women identified postnatal depression at a higher rate than men. Most commonly, postnatal depression was perceived as having a biological rather than psychosocial etiology (34.5%). Men and women differed in their knowledge about the symptoms of postnatal depression with more women correctly identifying core depressive symptoms. The specific term 'perinatal depression' was not well recognised. Although not well recognised as a general health issue, when prompted, 39% of respondents were aware of anxiety as a specific perinatal mental health issue. Most adult Australians (60%) were unaware that perinatal depression and anxiety could be experienced by men. Awareness of postnatal depression appeared high. However, areas including anxiety, antenatal mental health, and men's mental health were less well-understood. There remains considerable scope, and a need for, continued awareness-raising around anxiety, mental health in pregnancy and men's mental health.

Screening for perinatal depression and anxiety in community-based maternal and child health settings may help close the detection and treatment gap among women at higher risk for these conditions. We aim to review perinatal depression and anxiety screening tools, timing, and follow-up processes for positive screens in community-based settings. We conducted a systematic review of the literature to identify papers describing screening and interventions for perinatal depression and anxiety in community-based settings. We identified 49 papers describing 47 studies of perinatal depression or anxiety screening in community-based settings. The Edinburgh Postnatal Depression Scale (EPDS) was the most frequently used screening tool. Referral and referral tracking for those who screened positive for symptoms were inadequately described. Types of training and technical assistance provided for screening varied widely. It is feasible and acceptable to screen for perinatal depression in community settings, but there is a need for systematic research examining which screening tools to use, the ideal frequency of screening, and referral completion rates. There is a lack of information regarding perinatal anxiety screening and a lack of uniformity in training regarding screening in community-based settings. Future studies should compare the efficacy of screening in community-based settings to screening in healthcare settings.

Background Pregnant migrants are particularly vulnerable to mental illness because they are exposed to stressors including conflict, poverty, and discrimination. We aimed to assess the global prevalence of perinatal mental health disorders or substance use among migrant women. Methods We searched MEDLINE, Embase, PsycINFO, CENTRAL, Global Health, Scopus, and Web of Science for studies published from inception until July 8, 2022. Cohort, cross-sectional, and interventional studies with prevalence data for any mental illness in the perinatal period or substance use in pregnancy were included. The primary outcome was the prevalence of perinatal mental health disorders amongst migrant women globally. A random-effects meta-analysis was used to calculate pooled prevalence estimates. PROSPERO: CRD42021226291. Results 18,650 studies were retrieved, of which 135 studies (comprising data from 621,995 participants) met the inclusion criteria. The pooled prevalence of perinatal depressive disorders was 24·2% (range 0·5-95·5%; I2 98·8%; τ2 0·01) among all migrant women, 32·5% (1·5-81·6; 98·7%; τ2 0·01) among forced migrants, and 13·7% (4·7-35·1; 91·5%; τ2 0·01) among economic migrants (p &amp;lt; 0·001). The pooled prevalence of perinatal anxiety disorders was 19·6% (range 1·2-53·1; I2 96·8%; τ2 0·01) among all migrants. The pooled prevalence of perinatal post-traumatic stress disorder (PTSD) among all migrant women was 8·9% (range 3·2-33·3; I2 97·4%; τ2 0·18). The pooled prevalence of perinatal PTSD among forced migrants was 17·1% (range 6·5-44·3; I2 96·6%; τ2 0·32). Conclusions One in four migrant women who are pregnant or postpartum experience perinatal depression, one in five perinatal anxiety, and one in 11 perinatal PTSD. The burden of perinatal mental illness appears higher amongst forced migrant women compared to economic migrants. These findings highlight the need for community-based perinatal mental health screening and access to interventions that are culturally sensitive. Key messages • Women who are forced migrants have a higher prevalence of perinatal depressive disorders compared with women who are economic migrants; forced migrants also experience a high burden of PTSD. • The findings highlight the need for culturally sensitive mental health screening and care for migrant women who are pregnant or postpartum, particularly for forced migrants.

Background: Perinatal mental health disorders significantly contribute to maternal and neonatal morbidity, particularly in low- and middle-income countries (LMICs) such as Indonesia. Midwives, as frontline maternal healthcare providers, are uniquely positioned to screen for and support women experiencing mental health disorders. However, their involvement remains limited due to systemic, educational, and institutional barriers. Purpose: This study aims to understand the factors influencing midwives' knowledge and utilization of perinatal mental health screening services in Indonesia. Methods: A secondary analysis was conducted using cross-sectional data from an online survey of 300 midwives across Indonesia between June-August 2024. Variables included demographic characteristics, training experience, access to mental health resources, screening knowledge, and utilization behavior. Descriptive statistics and path analysis were used to examine direct and indirect influences on screening utilization. Results: Despite an average of 15 years of clinical experience, only 9.7% of midwives had used mental health screening tools. Just 8.7% had received formal mental health training, and only one-third had access to relevant guidelines. Screening knowledge was significantly predicted by access to structured information sources (β = 1.42; p &lt; 0.001) and directly influenced screening utilization (β = 3.05; p &lt; 0.001). Indirect factors, such as duration of service or interest in training, had no significant effect. Public health outreach and structured training improved access to learning materials. Conclusion: Despite strong interest among midwives, gaps in training, resources, and institutional support hinder effective mental health screening. Strengthening structured training programs and improving access to information are essential steps toward empowering midwives in perinatal mental health care. However, as most participants were from Western Indonesia, these findings should be interpreted with caution, and future studies should include broader geographic representation to better capture the national context

Background and ObjectivesUp to 10% of fathers experience perinatal depression, often accompanied by anxiety, with a detrimental impact on the emotional and behavioural development of infants. Yet, few evidence-based interventions specifically for paternal perinatal depression or anxiety exist, and few depressed or anxious fathers engage with support. This mini-review aims to build on the evidence base set by other recent systematic reviews by synthesising more recently available studies on interventions for paternal perinatal depression and anxiety. Secondarily, we also aimed to identify useful information on key implementation strategies, if any, that increase the engagement of men.MethodsWe drew upon three major previous systematic reviews and performed an updated search of PubMed/Medline; Psycinfo; Cochrane Database; Embase and Cinahl. The search was limited to trials, feasibility studies or pilot studies of interventions published between 2015 and 2020 that reported on fathers' perinatal mental health. We included psychological, educational, psychosocial, paternal, couple-focused, or group therapies, delivered face-to-face, via telephone and/or online that reported on either paternal depression, anxiety or both.ResultsEleven studies satisfied search criteria (5 of which were not included in previous reviews). The majority were randomised controlled trials. Most interventions incorporated counselling, therapy or psychoeducation and took an indirect approach to perinatal mental health through antenatal or postnatal education and were couple-focused. No studies reported a presence of diagnosed depression or anxiety at baseline, although five studies reported a positive effect on sub-threshold symptoms.DiscussionThere was some evidence that these approaches may be useful in the initial engagement of fathers with perinatal supports and improve depression and anxiety scores. No studies targeted the explicit treatment of clinically depressed or anxious men, and this remains the most substantial gap in the peer-reviewed evidence base. Our results highlight the need to deliver perinatal interventions specifically designed for men and evaluate them in populations with clinical levels of depressive and anxious symptomatology.

There are one billion migrants globally, of whom 82 million are forced migrants. Pregnant migrants face pre-migration stressors such as conflict, transit stressors including poverty, and post-migration stressors including navigating the immigration system; these stressors can make them vulnerable to mental illness. We aimed to assess the global prevalence of and risk factors for perinatal mental health disorders or substance use among women who are migrants. In this systematic review and meta-analysis, we searched OVID MEDLINE, Embase, PsycINFO, CENTRAL, Global Health, Scopus, and Web of Science for studies published from database inception until July 8, 2022. Cohort, cross-sectional, and interventional studies with prevalence data for any mental illness in pregnancy or the postnatal period (ie, up to a year after delivery) or substance use in pregnancy were included. The primary outcome was the prevalence of perinatal common mental health disorders among women who are migrants, globally. Data for study quality and risk factors were also extracted. A random-effects meta-analysis was used to calculate pooled prevalence estimates, when appropriate. Sensitivity analyses were conducted according to study quality, sample representativeness, and method of outcome assessment. Risk factor data were synthesised narratively. This study is registered with PROSPERO, CRD42021226291. 18 650 studies were retrieved, of which 135 studies comprising data from 621 995 participants met the inclusion criteria. 123 (91%) of 135 studies were conducted in high-income host countries. Five (4%) of 135 studies were interventional, 40 (30%) were cohort, and 90 (66%) were cross-sectional. The most common regions of origin of participants were South America, the Middle East, and north Africa. Only 26 studies presented disaggregated data for forced migrants or economic migrants. The pooled prevalence of perinatal depressive disorders was 24·2% (range 0·5-95·5%; I2 98·8%; τ2 0·01) among all women who are migrants, 32·5% (1·5-81·6; 98·7%; 0·01) among forced migrants, and 13·7% (4·7-35·1; 91·5%; 0·01) among economic migrants (p<0·001). The pooled prevalence of perinatal anxiety disorders was 19·6% (range 1·2-53·1; I2 96·8%; τ2 0·01) among all migrants. The pooled prevalence of perinatal post-traumatic stress disorder (PTSD) among all migrant women was 8·9% (range 3·2-33·3; I2 97·4%; τ2 0·18). The pooled prevalence of perinatal PTSD among forced migrants was 17·1% (range 6·5-44·3; I2 96·6%; τ2 0·32). Key risk factors for perinatal depression were being a recently arrived immigrant (ie, approximately within the past year), having poor social support, and having a poor relationship with one's partner. One in four women who are migrants and who are pregnant or post partum experience perinatal depression, one in five perinatal anxiety, and one in 11 perinatal PTSD. The burden of perinatal mental illness appears higher among women who are forced migrants compared with women who are economic migrants. To our knowledge, we have provided the first pooled estimate of perinatal depression and PTSD among women who are forced migrants. Interpreting the prevalence estimate should be observed with caution due to the very wide range found within the included studies. Additionally, 66% of studies were cross-sectional representing low quality evidence. These findings highlight the need for community-based routine perinatal mental health screening for migrant communities, and access to interventions that are culturally sensitive, particularly for forced migrants who might experience a higher burden of disease than economic migrants. UK National Institute for Health Research (NIHR); March of Dimes European Preterm Birth Research Centre, Imperial College; Imperial College NIHR Biomedical Research Centre; and Nuffield Department of Population Health, University of Oxford.

To characterize co-occurring social determinants of health for clients experiencing perinatal anxiety and depression (perinatal mood and anxiety disorders) or serious mental illness (SMI) in a diverse population receiving prenatal care in a safety-net health system, we conducted a latent class analysis, using data from a social determinants screener in pregnancy for the health system's clients during 2017-20. The sample included clients with positive screens for depression or anxiety or SMI diagnoses. Prenatal clients with a positive screen for perinatal mood and anxiety disorders or SMI comprised 13-30percent of classes, characterized by more than two co-occurring social determinants (for example, co-occurring socioeconomic and interpersonal factors). The study findings highlight the salience of social determinants among prenatal patients experiencing perinatal mood and anxiety disorder and SMI and suggest the necessity of consistent screening for both social determinants and perinatal mental health. Policies to address social determinants within and beyond health care settings are critical.

Perinatal mental health and the COVID-19 pandemic.

Gold Award: Building the Capacity of Frontline Providers to Treat Mental and Substance Use Disorders Among Pregnant and Postpartum Women.

Mental Health Impacts of Climate Change for Birthing People and the Provider's Role.

BackgroundMental health disorders are the most common perinatal conditions. They affect mothers, babies, partners, and support networks. However, <15% of pregnant and postpartum women seek timely help for their mental health care. Low perinatal mental health knowledge and universal screening unacceptability are cited as important deterrents to obtaining timely mental health care.ObjectiveThe purpose of this quantitative cross-sectional study was 2-fold: (1) to determine African immigrant mothers’ views of perinatal mental health and to identify predictors of those views and (2) to identify African immigrant mothers’ views regarding perinatal mental health screening and to determine factors associated with those views.MethodsA cross-sectional survey was conducted using a convenience sample of African immigrant women from the province of Alberta, Canada. Respondents were eligible to participate if they were aged ≥18 years, had a live birth, and the infant was aged ≤2 years. Questions were drawn from the Edinburgh Postnatal Depression Scale, the Generalized Anxiety Disorder-7 scale, and additional questions were developed using the Alberta Maternal Mental Health 2012 survey as a guide and tested to reflect the immigrant context. Descriptive and multivariable regression analyses were conducted.ResultsAmong the 120 respondents, 46.5% (53/114) were aged 31-35 years, 76.1% (89/117) were employed or on maternity leave, 92.5% (111/120) were married, and 55.6% (65/117) had younger infants aged 0 to 12 months. Significantly more respondents had higher levels of knowledge of postnatal (109/115, 94.8%) than prenatal (57/110, 51.2%) mental health (P<.001). Only 25.4% (28/110) of the respondents accurately identified that prenatal anxiety or depression could negatively impact child development. Personal knowledge of postpartum anxiety and depression was a significant predictor of prenatal and postnatal mental health knowledge. Most respondents strongly agreed or agreed that all women should be screened in the prenatal (82/109, 75.2%) and postnatal (91/110, 82.7%) periods. Respondents reported that their partner would be their first choice when seeking help and support. The acceptability of postnatal screening was a significant predictor of prenatal mental health knowledge (P<.001), whereas the acceptability of prenatal screening was a significant predictor of postnatal mental health knowledge (P=.03). Prenatal mental health knowledge was a significant predictor of both prenatal (P<.001) and postnatal (P=.001) screening acceptability.ConclusionsAlthough African mothers’ knowledge of postnatal mental health is high, their prenatal mental health knowledge and its influence on child development are limited. Perinatal mental health interventions for African immigrant mothers in Alberta should target these knowledge gaps. The high acceptability of universal perinatal mental health screening among African mothers provides a promising strategy for perinatal mental health literacy initiatives to achieve optimal perinatal mental health.